ESRD: Definition and Healthcare Context
Full name: End-Stage Renal Disease
End-Stage Renal Disease (ESRD) is permanent, complete kidney failure that requires dialysis or a kidney transplant to maintain life. ESRD is the only condition — regardless of age — that qualifies individuals for Medicare solely on the basis of diagnosis. Medicare ESRD coverage begins the fourth month of dialysis treatment or upon kidney transplant. CMS tracks dialysis facility quality through the ESRD Quality Incentive Program (QIP) and publishes facility performance data on Care Compare. In 2024, approximately 808,000 patients receive ESRD treatment in the United States.
How it’s used
- CMS Care Compare — Dialysis Facility: ESRD patient outcomes and dialysis facility quality measures — including adequacy of dialysis, anemia management, and patient safety — are published through Care Compare.
- CMS Provider of Services (POS) file: dialysis facilities are CCN-keyed in the POS file, letting Fonteum link ESRD facility identity to Care Compare quality measures.
- Medicare ESRD entitlement: ESRD is the one diagnosis that qualifies a person for Medicare at any age, making dialysis facilities a distinct provider population in Fonteum's data.
Frequently asked questions
- What is ESRD?
- End-Stage Renal Disease (ESRD) is permanent kidney failure requiring dialysis or a kidney transplant. It is the only condition that qualifies people of any age for Medicare.
- When does Medicare cover ESRD?
- Medicare ESRD coverage begins the first month of kidney transplant hospitalization, or the fourth month of dialysis treatment.
- Where is ESRD quality data published?
- CMS publishes dialysis facility quality data — including star ratings, adequacy measures, and patient survey results — on CMS Care Compare.