GLOBAL ECONOMY
In CY 2025, the global economy demonstrated resilience despite persistent geopolitical tensions, evolving trade dynamics and uneven regional growth trends. According to the International Monetary Funds (IMF) World Economic Outlook (WEO) published in April 2026, global GDP is projected to grow at 3.1% in CY 2026 and at 3.2% in CY 2027, moderating from the 3.4% recorded in CY 2025 and remaining well below pre- pandemic averages. This moderation reflects, in significant part, the escalation of the West Asia conflict, which has introduced renewed supply chain pressures, elevated energy price volatility, and broader risk-off sentiment across global markets. Advanced economies are expected to grow at 1.8% in CY 2026 and 1.7% in CY 2027.
Growth was supported primarily by emerging markets, particularly India and parts of Southeast Asia, while China continued to face pressure from weak domestic demand and an ongoing property market overhang. Among advanced economies, the US maintained relatively steady momentum, whereas Europe recorded modest growth amid softer demand conditions and tighter financial settings.
Global inflation moderated further during CY 2025, enabling several central banks to gradually shift towards more accommodative policy stances. However, elevated geopolitical uncertainty, trade realignments and supply-side disruptions, including the continued impact of the Russia-Ukraine conflict, Middle East tensions and US tariff developments, continued to influence the broader macroeconomic environment.
The persistence of global trade tensions and tariff-related uncertainties has contributed to a more cautious investment climate. The World Bank has identified increased risks to global growth, including concerns and disruptions in trade and investment networks as key consequences of escalating trade barriers. However, emerging markets in South and Southeast Asia, Central Asia and the Middle East remain relatively better positioned to navigate these headwinds, underpinned by strong domestic consumption and continued public investment.
GlObal OUTLOOK I
Looking ahead, global GDP growth is projected at 3.1% in CY 2026 and 3.2% in CY 2027, per the IMFs April 2026 World Economic Outlook. The global GDP is estimated to grow from USD 111.1 trillion in CY 2024 to USD 142.6 trillion in CY 2029, reflecting a CAGR of 5.1%. Emerging markets and developing economies are expected to remain the primary engines of this growth, with a projected CAGR of 6.0% between CY 2024 and CY 2029, compared to 4.4% for advanced economies. Countries such as India, Uzbekistan, and the Philippines are amongst the fastest-growing economies within this cohort, supported by favorable demographics, rising consumption, and structural reforms. India is projected to grow at a CAGR of approximately 9.0% in USD terms over the same period, potentially becoming the worlds third-largest economy by CY 2027.
Risks to the global outlook include ongoing geopolitical conflicts, further tariff escalation, potential financial market volatility, and currency pressures in lower-income economies. Nonetheless, the structural drivers of growth in emerging Asia, including urbanization, a rising middle class, and digital adoption, are expected to remain broadly intact. Alongside these broader trends, healthcare is emerging as one of the most resilient and structurally expanding sectors globally.
[Source: IMF World Economic Outlook, April2026]
INDIAN ECONOMIC OVERVIEW
In FY 2025-26, India sustained its position as one of the worlds fastest-growing major economies. The Second Advance Estimates released by the Ministry of Statistics and Programme Implementation (MoSPI), published under the new base year series (2022-23), place real GDP growth at 7.7% in FY 2025-26, up from 7.1% in FY 2024-25. This reaffirms Indias standing as the fastest-growing major economy globally and the largest in South Asia.
[Source: https://www.pib.govin/PressReleasePage.aspx?PRID=2269286 ®=48&lang=2]
P: Projections [Source: Provisional Estimates of Annual Gross Domestic Product For2025-26]
Growth was supported by strong domestic demand, sustained public capital expenditure, resilient services activity and continued momentum across manufacturing, construction and trade-related sectors. Inflationary pressures moderated during the year, aided by stable food prices, improving supply conditions and prudent monetary management. Gross Fixed Capital Formation (GFCF) expanded at a healthy pace, supported by sustained public investment and a gradual recovery in private sector capital formation.
Government expenditure remained a key driver of economic activity, with the Union Budget 2026-27 continuing its strong focus on infrastructure creation, employment generation, manufacturing competitiveness and social development. The healthcare sector remained a priority area, with continued policy support towards medical tourism, allied healthcare capacity building and broader care ecosystem expansion.
Indias per capita income has grown substantially over the past decade, from Rs. 46,492 in FY 2009-10 to Rs. 155,892 in FY 2023-24, and is projected to reach Rs. 239,859 by FY 2028-29. This improvement in household income has translated into higher consumption, greater spending on healthcare services and improved insurance penetration. The
countrys urban population is expected to grow from 36.0% in FY 2023-24 to 40.0% by FY 2028-29, further supporting demand for organized healthcare infrastructure and specialized services.
[Source: MoSPI New Series, Feb 2026]
INDIAN OUTLOOK
Indias economic fundamentals remain strong. The country is poised to become the worlds third-largest economy by 2027, surpassing Japan and Germany, with a GDP exceeding USD 5 trillion. The IMF, in its April 2026 WEO, projects India as one of the fastest-growing major economies globally, with growth supported by robust domestic demand, sustained infrastructure investment, and structural reform momentum.
Several structural drivers underpin Indias economic outlook. Indias unique demographic dividend, with more than 58% of its population in the 25-64 working-age group in 2024, rising to an estimated 64% by 2029, provides significant competitive advantages in terms of labor supply, productivity and consumption.
While external risks including global trade moderation, geopolitical uncertainties and potential financial market volatility may create near-term headwinds, Indias robust domestic demand base, ongoing structural reforms and favorable demographics provide a strong foundation for sustained medium-term growth.
[Source: MoSPI New Series, Feb 2026]
INDIAN HEALTHCARE SECTOR
Indias healthcare sector continued to witness strong growth and remained a critical pillar in the countrys journey towards a healthier and more inclusive future. The sector spans healthcare delivery, pharmaceuticals, medical devices, diagnostics and specialized care services, with increasing emphasis on chronic disease management.
Market Size and Growth Trajectory
The Indian healthcare market is valued at approximately USD 498 billion in 2026 and is projected to reach USD 719 billion by 2032, reflecting a CAGR of 6.31% over the forecast period.
Financing Structure and Public Expenditure
Structurally, Indias health system is characterized by a dominant private sector and a comparatively modest public financing base. Total current health expenditure stood at 3.3% of GDP in FY 2021-22, while domestic government expenditure on health amounted to just 1.9% of GDP in FY 2025-26. Against this backdrop, out-of-pocket expenditure has remained the single largest source of health financing in India, though it has
seen a significant decline from 55.1% in 2017 to 39.4% of total health costs by FY 2024-25.
Infrastructure and Workforce
Despite the scale of its healthcare infrastructure, India continues to address capacity gaps. As of 2025, the country has approximately 70,000 operational hospitals, of which 63% are privately owned, with a bed-to-population density of approximately 1.3 per 1,000, well below the WHO- recommended benchmark of 3.0 beds per 1,000.
Government hospitals alone account for just 0.79 beds per 1,000 population, placing significant pressure on private providers to fill the gap.
On the workforce side, the doctor-to-population ratio stood at 1:811 as of April 2025, surpassing the WHO benchmark of1:1,000, supported by a registered base of approximately 1,386,150 allopathic doctors and 751,768 AYUSH practitioners, alongside a nursing workforce exceeding 3.9 million professionals. Two-thirds of all curative care in India is delivered by private facilities, underscoring the private sectors central and expanding role in the countrys healthcare architecture.
[Sources: WHO - Crisis or opportunity? Health financing in times of uncertainty: Country profiles from the South-East Asia Region / Frost & Sullivan - Industry Report on Dialysis Services Market (Nov 2025) IBEF Healthcare Industry Report (March-May 2026) India Health Insurance Market Report]
Indian Healthcare Market - Segment Overview
| Segment | Market Size | CAGR |
| (USD Bn, 2024) | (2024- 2029F) | |
| Hospitals & Healthcare Delivery | 327.6 | 18.2% |
| Pharmaceuticals | 50.7 | 12.2% |
| Others (Insurance, and Tele, | 29.7 | 10.0% |
| Among Others) | ||
| Medical Devices | 21.9 | 20.4% |
| Diagnostic Services | 13.1 | 13.0% |
| Total | 443.0 | 19.0% |
[Source: IMR Report, Frost & Sullivan, November2025]
KEY SEGMENTS AND GROWTH DRIVERS
Rising Burden of Chronic Diseases
The burden of non-communicable and chronic disease in India further reinforces long-term demand growth for specialized healthcare services. According to the WHO, non-communicable diseases account for 63% of total deaths in India, with cardiovascular diseases the leading cause.
The top 5 NCDs as per DALYs are cardiovascular disease, cancer, mental disorder, musculoskeletal disorders, and diabetes and kidney disease. Cardiovascular diseases account for most NCD
deaths, with approximately 19 million deaths in 2021, followed by cancers (10 million), chronic respiratory diseases (4 million), and diabetes (over 2 million including kidney disease deaths caused by diabetes). In India, diabetes is the major cause of CKD and ESRD, which accounts for 33% of the causes, followed by hypertension (13%).
Ageing Demographics and Rising Disposable Income
Indias demographic profile is shifting in ways that will structurally expand demand for healthcare services over the long term. The elderly population (60+ years) is expected to grow to 12.9% by 2030 and 20.8% by 2050, a cohort that typically carries a disproportionately higher burden of chronic and lifestyle- related diseases, including renal, cardiovascular, and metabolic conditions, and requires sustained, specialist-led care.
Alongside this demographic shift, rising household incomes are expanding the addressable market for organized and private healthcare. Indias total disposable personal income grew from Rs. 192 trillion in FY 2017-18 to Rs. 296 trillion in FY 2022-23, reflecting a CAGR of approximately 9%, and is estimated to reach Rs. 353 trillion by FY 2025-26. This growth is being accompanied by a meaningful compositional shift at the top of the income pyramid, with upper-middle and high-income population segments are projected to grow at CAGRs of 5% and 12% respectively between FY 2020-21 and FY 2028-29. As income levels rise, households demonstrate a greater willingness to spend on quality healthcare, preventive services, and specialist treatment, reinforcing both volume and realization growth for organized providers.
Government Initiatives
The policy environment has evolved meaningfully in recent years. The launch of Ayushman Bharat in 2018, Indias flagship universal health coverage initiative, brought together a primary care component through the conversion of existing facilities into approximately 150,000 health and wellness centers, now exceeding 178,000 operational centers as of 2025, and a hospital care component in the form of Pradhan Mantri Jan Arogya Yojana (PM-JAY). PM-JAY aims to cover 514 million people, providing free secondary and tertiary inpatient care through both public and private empaneled hospitals, with a benefit ceiling of Rs. 500,000 (approximately USD 6,800) per enrolled family per year.
As of 2025, more than 42 crores health cards have been issued and over 9.64 crores hospital admissions funded under the scheme, directly expanding healthcare utilization among economically weaker populations. Over 32,574 hospitals are now empanelled under public insurance frameworks, reflecting significant institutional capacity expansion. This policy shift represents a meaningful structural tailwind for organized private healthcare providers, as public insurance coverage progressively expands the addressable patient pool for institutional care.
Expanding Insurance Coverage
Despite the scale of government-led coverage, only approximately 37% of the total population is covered by any form of health insurance scheme, leaving a significant portion uninsured. Government expenditure as a percentage of total healthcare expenditure has grown from 33.0% in FY 2016-17 to 39.1% in FY 2021-22, while out-of-pocket spending has declined from 55.1% to 46.0% over the same period. Nonetheless, Indias OOP burden remains notably high, surpassing Asian peers where OOP spending typically accounts for approximately 30-35% of healthcare expenses, and significantly exceeding the WHOs recommended range of 15-20%.
Private health insurance adoption is accelerating to bridge this gap. Gross premiums underwritten grew from USD 6.6 billion in FY 2018-19 to USD 13.1 billion in FY 2023-24 at a CAGR of 14.6%, driven by rising health awareness, growing household incomes, increasing medical costs, and greater hospital acceptance of insurance. Gross written premiums are expected to grow further from USD 15.46 billion in 2026 to USD 22.86 billion by 2031 at a CAGR of 8.13%, supported by regulatory simplification, digital distribution, and expanding hospital networks. Medical inflation reached 13% in FY 2024-25 and is projected at 11.5% for FY 2025-26, consistently more than double the general CPI rate of 4-6%, with health insurance claims surging 21% in FY 2024-25, reinforcing the structural case for broader insurance adoption across India.
[Source: Aon Global Medical Trend Rates Report 2025]
Medical Tourism
India has emerged as one of the most significant destinations in this evolving global landscape. Industry estimates place the medical tourism market at about USD 8.7 billion in FY 2024-25, with projections of USD 16.2 billion by FY 2029-30, supported by the governments Heal in India initiative and the introduction of specialized AYUSH visas. The sector is increasingly defined by its 65%-80% cost advantage over Western nations and a growing reputation for specialized clinical excellence in nephrology,
where India now performs some of the worlds highest volumes of renal transplants and complex dialysis management using advanced robotic systems. Beyond traditional curative care, the integration of Ayurveda and holistic wellness, formalized through five new regional medical tourism hubs announced in the Union Budget 2026-27, has positioned India as the 10th ranked destination globally on the Medical Tourism Index, drawing over 500,000 international patients annually as of FY 2024-25. The sector also supported an estimated 8.46 crores direct and indirect jobs, accounting for about 13.3% of total employment.
[Source: PIB: Medical and Wellness Tourism in India, May2026] INDIAN DIALYSIS AND RENAL CARE SECTOR OVERVIEW
Disease Burden and Addressable Market
Chronic Kidney Disease (CKD) is a significant and growing public health challenge in India. CKD prevalence stands at an estimated 8.7% of the total population, translating to approximately 123.7 million CKD patients in FY 2023-24 given Indias 1.45 billion population. Diabetes and hypertension, the two leading causes of CKD, are themselves growing rapidly: diabetes affected approximately 101 million Indians in FY 2022-23, and is projected to reach 134 million by FY 2029-30, while hypertension prevalence is estimated at 35.5% among adults. Together, diabetes and hypertension cause or contribute to approximately 46% of all CKD cases in India.
Despite the large CKD population, diagnosis rates remain critically low. Only approximately 7% (8.5 million) of the CKD population is diagnosed. Of the diagnosed population, an estimated 4.2 million patients are at Stage 5 (End-Stage Renal Disease or ESRD) in FY 2023-24, requiring regular dialysis or kidney transplantation. However, only approximately 285,000 patients underwent dialysis in FY 2023-24, representing just 6.8% of the total ESRD population, highlighting an enormous unmet need. More than 325,000 new ESRD patients are added every year, creating an expanding treatment gap that organized providers are well positioned to address.
India - Addressable Dialysis Services Market (2019-2029F)
| Category | FY 2018-19 | FY 2023-24 | FY 2028-29F | CAGR (2024-29F) |
| CKD Population (million) | 116.1 | 123.3 | 132.1 | 14% |
| Patients Requiring Dialysis (million) | 2.8 | 4.2 | 6.9 | 10.6% |
| Patients Undergoing Dialysis (million) | 0.18 | 0.28 | 0.52 | 12.7% |
| In-Clinic HD Treatments (million/yr) | 19.6 | 33.9 | 66.1 | 14.3% |
| Dialysis Market Revenue (USD million) | 409 | 818 | 1,979 | 19.3% |
Market Structure and Competitive Landscape
Indias dialysis services market is predominantly private- sector-driven, with approximately 80% of 5,000 dialysis clinics operated by private players as of FY 2023-24. The total number of dialysis clinics has grown from approximately 700 in FY 2009-10 to 5,000 in FY 2023-24, reflecting a compound annual expansion over this period.
Despite this growth, India still requires approximately 10,000 HD clinics and 105,000 HD machines against the existing 5,000 clinics and 40,000 machines, highlighting a structural supply- demand gap that will require years of sustained investment to close.
The market is significantly underpenetrated and highly fragmented. Organized dialysis chains, defined as scaled networks operating multiple clinics under a single brand with standardized clinical protocols, account for only approximately 20% of the total Indian dialysis market by revenue, with the remaining 80% served by standalone private clinics, hospital- based units and government facilities. However, organized players are growing significantly faster: the revenue CAGR of organized networks is estimated at 22.0% between 2024 and 2029, compared to 19.0% for the unorganized segment, as hospitals increasingly outsource dialysis operations to specialized providers.
Regulatory and Government Support • PM National Dialysis Program (PMNDP): Launched in April 2016 to provide free dialysis services to BPL patients through PPP model. As of February 2025, it was
implemented across all 36 states/UTs in 748 districts at 1,609 clinics, deploying 11,148 HD machines. A total 27.28 lakh patients have availed dialysis services and 329.45 lakh treatments conducted. Gujarat has the highest share of functional PMNDP clinics at 17% (272 clinics).
• Ayushman Bharat - PM-JAY: Worlds largest
government health insurance program, covering ~70 crores beneficiaries with Rs. 5 lakhs health cover per family per year. Dialysis coverage reimburses an average of Rs. 1,650 per treatment (raised from Rs. 1,500 to Rs. 1,900 in April 2022 for Tier I cities). Extended to all senior citizens aged 70 and above in September 2024, benefiting ~4.5 crores additional families.
• Medical Devices Rules 2017: Central Drugs Standard Control Organisation (CDSCO) regulates dialysis machines as Class C medical devices, ensuring safety, quality and efficacy standards for all equipment marketed in India.
• Clinical Establishments Act (CEA): Regulates
operations of clinical establishments including dialysis clinics, setting standards for service quality and patient safety.
• State-Level Insurance Schemes: Multiple state
programs provide additional coverage: Tamil Nadus CM Comprehensive Health Insurance Scheme (Rs. 8800/month for HD), Andhra Pradeshs Dr. YSR Aarogyasri, Telanganas Aarogyasri (~? 1,350/treatment), Maharashtras MJPJAY (~? 1,300/treatment).
Emerging Trends in the Renal Care Industry
| Trend | Key Highlights |
| Telemedicine Adoption | Enabling remote consultations, follow-up care, diet counseling and chronic kidney disease (CKD) management. |
| AI & Data Analytics | Supporting early diagnosis, treatment planning, patient monitoring and operational efficiency. |
| Home-based Care | Home dialysis and remote monitoring solutions are gradually gaining acceptance. |
| Digital Transformation | Use of electronic medical records, mobile apps and integrated patient management systems is improving care delivery. |
| Preventive Healthcare | Rising awareness around early screening for diabetes, hypertension and kidney disease is supporting timely intervention. |
| Medical Technology | Advanced dialysis machines, water systems and monitoring devices are improving treatment quality and safety. |
Global disease burden and dialysis need
Chronic Kidney Disease (CKD) is a global pandemic affecting an estimated 800 million people worldwide, approximately 9-10% of the total global population, with the majority residing in low- and middle-income countries. CKD is the third fastest-growing cause of death globally and the only major NCD to exhibit a continued rise in age-adjusted mortality, projected to become the fifth leading cause of death worldwide by CY 2040, from its 12th rank in CY 2017.
The primary drivers of CKD growth: diabetes and hypertension, are themselves expanding at alarming rates. Globally, the number of people living with diabetes rose from 200 million in CY 1990 to 830 million in CY 2022. India alone accounts for approximately 101 million people with diabetics, representing 15% of the global burden. Hypertension affects approximately 1.4 billion people globally, with prevalence rising especially rapidly in Asia-Pacific (144% growth in prevalence between CY 1990 and CY 2019 in APAC, compared to 41% in Europe and America combined). Together, diabetes and hypertension account for approximately 50.6% and 23.3% of CKD cases worldwide respectively.
Approximately 30 million patients globally require dialysis or kidney transplantation annually, with a significant proportion unable to access treatment due to financial or infrastructure barriers. In CY 2024, approximately 4.26 million patients globally were on regular dialysis treatment. This figure is expected to grow at a CAGR of 5.0% to reach approximately 5.45 million by CY 2029, with the majority of incremental growth coming from underpenetrated Asian markets, particularly India and China.
CKD and Dialysis Burden - Select Countries (2024)
| Country | Prevalence | (Diagnosed) | Patients on Dialysis | Spend(USD) |
| India | 123.3 million | 4.2 million | 0.28 million | 2,700 |
| USA | 36.0 million | 0.82 million | 0.51 million | 37,000 |
| Philippines | 13.2 million | 0.33 million | 0.05 million | 9,500 |
| Saudi Arabia | 3.5 million | 0.09 million | 0.03 million | 45,000 |
| Uzbekistan | 4.2 million | 0.03 million | 0.008 million | 9,000 |
| Germany | 8.4 million | 0.10 million | 0.08 million | 49,000 |
[Source: I MR Report, Frost & Sullivan, November2025]
Global dialysis services market
Global dialysis services revenue was estimated at approximately USD 75.2 billion in CY 2024 and is projected to grow at a CAGR of 7.1% to reach approximately USD 106.2 billion by CY 2029. North America and Europe together account for more than 70% of global dialysis revenue, a reflection of higher treatment costs (USD 37,000-49,000 per patient per year vs. USD 2,700 in India), nearly universal access and well-developed organized networks. However, both regions are expected to grow more slowly than Asia-Pacific, Latin America and the Middle East as markets approach saturation.
Asia-Pacific represents approximately 18.7% of global dialysis market revenue in CY 2024 and is expected to grow at a significantly higher rate than other regions during the forecast period, driven by rising CKD burden, expanding organized networks, improving government reimbursements and increasing disease awareness.
International Markets - Dialysis Revenue Forecast
| Market | Revenue 2024 (USD million) | Revenue 2029F (USD million) | CAGR (2024-29F) |
| India | 818 | 1,979 | 19.3% |
| Philippines | 492 | 1,361 | 22.6% |
| Saudi Arabia | 1,435 | 3,214 | 17.5% |
| Uzbekistan | 79 | 171 | 16.7% |
| Global Total | 75,200 | 106,200 | 7.1% |
[Source: IMR Report, Frost & Sullivan, November2025]
The Philippines
CKD is the leading cause of death in the Philippines, accounting for approximately 6.2% of overall mortality and causing approximately 46,000 deaths in 2024. CKD prevalence in the Philippines is approximately 11.4%, higher than the global median of 9.6%, affecting approximately 13.2 million people. The Philippines dialysis services market was valued at approximately USD 492.2 million in 2024 and is projected to grow at a CAGR of 22.6% to reach approximately USD 1,361.4 million by 2029.
The government-backed PhilHealth program has significantly expanded dialysis coverage with the Phil Health Card: reimbursement per HD treatment increased from USD 46 (PHP 2,600) in 2022 to USD 112 (PHP 6,350) in Q4 2024, with no co-payment from patients. Coverage was also extended from 90 to 156 HD treatments per year in 2023. Government dialysis subsidies surged from USD 300 million in 2022 to USD 1.3 billion in 2025. The number of dialysis patients is expected to grow 35% from approximately 54,000 in 2024 to over 80,000 by 2029.
Philippines - Dialysis Services Market Overview
| Category | 2019 | 2024 | 2029F |
| CKD Population (million) | 12.2 | 13.2 | 14.6 |
| Patients Requiring Dialysis (000) | 238.6 | 329.3 | 465.0 |
| Patients Undergoing Dialysis (000) | 36.0 | 54.0 | 82.3 |
| Market Revenue (USD million) | 255 | 492 | 1,361 |
| CAGR (2024-2029F) | - | - |
22.6% |
[Source: IMR Report, Frost & Sullivan, November2025]
Uzbekistan
CKD poses a significant and growing burden in Uzbekistan, with approximately 4.2 million CKD patients in 2024 (expected to grow at a CAGR of 2.3% to 4.7 million by 2029). Uzbekistans dialysis services market was valued at approximately USD 78.9 million in 2024 and is projected to grow at a CAGR of 16.7% to reach approximately USD 170.5 million by 2029. The Uzbek governments public health benefits program provides free dialysis care to patients with kidney failure, with government reimbursement of approximately USD 48 per treatment.
Saudi Arabia
Saudi Arabia has approximately 3.5 million CKD patients in 2024, with annual CKD deaths expected to increase from approximately 5,400 in 2024 to over 7,000 by 2029. The dialysis patient population is expected to nearly double from approximately 31,800 in 2024 to 61,200 by 2029. The Saudi dialysis services market was valued at approximately USD 1,434.8 million in 2024 and is projected to grow at a CAGR of 17.5% to reach approximately USD 3,214.4 million by 2029.
The Saudi government reimburses approximately USD 300 per dialysis treatment, among the highest reimbursement rates globally, making the market financially attractive for organized providers. Dialysis treatment is fully government funded for every patient, with the Ministry of Health regularly floating multiple government tenders to engage private operators in service delivery. Under Vision 2030s Health Sector Transformation Program (HSTP), the KSA Ministry of Health is actively promoting PPP models in dialysis services.
Nepal
CKD prevalence in Nepal stands at 6.2%, with an age-standardized prevalence of 10,887.7 per 100,000 population, reflecting a significant and growing public health burden driven by rising rates of diabetes, hypertension, and other non-communicable diseases. CKD affected over 1.8 million people in Nepal in 2019, and the disease burden has been rising steadily over the past three decades. In urban areas, the estimated prevalence of CKD is as high as 11%.
Despite this burden, Nepals dialysis infrastructure remains critically underdeveloped. The country has only 56 nephrologists
and 60 hemodialysis centers, the majority of which are located in the capital, serving only 15% of the population. Nepal currently has 1.4 long-term hemodialysis centers, 0.2 peritoneal dialysis centers, and 0.1 transplant centers per million people, figures that are widely considered inadequate given the rising demand and the dispersed distribution of the population. Only a few hospitals participate in the government program, resulting in long waiting periods for patients. Patients also face significant non-medical costs, including travel, accommodation, and food, as dialysis services are centralized and primarily located in large cities.
This combination of high disease burden, severe infrastructure deficit, geographic concentration of services, and large underserved population presents a compelling opportunity for organized private dialysis providers to expand access and improve quality of care across the country.
OVERVIEW
Nephrocare Health Services Limited (also referred to as NephroPlus, Nephrocare, or the Company), operating under the NephroPlus brand, is Indias and Asias largest dialysis network and the fifth largest globally by treatment volumes. It is the only dialysis network from Asia to be listed on stock exchanges, having been listed on the BSE and NSE on December 17, 2025, and the only Indian dialysis network to have scaled internationally.
Founded in 2010 in Hyderabad by Founder, Chairman and Managing Director Vikram Vuppala and Co-Founder Kamal Shah, himself a dialysis patient of over 28 years, the Company was built on a belief that dialysis need not define or diminish life. Its fou ndi ng mission was, a nd remai ns, to redefi ne dia lysis care a nd enable people on dialysis to lead long, happy, and productive lives. As of FY 2025-26, NephroPlus operates 524 clinics globally across 335+ cities, serving 36,981+ patients across India, the Philippines, Uzbekistan, and Nepal, holding over 50% market share in Indias organized dialysis market.
What sets NephroPlus apart from the outset is the depth of patient understanding embedded in its DNA. As Co-Founder Kamal Shah has demonstrated through his own life, working full-time, exercising, and travelling extensively while on dialysis, the Companys clinical and operational philosophy is rooted in lived experience rather than institutional assumption. This ethos is reflected in every dimension of the NephroPlus model: clinics designed to be welcoming and community-oriented, guests treated with the dignity of the Indian tradition of Atithi Devo Bhava, and a culture where patients are called guests, a deliberate and purposeful choice.
Over the past 16 years, this vision has been translated into a scaled, diversified, and financially disciplined platform. NephroPlus was listed on the Indian stock exchanges on
December 17, 2026, becoming the only dialysis network from Asia to achieve this milestone, and has since attracted a marquee shareholder base spanning leading domestic and foreign institutional investors.
The Company operates a scalable, asset-light and capital- efficient business model with a diversified presence across India and selected international markets. As of FY 2025-26, the Company operates 524 clinics across 335+ cities in India, the Philippines, Uzbekistan, and Nepal, serving over 36,981 guests and performing approximately 3.4 million treatments. In India, NephroPlus commands over 50% market share in the organized dialysis segment, with approximately 79% of its clinics situated in Tier II and Tier III cities and towns, a deliberate strategic choice to take quality care to where it is most needed and least available.
NephroPlus commenced its international operations with its entry into Nepal in December 2018, leveraging geographic proximity and demographic similarities with India. Following its cluster-based expansion strategy, the Company has established a network of six clinics across Nepal, serving over 850 patients as of March 31, 2026. The Nepal operations are managed as an extension of the Indian network, enabling operational efficiencies and standardized clinical care.
Nephrocare entered the Philippines through the acquisition of a majority stake in Royal Care Dialysis Clinics in October 2020, further consolidating its position through the acquisition of RTSI (six clinics) in 2024 and a chain of seven additional clinics in 2025.
As of March 31, 2026, Nephrocare operates 44 clinics in the Philippines and has become one of the dominant dialysis networks in the country. Private dialysis chains account for more than 90% of the Philippine dialysis market.
Nephrocare entered Uzbekistan through a landmark PPP arrangement, winning a competitive tender issued by the Ministry of Health against global players including Fresenius Medical Care and Diaverum. The Asian Development Bank (ADB) signed a financing package of USD 8.4 million with Nephrocare in 2022 for four dialysis clinics. Nephrocare subsequently won a USD 75+ million PPP tender to establish four clinics including the worlds largest dialysis clinic (165-bed) in Tashkent, which was launched in 2023. The IFC confirmed that Nephrocares services in Uzbekistan cost the government USD 48 per treatment vs. USD 60 prior to the partnership, demonstrating tangible cost savings alongside quality improvements. As of March 31, 2026, Nephrocare operates six clinics in Uzbekistan, serving 1400+ patients at the Tashkent center alone.
Nephrocare entered Saudi Arabia in 2023 through a 51% joint venture with KSAs Tibbiyah Group to invest, operate and manage dialysis departments and clinics in both public and private healthcare facilities in the Kingdom.
An Integrated Renal Care Ecosystem
Nephrocares service delivery model combines clinical quality with accessibility through multiple operating formats, including hospital-based captive centers, public-private partnership (PPP) clinics, and standalone centers. This diversified model enables deeper market penetration, particularly in underserved regions, with approximately 73% of revenues generated from Tier II and Tier III cities and towns and approximately 78% of consider: its clinics in India located outside the top metros.
Beyond conventional in-clinic hemodialysis, the Company has developed a n integrated renal ca re ecosystem comprisi ng home hemodialysis, holiday dialysis, dialysis on call, mobile dialysis units, diagnostics support, pharmacy services, and patient wellness programs. As of March 31, 2026, the Companys asset- light, capital-efficient model spans three clinic formats: Captive (272 clinics), PPP (182 clinics), and Standalone (70 clinics), with approximately 52% of clinics operating under revenue-sharing arrangements that limit upfront capital requirement. Captive arrangements typically carry tenures of 7-15 years, providing revenue visibility and contract renewal rates have historically exceeded more than 95%.
Key Business Segments In-Clinic Dialysis Services
This remains the Companys core operating segment, delivered through a widespread network of physical centers across three formats.
Captive Clinics (Hospital Partnerships) are long-term arrangements with private and trust hospitals to establish and manage dialysis units within hospital premises. The hospital provides space, utilities, and access to a captive patient flow, while NephroPlus manages end-to-end clinical operations. The Company currently partners with over 300 private hospitals across India, including Fortis Escorts Hospitals, Medanta, Care Hospitals, and Wockhardt, under agreements typically ranging from 7 to 15 years.
• Public-Private Partnerships (PPP) involve operating dialysis
centers within government hospitals under subsidized or reimbursement-based frameworks. The Company has selectively participated in PPP programs, including the PM National Dialysis Program, across states such as Andhra Pradesh, Bihar, Uttarakhand, and Karnataka, and won a global tender from Uzbekistans Ministry of Health to operate a USD 75 million dialysis PPP, which includes the worlds largest single dialysis clinic of 165 beds in Tashkent.
• Standalone clinics are independently operated centers established in high-demand markets outside hospital settings. While currently a small component of the portfolio (less than 5% of India revenue), standalone clinics are expected to grow in prominence as regulatory recognition and market maturity increase over the next 5-10 years.
Off-Clinic Dialysis Services
The Company offers flexible treatment models designed to improve patient convenience and accessibility, reducing dependence on fixed clinic infrastructure.
• Home Hemodialysis (HHD) involves permanent dialysis set-ups at patient residences for regular scheduled treatment, enabling patients to receive care without commuting to a clinic
• Dialysis on Call (DoC) provides temporary dialysis set-ups delivered at homes or at hospitals lacking in-house dialysis capability, catering to acute and emergency needs
• Dialysis on Wheels (DoW) deploys mobile dialysis units to bring treatment directly to patient locations, particularly relevant in underserved or remotely located communities
• Holiday Dialysis is the Companys proprietary program that coordinates dialysis treatment across NephroPlus clinics nationwide and internationally, enabling guests to travel while maintaining uninterrupted care continuity, a first-of-its-kind initiative in the Indian dialysis segment
Ancillary and Wellness Services
The Company provides complementary healthcare services to support holistic renal care, including pharmacy sales, diagnostic services, diet and nutrition counseling, and mental health and patient support programs. Annual patient engagement initiatives such as Aashayein, a guest forum involving nephrologists, urologists, dieticians, and transplant specialists, and the Dialysis Olympiad, a unique Olympic-style sporting event for guests conducted across India and the Philippines, reflect the Companys commitment to the emotional and physical wellbeing of its guests beyond the clinical treatment session.
Driving Clinical Excellence and Quality Quality Infrastructure and Accreditations
149 clinics are accredited by the National Accreditation Board for Hospitals and Healthcare Providers (NABH), 3 clinics hold Joint Commission International (JCI) accreditation, and all facilities operate under ISO 9001:2015 certification. The Company maintains an internal quality and operational audit framework to ensure continuous adherence to clinical protocols and service excellence standards.
RenAssure - Standardized Clinical Protocol
The Companys proprietary RenAssure protocol is a standardized, evidence-based clinical framework comprising a comprehensive checklist covering guest admission, treatment preparation, mid-session monitoring, and post-treatment review. It ensures consistency of care outcomes across all 524 clinics globally, enabling replication of clinical quality independent of geography or clinic format.
Enpidia - Training Academy
Enpidia is Indias only dialysis training institute. The academy offers a 24-month diploma program and has trained 175 dialysis technicians in FY 2025-26. T raining academies operate across 9 locations in India, providing a continuous and cost-efficient pipeline of certified paramedical talent absorbed directly into the NephroPlus network.
Advisory Panel for Clinical Experts
The Companys protocols are reviewed and validated by an advisory team of internationally recognized nephrology experts, including Professor Vivekanand Jha, Dr. Suresh Sankar,
Dr. Umesh Khanna, and Dr. Avinash Ignatius, ensuring alignment with global best practices. The Company is also actively involved in five ongoing clinical trials and presents independent research at international nephrology conferences.
Renova - Patented Dialyzer Reprocessing System
Renova is a cloud-enabled, globally patented dialyzer reprocessing machine developed in-house, allowing safe reuse of dialyzers for the same patient without compromising quality. The system reduces material costs, minimizes human error, and enhances traceability of treatment across the network, a recognized innovation, having received the Innovation in Health category award at the 14th Aegis Graham Bell Awards in February
2024.
Recognition
The Company holds a Guinness World Record for the most people to sign up for a kidney screening online in one week, and an India Book of Records recognition for the maximum people screened for serum creatinine testing; both achieved in March
2025. It was also recognized as Dialysis Chain of the Year at the ET Healthworld Healthcare Awards in June 2025.
Key Operational KPIs
| KPI | FY 2022-23 | FY 2023-24 | FY 2024-25 | FY 2025-26 |
| No. of Clinics (period-end) | 316 | 436 | 490 | 524 |
| Active Patients (period-end) | 22,890 | 28,947 | 33,076 | 36,981 |
| Total Treatments (million) | 2.29 | 2.67 | 3.30 | 3.84 |
| Revenue per Treatment (?) | 1,912 | 2,084 | 2,292 | 2,598 |
| Frequency (treatments/wk) | 2.20 | 2.22 | 2.23 | 2.26 |
| Utilization (%) | 68.63% | 69.88% | 72.10% | 74.37% |
TECHNOLOGY AND CAPABILITY DEVELOPMENT
Technology is central to Nephrocares operating model and forms one of the five strategic pillars of its long-term growth strategy. The Company has made sustained investments in digital infrastructure to drive efficiency, improve clinical monitoring, and enhance the patient experience across its distributed network.
The cloud-enabled and globally patented Renova Dialyzer Reprocessing System reduces human error and enhances traceability of every treatment delivered across the network. Proprietary data platforms and AI-powered clinical dashboards enable early identification of high-risk guests, supporting proactive clinical intervention and reducing adverse events. User-friendly mobile applications improve resource utilization, treatment scheduling, and operational transparency at the clinic level. The Company also leverages electronic health
records and telemedicine capabilities to support continuity of care and patient engagement between in-clinic sessions.
HUMan RESOURCES I
Nephrocares people strategy is built on the principle that in a business where clinical quality is non-negotiable and margins are hard-won; the workforce is simultaneously the primary cost lever and the primary quality lever.
At the center of this model is Enpidia, Indias only BONENT- accredited dialysis training institute, operating across 9 locations and running a 24-month diploma program that has produced 175 certified technicians in FY 2025-26. This in-house pipeline reduces dependence on external hiring, controls wage inflation, and ensures consistent clinical competency across geographies - a model now replicated in the Companys international operations.
Workforce deployment follows an up-or-out progression model, maintaining a lean, high-quality staffing pyramid at each clinic. HR costs are held at approximately 20% of revenue, among the lowest in comparable healthcare service businesses globally, while clinical standards are upheld through BONENT certification, the RenAssure protocol framework, and rigorous internal audits.
Complementing this is an in-house biomedical engineering team that manages preventive maintenance, centralized spare parts inventory, and machine lifecycle optimization, reducing equipment downtime and extending machine life by 3-4 years beyond industry benchmarks, at a fraction of the cost of outsourced AMC arrangements.
SUSTAINABILITY PERFORMANCE
Environment
The Companys primary environmental contributions are channeled through its clinical innovations. The Renova Dialyzer Reprocessing System reduces medical consumable waste by enabling safe dialyzer reuse, directly lowering the volume of single-use medical equipment discarded per treatment. Centralized procurement and protocol-driven consumable usage reduce excess materia l consumption across the network. As the Company scales, embedding resource efficiency into standardized clinical protocols supports a reduction in per-treatment environmental intensity. The Company continues to evaluate opportunities to improve energy management and waste disposal practices across its clinic network.
Community and CSR
The NephroPlus Foundation serves as the vehicle for the Companys broader social commitments, including community health education, kidney screening drives, and support for economically vulnerable patients who cannot afford dialysis.
Governance and Leadership
The Board of Directors comprises a balanced mix of Executive and Independent Directors, including professionals with prior leadership experience at McKinsey & Company, Abbott Laboratories, HSBC, Bank of America, JP Morgan Chase, Apollo Specialty Hospitals, Max Healthcare, and Manipal Health Enterprises, among others.
The Boards composition ensures a diversity of perspective across clinical, financial, operational, and regulatory domains. The Company applies ROCE as its primary capital allocation filter, ensuring that all expansion decisions, including organic, inorganic, or geographic, meet a consistent return threshold. Contract renewa l rates i n excess of 95% in ca ptive arra ngements and close to 100% in PPP contracts reflect the quality and durability of the Companys stakeholder relationships.
Financial Performance Review
FY 2025-26 reflected resilient growth momentum, supported by treatment volume growth, expanding international contribution, improving operational efficiency and disciplined capital allocation.
Revenue has compounded at 32% CAGR between FY 2022-23 and FY 2025-26, with EBITDA margins expanding from 22.05% to 22.73% over the same period, reflecting the operating lever age inherent in a scaled, protocol-driven network. Annualized ROCE (pre-tax) has improved to 21.04% in FY 2025-26, up from 10.00% in FY 2023-24, underscoring the capital efficiency of the asset-light, multi-format business model.
International revenues, which contributed just 12% of total revenues in FY 2022-23, now account for approximately 42% of FY 2025-26 revenues, proving the Companys ability to export its India-built operating playbook to higher-priced geographies and generate superior margins relative to local competition.
Key Financial Metrics
| Parameter | FY 2022-23 | FY 2023-24 | FY 2024-25 | FY 2025-26 |
| Operating Revenue ( million) | 4,372.95 | 5,661.55 | 7,558.12 | 9,988.45 |
| EBITDA (excl. other inc.) ( million) | 485.97 | 996.58 | 1,666.37 | 2,269.70 |
| EBITDA Margin (%) | 11.11% | 17.59% | 22.05% | 22.73% |
| PAT ( million) | (117.88) | 351.33 | 670.96 | 768.40 |
| PAT Margin (%) | (2.70%) | 6.21% | 8.88% | 7.69% |
| RoCE(%) | 044% | 10.00% | 18.67% | 21.04% |
| RoE (%) | (3.00%) | 8.76% | 13.45% | 9.04% |
| Net Debt/EBITDA (x) | 3.77 | 1.83 | 0.58 | (0.75) |
| CFO/EBITDA (%) | 23.19% | 72.53% | 81.22% | 102.51% |
| Intl Revenue Contribution (%) | 11.70% | 23.78% | 31.79% | 41.80% |
Note: From FY2024-25 onwards, the Company has begun representing Adjusted EBITDA and Adjusted RoCE for the markets.Refer to pages 16-17 for the adjusted figures.
Key Ratios Monitored
| Particulars | FY 2025-26 | FY 2024-25 | Change(%) |
| Net Profit Margin (%) | 77% | 8.9% | (13.3%) |
| Debtors Turnover (times) | 3.42x | 3.22x | 6.3% |
| Debtors Days | 106.6 | 113.3 | (5.9%) |
| Inventory Turnover (times) | 7.60x | 7.39x | 2.9% |
| Inventory Days (DIO) | 48.0 | 49.4 | (2.8%) |
| Interest Coverage Ratio | 2.26x | 4.52x | (49.9%) |
| Current Ratio | 2.80x | 1.92x | 45.9% |
| Debt/Equity Ratio | 0.02x | 0.39x | (94.7%) |
| Return on Net Worth (%) | 9.03% | 13.19% | (31.5%) |
RISK GOVERNANCE STRUCTURE
Nephrocare operates in a complex and evolving environment, and the Companys performance is subject to various risks that may impact its financial condition, clinical operations and growth trajectory. The Company has established a governance framework to identify, assess and mitigate business, clinical, operational and compliance risks across its network.
| Risk Category | Risk Description | Mitigation Measures |
| High Treatment Costs and Affordability Constraints | Per session dialysis costs range from Rs. 1,000-3,500, creating financial burden for patients. Lack of comprehensive insurance or low-income limits access and increases mortality risk, impacting patient volumes. | Participation in PM-JAY, PMNDP and state schemes; diversified payer mix; procurement efficiencies to manage cost per treatment. |
| Geographic Disparities and Access Gaps | -90% of dialysis facilities are in urban areas; rural and semi-urban populations remain underserved. Over 60% of patients travel more than 50 km for HD. | Continued expansion in Tier II/III markets (-73% of revenue from non-metro markets); PPP model and standalone clinic additions in underserved regions. |
| Human Resource Shortage | India has approximately 2,600 nephrologists (1.90 per million population vs. global median of 9.95 per million). Severe shortage of dialysis technicians and nurses; high attrition rates. | Enpidia Training Academy (Indias only BONENT-accredited institution); in-house training programs; competitive remuneration and career development. |
| Patient Compliance and Adherence | Only 50% of Indian dialysis patients receive the WHO-recommended three treatments per week; 47% receive two and the remainder receive only one per week. Poor adherence worsens outcomes and constrains revenue per patient. | Patient education programs; financial counselling; accessible clinic locations; PPP model providing subsidized treatment to low-income patients. |
| Regulatory and Reimbursement Risks | Complexity in regulatory approvals, delayed empanelment under government health schemes, and potential changes to reimbursement rates (PM-JAY, Phil Hea lth, Uzbekistan government rates) may impact revenue predictability. | Active engagement with DSPAI; diversified payer mix; multi- geography presence reducing concentration risk; contract terms providing escalation clauses. |
| International Expansion Risks | Operations across diverse regulatory, currency and cultural environments (Philippines, Uzbekistan, KSA, Nepal) expose the Company to execution, integration, currency and political risks. | Localized management teams; PPP structures with government backing in Uzbekistan; JV structure with local partner (Tibbiyah) in KSA; ADB and IFC support providing credibility. |
| Cybersecurity and Data Privacy Risks | Increasing digital integration of patient records, IoT- enabled machines and teleconsultation platforms heightens cyber risk and data privacy obligations across multiple jurisdictions. | Strengthened IT security infrastructure; data governance frameworks; regular security audits and staff training. |
INTERNAL CONTROL SYSTEMS AND THEIR ADEQUACY
The Company has implemented internal financial and operational controls commensurate with the scale and complexity of its business. These controls are designed to ensure orderly operations, safeguard assets, prevent and detect fraud, maintain accurate accounting records and support timely preparation of reliable financial information.
The effectiveness of these controls is reviewed through continuous management monitoring, internal audits and independent assurance processes. Based on the reviews undertaken during the year, management believes that the Companys internal control systems were adequate and operating effectively.
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