Summary

Jonathan Benassaya

The kidney disease burden weighs heavily on society.

The burden of kidney disease worldwide is substantial and rising:

Chronic kidney disease (CKD) affects an estimated 10-16% of adults globally. Many of those with early CKD are undiagnosed and progress to more severe stages.

It's estimated that around 1.2 million people worldwide currently have end-stage kidney disease (ESKD), requiring dialysis or transplantation to stay alive.

Kidney disease directly contributes to around 1.4 million deaths per year globally and is the 6th fastest-growing cause of death. It also worsens outcomes for several other top global killers like diabetes and cardiovascular disease.

Studies show the growth rate of people needing dialysis or transplantation ranges from 6% to 12% annually worldwide. This demand is costly and expected to double in the next decade.

Annual global costs related to kidney disease (dialysis, transplantation, medications) are conservatively estimated to be over $1 trillion and rising each year.

So, in summary, many hundreds of millions are estimated to have some form of kidney disease globally, with over a million dying each year and advanced kidney failure rates steadily increasing. This growing epidemic-like scenario implies an extremely high health, economic, and social burden worldwide.

→ learn more in the
Market Size⁠
section

The Standard of Care, Hemodialysis, is an old and expensive process while extremely taxing for patients.

Hemodialysis can be pretty tricky and taxing for patients for a few key reasons:

It removes toxins and excess fluids, which can cause side effects. The rapid fluid shifts during hemodialysis can lead to low blood pressure, muscle cramps, nausea, headaches, and fatigue. It's a form of rapid detox which puts strain on the body.

Frequent treatment schedule. Most patients undergo hemodialysis three days a week, for three to five hours per session. This frequent and lengthy treatment schedule can be burdensome and interrupt daily life.

Vascular access complications. Most hemodialysis requires surgical creation of vascular access (AV fistula or graft), and these can get infected, clot off, or have other mechanical issues requiring hospitalization.

Dietary and fluid restrictions. To avoid complications, hemodialysis patients must follow strict fluid, sodium, potassium, and phosphorus-restricted diets, which can be challenging. The buildup of these electrolytes between treatments can cause issues.

Long-term risks. The fluctuations and demands of ongoing intermittent hemodialysis can strain the heart and cardiovascular system over time.

So, in short, the combination of acute side effects during and after treatment, demanding treatment schedules, vascular access issues, challenging dietary restrictions, and long-term cardiovascular impacts make hemodialysis quite burdensome compared to a normally functioning kidney.

But there is a better care for dialysis: Peritoneal Dialysis.

Peritoneal Dialysis is a dialysis process involving infusing dialysate into the peritoneal cavity and using the peritoneal membrane to filter waste.

PD offers flexibility, improved quality of life, preservation of residual kidney function, and lower cost.

However, it has limitations and may not be suitable for patients with certain conditions.

→ learn more in the
Peritoneal Dialysis⁠
section

Unfortunately, the penetration rate of Peritoneal Dialysis is low.

There are a few key reasons why the penetration rate of peritoneal dialysis (PD) tends to be lower than that of hemodialysis:

Lack of awareness/education - Many patients and even some doctors must be made aware that PD is an option for dialysis or must understand how it works thoroughly. There needs to be more awareness and education about PD compared to hemodialysis.

Perceived complexity - PD requires patients or their caregivers to learn a multi-step process to perform exchanges 3-5 times daily. This can seem daunting and complex, especially for elderly patients or those without a robust support system.

Access issues - PD requires that patients have adequate space in their abdomen and no history of extensive abdominal surgeries or injuries. Some patients have physical limitations that make PD challenging or impossible.

Risk of infection - The tubing and catheter used in PD raise the risk of peritonitis if proper sterile technique is not followed. Some doctors and patients view the infection risk as too high.

Supply/reimbursement issues - In some healthcare systems and countries, there are inadequate supplies, resources, and reimbursement to make PD accessible to all patients who need dialysis. This limits PD uptake.

In summary, while PD offers benefits like flexibility and preservation of vascular access sites, the perception of complexity, infection risk, and supply constraints hinder its wider adoption at the same rates as hemodialysis. Overcoming these barriers could increase PD utilization.

How can Baxter win in the race for better kidney disease care?

Given the massive increase in patients' quality of life, PD doesn’t need to be proven as the best dialysis solution. From a reimbursement standpoint, HD is reimbursed 22% more than PD, making it relatively equal financially.

We need to believe that for Baxter to win, there needs to be a massive increase in both patient's and doctors’ awareness. To deliver an increase in awareness, marketing will have to be developed in a way that is compliant with each country's regulation (→ see

DTC advertising Regulation⁠

). Since PD is not a prescription drug, it may be possible to market it and its benefits directly to consumers as a medical device or a health service. A country-by-country strategy needs to be developed, but a clear opportunity exists to become creative while staying compliant. One idea would be a B2B2C route where Baxter is the intermediary between patients and providers. Baxter would advertise PD under the Baxter Peritoneal Dialysis Hospital Network (BPDHN) (this is a placeholder), and any patient interested in getting more information would be redirected to one of the doctors/clinics/hospitals in the network. Baxter could create a brand around BPDHN (a-la-Intel Inside) where patients would recognize the BPDHN through leaflets in their doctor's waiting room or a sticker on the storefront of a clinic. A flywheel could be created by allowing doctors to join the network to offer PD to their patients.

Awareness won’t be the only element to deliver to be successful; accessibility to a PD provider would be as important, i.e., How can a patient who learns about PD receive the treatment? On that front, there are multiple options, too, from building a network of Physicians from the ground up to delivering PD directly to patients through Baxter clinics to a hybrid model where each market could be seeded with a Baxter clinic. In contrast, the density of the network increases over time.

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