Dialysis Center Feasibility Study
The SBA loan record for dialysis center projects nationally and by state, and what a feasibility study for one has to test.
Daniel Smith, MAI
Dialysis center feasibility study consultant
Loan Analytics writes the dialysis center feasibility study that a credit committee weighs before it approves a clinic loan, and the SBA's own loan files show why a credit officer will want one in hand. Since FY1991 SBA lenders have approved 135 7(a) loans for $103.7 million and 31 504 loans for $31.0 million to dialysis center projects across the whole country. In FY2017 to FY2026 the record is 28 7(a) loans for $31.9 million and 5 504 loans for $7.0 million, and no fiscal year since FY2019 has carried more than 3 7(a) approvals. California holds 14 of the decade's loans and $22.2 million; Texas follows with 6 loans and $5.8 million. A lender underwriting a dialysis unit almost anywhere else is looking at a request with few or no precedents in its own state.
The record also tells a lender what kind of request to expect, and our scope is built on it. The median 7(a) dialysis loan is $291,750 and the lower quartile $150,000, sizes that fit equipment and the fit-out of a leased unit, yet the upper quartile reaches $2.0 million, and the 7 loans above that mark account for $24.2 million of the decade's 7(a) dollars. The class has no published cancellation or charge-off figure, because no cohort reaches 30 loans, so the lender has no loss benchmark and leans on the study instead. The study we deliver names the nephrology practice that will refer patients and round at the unit, counts the kidney-failure patients already treated within reach of the site and the units that serve them now, sizes the stations and shifts that census supports, splits revenue between Medicare and commercial coverage, prices the water treatment system, machines, chairs and utility work from quotes, staffs the floor to the census, and tests debt service coverage month by month while the patient roster fills.
Each study is written for the program and the lender holding the file, whether the money comes as an SBA 7(a) or 504 loan, through USDA's Business and Industry guarantee, or straight from a bank without any guarantee. For a 7(a) request close to the $291,750 median the work concentrates on referrals, ramp and payer mix; for a building or a ground-up unit sized like the class's largest loans it adds the construction budget and treats the improvements as special-purpose, supported by the operator's lease or credit rather than by resale. Daniel Smith, MAI signs the conclusion a credit committee will quote. Describe the project, the program and the lender's deadline in the Request Scope & Timeline form; the reply sets out the dialysis study's scope, its schedule against that deadline and its fee.
Request Scope & Timeline
A very thin dialysis record
Dialysis centers barely register in SBA lending. From FY2017 through FY2026 the 7(a) program approved 28 loans to dialysis center borrowers, for $31.9 million in total, and the median loan was $291,750. No 504 figures are reported for the class. Annual counts never rose above 5, the level of both FY2017 and FY2018, and in FY2020 and again in FY2024 only 1 loan was approved. FY2023 alone carried $7.8 million on 3 loans, which shows how a single project can dominate a total this small. Dollars were just as uneven: $7.9 million on 5 loans in FY2018, but $465,000 on 3 loans in FY2026.
Rates we cannot publish
Both the cancellation and the charge-off rate are withheld for dialysis. Each cohort holds fewer than 30 loans, below the size at which we report a rate, so neither should be read as zero or as a sign of a clean record. What a lender can take from the file is narrower: SBA lenders have financed a small number of independent operators, at sizes that fit an equipment and build-out loan for a single clinic more than a property purchase.
Referrals, stations and reimbursement
The economics of a dialysis center turn on referrals and reimbursement. A feasibility study has to document the nephrologists who will refer to and round at the clinic, the prevalence of end-stage kidney disease in the service area, travel times to existing units, and the number of stations those patients can support across shifts. Payer mix is central, because Medicare sets much of the revenue and commercially insured patients carry much of the margin. On cost, the study needs the water treatment system, dialysis machines, chairs, plumbing and electrical upgrades, and nurse and technician staffing at required ratios. Debt service coverage should be modeled on a realistic patient ramp, since a new unit fills over months. The appraisal must treat the build-out as highly specialized and rely on the lease or the operator's credit, not on resale value.
The class follows the borrower's industry code, and the loans speak only for operators small enough to qualify for SBA programs. A borrower planning a clinic should treat these national totals as context and build its credit case on its own referral and payer evidence.
SBA loan record for dialysis center, United States, FY2017 to FY2026
| Program | Loans | Dollars | Median loan | Cancelled (floor) | Charged off (floor) |
|---|---|---|---|---|---|
| SBA 7(a) | 28 | $31.9 million | $291,750 | not reported: fewer than 30 loans in the cohort | not reported: fewer than 30 loans in the cohort |
Download this table (CSV). Cite as: Loan Analytics, SBA loan record for dialysis center, United States, FY2017 to FY2026, https://www.analytics.loan/dialysis-center-feasibility-study#record-C18.
Cancellation counts FY2017 to FY2024 approvals; charge-off counts FY2017 to FY2021 disbursed loans to date. Both are floors, and a rate needs at least 30 loans in its cohort.
SBA 7(a) dialysis center loans approved nationally, by fiscal year
| Fiscal year | Loans | Dollars |
|---|---|---|
| FY2017 | 5 | $2.8 million |
| FY2018 | 5 | $7.9 million |
| FY2019 | 2 | $297,300 |
| FY2020 | 1 | $2.8 million |
| FY2021 | 3 | $3.4 million |
| FY2022 | 2 | $400,000 |
| FY2023 | 3 | $7.8 million |
| FY2024 | 1 | $675,000 |
| FY2025 | 3 | $5.4 million |
| FY2026 | 3 | $465,000 |
Download this table (CSV). Cite as: Loan Analytics, SBA loan record for dialysis center, United States, FY2017 to FY2026, https://www.analytics.loan/dialysis-center-feasibility-study#record-C18.
Source: U.S. Small Business Administration, 7(a) and 504 loan-level FOIA files (data.sba.gov), as of 2026-09-30.
Related feasibility study pages
SBA lending to dialysis center projects, FY1991 to FY2026
Every SBA 7(a) and 504 loan approved for a dialysis center project since FY1991, by fiscal year, nationally.
A long record with a thin annual flow
SBA's loan-level files reach back to FY1991, and over that span they place 135 7(a) loans for $103.7 million and 31 504 loans for $31.0 million in the dialysis class. The FY2017 to FY2026 decade accounts for 28 of those 7(a) loans and $31.9 million of the 7(a) dollars, plus 5 of the 504 loans and $7.0 million. Read side by side, the figures say the recent decade produced fewer dialysis loans than the years before it, but not smaller ones: its slice of the 7(a) dollars is larger than its slice of the 7(a) count. These are approval dollars as SBA recorded them, with no adjustment for what it costs today to build and equip a treatment floor, so part of the shift may be cost rather than appetite. For a lender, the plain reading is still the right starting point for a study: dialysis has never been a volume class in SBA lending, and in the recent decade most of its 7(a) dollars sit in the few large loans the size bands below pick out.
When the class was busiest
The busiest run in the table is FY2002 through FY2010. Across that run the 7(a) count never fell below 4, reached 7 in FY2002, FY2007 and FY2010, and peaked at 8 in FY2009, matching FY1997 as the highest annual count in the record. The 504 program was active alongside it, with 3 loans in FY2008 and 3 more in FY2010. Then the flow broke. FY2011 recorded 0 loans in either program, FY2014 did the same, and from FY2019 onward the 7(a) count has stayed between 1 and 3 a year. A credit officer who has joined a bank since then may well never have underwritten a dialysis unit, and a study written for that reader cannot assume any familiarity with how a unit earns its revenue, what a station is, or why the water system sits in the budget.
Dollar totals that move with single loans
Where a year has dialysis loans, the long table prints its 7(a) dollars only if the year holds 5 or more dialysis loans, and it withholds some of those years as well, so the published years are few. They show how loosely the dollar line tracks the count. FY1999's 5 loans came to $1.8 million, FY2004's 5 to $4.2 million, FY2005's 5 to $4.0 million and FY2017's 5 to $2.8 million. FY1997 and FY2009, each with 8 loans, differ just as widely: $4.2 million against $7.1 million, the largest annual figure the FY1991 to FY2026 table prints. Every year the long table marks withheld or fewer than 5 loans carries no number there, and none should be estimated from the totals. What a study takes from this is that the national dollar series is not a demand curve. One building in a year lifts the total and a run of equipment loans leaves it flat, so a projection for a single unit has to come from its own service area, never from the national line.
The 504 line, and where it stops
The 504 program has a longer dialysis history than the decade figures alone suggest. Its 31 loans since FY1991 carry $31.0 million, and no year holds more than 3; it reached that level in FY1992, FY1998, FY2008, FY2010 and FY2012. Across the record its loans have run larger on average than the 7(a) loans to the class. In FY2017 to FY2026 it added 5 loans for $7.0 million: 2 in FY2018 and 1 in each of FY2019, FY2020 and FY2021, which makes FY2018 the busiest year of the decade once both programs are counted. From FY2022 through FY2026 the table shows 0 504 dialysis loans in every year. A sponsor who brings a 504 structure for a dialysis building is asking a lender for something the class has not used since FY2021, and the study must make more of the case: what the building is worth in its specialized use, what it would cost to convert to another tenant, and why the operator's lease or credit supports the real estate.
Floors, gaps and gross approvals
Two kinds of blank run through the year table, and neither is a zero. A year marked not measured is one in which too few of SBA's records carry an industry code that places the loan. For 7(a) that happens only in FY2001, but for 504 it covers FY1991, FY1993, FY1994, FY1997, FY1999, FY2000 and FY2001, so the early 504 dialysis record is incomplete and the total of 31 counts only what could be placed. Where SBA left the code missing or unplaceable on more loans than the source note tolerates, the class figure for that year is a floor. A study that cites the long record should say this, because a reviewer who scans the rows will see the early 504 years empty and may read that as no lending when it is no measurement. The year table counts gross approvals, and its source note says cancelled approvals stay in the count. Some of the 135 7(a) approvals and 31 504 approvals since FY1991 may therefore never have funded, and because the cancellation floor for the class is not reported, nobody can say from this page how many. That matters for how a study uses the figures. The count is evidence that SBA lenders have been willing to approve dialysis projects over a long period; it is not a count of units that opened, and still less of units that repaid. A study that cites it should use it for the first purpose only and look to the subject's own market for the second.
What the long record asks of the study
Taken together, the record gives a lender context and little else. It shows that SBA lenders have financed dialysis operators in every measured year except FY2011 and FY2014, that the recent decade's loans are fewer and larger on average, and that 504 has dropped out since FY2021. It cannot show how any of those clinics performed, because the cohorts are too small for a rate. The study therefore carries the burden a larger class would share with its loan history: it documents referral commitments in writing, counts the patients already treated within a realistic drive of the site, lists the competing units with their stations and shifts, and builds the ramp from the first treatment to the census at which debt service is covered. Each of those items stands in for a benchmark the national table cannot supply.
| Fiscal year | SBA 7(a) loans | SBA 7(a) dollars | SBA 504 loans | SBA 504 dollars |
|---|---|---|---|---|
| FY1991 | 3 | fewer than 5 loans | not measured | not measured |
| FY1992 | 1 | fewer than 5 loans | 3 | fewer than 5 loans |
| FY1993 | 2 | fewer than 5 loans | not measured | not measured |
| FY1994 | 2 | fewer than 5 loans | not measured | not measured |
| FY1995 | 5 | withheld | 2 | fewer than 5 loans |
| FY1996 | 1 | fewer than 5 loans | 2 | fewer than 5 loans |
| FY1997 | 8 | $4.2 million | not measured | not measured |
| FY1998 | 6 | withheld | 3 | fewer than 5 loans |
| FY1999 | 5 | $1.8 million | not measured | not measured |
| FY2000 | 4 | fewer than 5 loans | not measured | not measured |
| FY2001 | not measured | not measured | not measured | not measured |
| FY2002 | 7 | withheld | 1 | fewer than 5 loans |
| FY2003 | 5 | withheld | 1 | fewer than 5 loans |
| FY2004 | 5 | $4.2 million | 0 | $0 |
| FY2005 | 5 | $4.0 million | 0 | $0 |
| FY2006 | 6 | withheld | 2 | fewer than 5 loans |
| FY2007 | 7 | withheld | 1 | fewer than 5 loans |
| FY2008 | 4 | fewer than 5 loans | 3 | fewer than 5 loans |
| FY2009 | 8 | $7.1 million | 0 | $0 |
| FY2010 | 7 | withheld | 3 | fewer than 5 loans |
| FY2011 | 0 | $0 | 0 | $0 |
| FY2012 | 3 | fewer than 5 loans | 3 | fewer than 5 loans |
| FY2013 | 5 | withheld | 1 | fewer than 5 loans |
| FY2014 | 0 | $0 | 0 | $0 |
| FY2015 | 4 | fewer than 5 loans | 0 | $0 |
| FY2016 | 4 | fewer than 5 loans | 1 | fewer than 5 loans |
| FY2017 | 5 | $2.8 million | 0 | $0 |
| FY2018 | 5 | withheld | 2 | fewer than 5 loans |
| FY2019 | 2 | fewer than 5 loans | 1 | fewer than 5 loans |
| FY2020 | 1 | fewer than 5 loans | 1 | fewer than 5 loans |
| FY2021 | 3 | fewer than 5 loans | 1 | fewer than 5 loans |
| FY2022 | 2 | fewer than 5 loans | 0 | $0 |
| FY2023 | 3 | fewer than 5 loans | 0 | $0 |
| FY2024 | 1 | fewer than 5 loans | 0 | $0 |
| FY2025 | 3 | fewer than 5 loans | 0 | $0 |
| FY2026 | 3 | fewer than 5 loans | 0 | $0 |
| FY1991 to FY2026 | 135 | $103.7 million | 31 | $31.0 million |
| FY2017 to FY2026 | 28 | $31.9 million | 5 | $7.0 million |
Source: SBA 7(a) and 504 loan-level FOIA files as of 2026-09-30 (data.sba.gov; gross approvals, cancelled approvals included), aggregated by Loan Analytics; each figure is kept with its source file and retrieval date. A class figure counts the loans whose NAICS code places them in the class; in years when SBA's files leave the code missing or unplaceable for more than one loan in a hundred, the figure is a floor, and where too few loans are coded the year is not measured. Download this table (CSV). Cite as: Loan Analytics, "SBA 7(a) and 504 loans to dialysis center projects by fiscal year", https://www.analytics.loan/dialysis-center-feasibility-study#sba-record-sba-by-year.
Every state ranked for dialysis center lending
SBA loans to dialysis center projects in each state from FY2017 to FY2026, ranked, with loan size, program split and the cohort floors where at least 30 loans support them.
California carries the class
California dominates the decade's dialysis lending. Its 14 loans and $22.2 million outrank everything else on the table: Texas, New York and Florida together hold fewer loans, and its $22.2 million is more than half of the decade's $31.9 million in 7(a) dollars and $7.0 million in 504 dollars put together. For a California sponsor, a lender can at least see a set of recent SBA dialysis loans made in the same state. For everyone else, the in-state precedent is a few loans at most. The ranking also says what a study must do outside California. Where a state's record is 1 or 2 loans, the lender has no state benchmark at all, and the study has to bring the market evidence to the file rather than point to peers in the lender's own market.
Texas, and the rows that print no dollars
Texas is second by count with 6 loans for $5.8 million, and it is the only state besides California whose dollar total the table prints. New York follows with 3 loans and Florida, Hawaii and Michigan with 2 each; on those rows, as on every row below them, the dollar column reads fewer than five loans, since a dollar figure built on that handful of dialysis approvals could expose what one borrower received. A sponsor outside the top two states therefore brings the lender a count and nothing more: this page cannot say whether New York's or Florida's dialysis loans paid for a leased fit-out or for a building, and a study should not guess. A lender in Texas has more loans to look at, but a Texas study for a large project cannot treat the state's own record as precedent for its size, because the state total does not show that any Texas loan reached it. A lender in New York or Florida should not read its row as a market for dialysis credit at all; across the whole decade it is 3 loans in one state and 2 in the other.
Where the largest loans must be
The state totals can be read against the size bands. The 7(a) loans outside the band above $2.0 million share whatever is left of $31.9 million once that band's $24.2 million is taken out, and each 504 loan in the middle band is held to that band's ceiling; together they fall well short of California's $22.2 million. So California's total cannot be made of small loans alone: some of the decade's largest dialysis loans must be Californian. No other state can be tested the same way. Texas's $5.8 million on 6 loans neither requires a loan in the top band nor rules one out, and the states below Texas print no dollars at all, so the page cannot place any other large dialysis loan in a particular state. For a California sponsor with a building-scale request, that is the nearest thing the record offers to in-state precedent; for a large request anywhere else, the study should assume there is none and say so in the file.
The thin rows of the ranking
Below Texas the ranking is a list of counts. Arizona, Georgia, Ohio and Virginia hold 1 dialysis loan each for the decade, and none of the rows from New York down carries a size, so a sponsor in any of those states cannot show a lender whether its state's earlier dialysis loans bought chairs and a water room in leased space or a whole clinic. The comparison has to move to the national bands, which do print. The smallest band, $150,000 and under, holds 8 7(a) dialysis loans totalling $650,300, the band just above it holds 8 for $2.1 million, and the band above $2.0 million holds 7 for $24.2 million. A request that lands in the two small bands can be shown to look like most of the class by count; one in the band above $2.0 million can be shown to sit where the bulk of the decade's 7(a) dialysis dollars went, but not to have a peer in the sponsor's own state. In these states the study carries the whole comparison itself: the patients the referring nephrologists treat now, their written commitments, the payer mix, the months to break-even and the fit-out budget checked against contractor and vendor bids, with nothing in the state row to lean on.
No state reaches the measures
Every row of the state table ends at the dollar column, with a note in place of the median. None of the listed states has the loan count to support a median, to split the programs, or to publish a floor for cancellations or charge-offs, California at 14 loans included. A lender therefore cannot quote a state loss benchmark for a dialysis loan anywhere in the country, and the national program table cannot fill the gap, since its own rates are not reported either. A study in any state should say plainly that it works without a published loss rate for the class and show what replaces it: the sensitivity of coverage to a slower patient ramp, a thinner commercial share, higher wages for nurses and technicians and a later opening date. The state counts combine 7(a) and 504: the decade's 28 7(a) loans and 5 504 loans are all placed in the listed states, but the 7(a) and 504 columns are blank because no state has enough loans to split. A sponsor cannot learn from this table which program its own state's lenders have used for dialysis. The national year table shows that 504 has not financed a dialysis project since FY2021, so in practice a state's recent dialysis loans are most likely 7(a) loans, and a sponsor planning a 504 structure should expect the study to argue the real estate case without local precedent in either program.
States with no dialysis line
The table lists only the states where SBA lenders made a dialysis loan in the decade, and many are missing from it: Illinois, Pennsylvania, New Jersey, North Carolina, Colorado and Washington do not appear on it. A sponsor in one of those states brings the lender a file with no SBA dialysis precedent from the state since FY2017. That is not evidence that a unit cannot work there; it is evidence that the lender will judge the project on the study alone. The study for such a file should document the referral sources, the existing units and their capacity, and the payer mix more fully than a lender in a better-recorded class would ask, and it should set the subject against the national size figures so the request can be placed.
| State | Loans | Dollars | Median loan | SBA 7(a) loans | SBA 504 loans | Cancelled (floor) | Charged off (floor) |
|---|---|---|---|---|---|---|---|
| California | 14 | $22.2 million | too few loans for these measures | ||||
| Texas | 6 | $5.8 million | too few loans for these measures | ||||
| New York | 3 | fewer than five loans | too few loans for these measures | ||||
| Florida | 2 | fewer than five loans | too few loans for these measures | ||||
| Hawaii | 2 | fewer than five loans | too few loans for these measures | ||||
| Michigan | 2 | fewer than five loans | too few loans for these measures | ||||
| Arizona | 1 | fewer than five loans | too few loans for these measures | ||||
| Georgia | 1 | fewer than five loans | too few loans for these measures | ||||
| Ohio | 1 | fewer than five loans | too few loans for these measures | ||||
| Virginia | 1 | fewer than five loans | too few loans for these measures |
Source: Loan Analytics' SBA loan record from SBA's 7(a) and 504 loan-level files, approvals FY2017 to FY2026 as of 2026-09-30; rates are floors and need at least 30 loans in their cohort; dollars are not shown where fewer than five loans would reveal a single loan. Download this table (CSV). Cite as: Loan Analytics, "SBA dialysis center loans by state, FY2017 to FY2026", https://www.analytics.loan/dialysis-center-feasibility-study#states-states.
Loan sizes, program split and cohort floors for dialysis center loans
How large dialysis center loans run under each SBA program, how they fall into size bands, and how often they were cancelled or charged off.
Two kinds of dialysis loan
The quartiles of the decade's 7(a) dialysis loans describe a split class. The lower quartile is $150,000 and the median $291,750, but the upper quartile is $2.0 million, so the step from the median up to the upper quartile is far longer than the step from the lower quartile up to the median. It is the shape two kinds of borrower would produce: operators financing equipment and fit-out in leased space at the low end, and owners or developers financing a building or a full ground-up unit at the top. A lender reading a dialysis request needs to know at once which kind it holds, because the questions differ, and a study states it on its first page and organizes the rest around it.
Where the dollars sit, and the thin middle
The size bands make the split concrete. Dialysis 7(a) loans no larger than $150,000 number 8 and total $650,300, and the band just above it holds 8 more for $2.1 million. The band above $2.0 million holds 7 loans for $24.2 million, most of the $31.9 million the 7(a) program approved for the class in the decade. In between, the middle bands carry 3 and 2 loans whose dollars the table does not print, since each rests on fewer than 5 loans, and no dialysis loan in either program reached the table's largest band. Counted by loans, then, the class is mostly small loans; counted by dollars, it is mostly a few large ones. A lender's dialysis exposure comes from projects at the top end, and that is where a feasibility study does most of its work. Between the second band and the band above $2.0 million the distribution is sparse: 3 7(a) loans in the middle band and 2 in the band after it, with the 3 504 loans of the middle band beside them. A request in that range, larger than an equipment loan but short of a building, has the fewest peers in the class. The lender will want to know what the extra dollars buy that a $291,750 loan does not, whether that is a larger station count, a full leasehold build-out with its own water room, or a share of the real estate, and the study has to answer that before it argues demand.
504 loans start in the middle
The 504 column has no loan below the middle band. The 5 504 loans of the decade split between the middle band, with 3, and the band above $2.0 million, with 2; their dollars are not printed at those counts, though the year table puts them together at $7.0 million. Over the decade, then, 504 has served only the larger dialysis projects, those more likely to involve a building or a full build-out. The study for a 504 dialysis file therefore reads as much like a real estate study as an operating one: the specialized improvements, the cost to construct or convert them, the rent the operator can carry from its projected census, and the value support the appraisal will draw on.
The program table and its blank rates
The program table, drawn from Loan Analytics' loan cells, shows a single row for SBA 7(a); the decade's 504 dialysis loans appear in the year table and the size bands, which are aggregated from SBA's FOIA files. Every rate column in the 7(a) row is blank for one reason, which is size: cancellations are counted on approvals made in FY2017 to FY2024, charge-offs on the dialysis loans SBA disbursed from FY2017 through FY2021, and the share charged off within 5 years on its own cohort, and none of those groups holds 30 dialysis loans. None of them should be read as zero, and none as evidence of a clean book. A lender who asks how SBA dialysis loans have performed gets the honest answer from this page: the class is too small to say, and the study has to show the risk of this one project directly.
What a study tests for a small loan
For a request near the $291,750 median, the lender is financing equipment, installation and the first months of operation, and repayment depends on how fast the unit fills its chairs. The study for that file is built around the referral base and the ramp: written commitments from the nephrology practice, the patients those physicians already treat and where they dialyze now, the stations needed to serve them across the shifts the unit will run, the payer split between Medicare and commercial coverage, and a staffing plan that adds nurses and technicians as the census grows. The water treatment system gets its own line in the budget, priced from a vendor quote rather than an allowance, and working capital is sized to carry the unit until coverage is reached. The 8 loans at the bottom are small even by this class's standards, and the lower quartile, $150,000, sits exactly at their band's ceiling. A loan of that size is unlikely to cover the whole fit-out of a new unit, with its water system, machines and chairs; it reads more like added stations, replaced equipment or working capital for a unit already open. The study a lender asks for at that size is correspondingly narrower: the unit's operating history, the capacity being added, the referrals that justify it, and coverage with the new debt on top of what the operator already carries.
What a study adds for a large loan
For a request in the band above $2.0 million, where 7 of the decade's 7(a) loans and 2 of its 504 loans sit, the study adds the work a building demands. It reviews the construction or conversion budget against bids, including the plumbing and electrical upgrades a treatment floor needs, and starts the ramp at the certificate of occupancy rather than at closing. It tests coverage at the census the unit can reach in its first year and in the years after, and it gives the appraiser the market support for the operator's rent, because a dialysis build-out holds little value for a tenant outside the field. The $24.2 million the 7(a) program approved in loans of this size is where a lender's dialysis exposure sits, and these are the sections a credit officer reads first.
| Program | Loans | Dollars | Lower quartile | Median loan | Upper quartile | Cancelled (floor) | Charged off (floor) | Charged off within 5 years |
|---|---|---|---|---|---|---|---|---|
| SBA 7(a) | 28 | $31.9 million | $150,000 | $291,750 | $2.0 million | not reported: fewer than 30 loans in the cohort | not reported: fewer than 30 loans in the cohort | not reported: fewer than 30 loans in the cohort |
Source: Loan Analytics' SBA loan record from SBA's 7(a) and 504 loan-level files, approvals FY2017 to FY2026 as of 2026-09-30; rates are floors and need at least 30 loans in their cohort; dollars are not shown where fewer than five loans would reveal a single loan. Download this table (CSV). Cite as: Loan Analytics, "SBA dialysis center loans by program, FY2017 to FY2026", https://www.analytics.loan/dialysis-center-feasibility-study#loan-sizes-programs.
| Loan size | SBA 7(a) loans | SBA 7(a) dollars | SBA 504 loans | SBA 504 dollars |
|---|---|---|---|---|
| $150,000 or less | 8 | $650,300 | 0 | $0 |
| Over $150,000 to $350,000 | 8 | $2.1 million | 0 | $0 |
| Over $350,000 to $1 million | 3 | fewer than 5 loans | 3 | fewer than 5 loans |
| Over $1 million to $2 million | 2 | fewer than 5 loans | 0 | $0 |
| Over $2 million to $5 million | 7 | $24.2 million | 2 | fewer than 5 loans |
| Over $5 million | 0 | $0 | 0 | $0 |
Source: SBA 7(a) and 504 loan-level FOIA files as of 2026-09-30 (data.sba.gov; gross approvals, cancelled approvals included), aggregated by Loan Analytics; each figure is kept with its source file and retrieval date. Download this table (CSV). Cite as: Loan Analytics, "SBA dialysis center loans by size band, FY2017 to FY2026 approvals", https://www.analytics.loan/dialysis-center-feasibility-study#loan-sizes-size-bands.
Questions buyers ask
Who prepares a feasibility study for a dialysis center loan?
Loan Analytics does, as a consultant independent of the sponsor, and the study goes into the lender's file under the signature of Daniel Smith, MAI. It is written to whichever program finances the unit, from SBA's 7(a) and 504 loans to USDA's guarantee for Business and Industry loans or a bank lending to the clinic on its own account, and it places the subject against the SBA record this page prints: 135 7(a) loans and 31 504 loans to dialysis projects since FY1991, 28 and 5 of them in FY2017 to FY2026. Because that record is too thin to give the lender a loss rate or a state benchmark, the study's own evidence on referrals, patients, payers and costs carries the credit case.
Do lenders insist on a feasibility study for a dialysis clinic loan?
The lender decides that under its own credit policy and the rules of the program it uses, and no table can answer it for one file. What this page shows is why a lender is likely to ask. For dialysis, the record prints no cancellation or charge-off rate at all, since every cohort falls short of 30 loans; outside California no state has more than 6 loans in the decade; and a dialysis build-out is specialized, so the collateral leans on the operator rather than on resale. A study answers the questions the record leaves open, in the form a credit committee can file.
What does a dialysis center feasibility study cost?
Loan Analytics' 2026 fee survey, posted on this site, collects the fee bands that study providers publish. A standard special-purpose asset on a single site falls in the $5,000 to $12,500 band. For the complex tier, which the survey describes through examples such as ground-up hotels, multi-site projects, unusual concepts and phased construction, it is $10,000 to $25,000. For work to USDA's standard it is $7,500 to $18,750 or more. Dialysis is not among the survey's named examples, and the survey adds that the fee is not set or capped by SBA. Where a dialysis study lands in those bands turns on whether it covers a leased fit-out or a building, how many units it covers and which program finances it; the fee itself comes in our answer to the scope request.
How long does a dialysis center feasibility study take?
Our reply to a scope request sets the timing against the lender's deadline; there is no standard period to quote. What takes the time in a dialysis study is evidence held by other people: letters from the referring nephrologists, the payer contracts or the operator's payer history, bids for the water treatment system and the plumbing and electrical work, and, for a building, the construction budget and schedule. A sponsor who has those in hand at the start shortens the study. For a request near the $291,750 median most of the work is the referral and ramp evidence; for a project in the band above $2.0 million the construction review adds to it.
What will a lender want a dialysis feasibility study to test?
It tests demand, revenue, cost and coverage. Demand: the kidney-failure patients already treated within reach of the site, the nephrologists who will refer them and round at the unit, and the existing units with their stations and shifts. Revenue: the payer mix, because the split between Medicare and commercial coverage decides both the revenue per treatment and the margin. Cost: machines, chairs, the water system, the build-out and staffing at the ratios the operator must keep. Coverage: debt service tested month by month through the ramp. With 28 7(a) loans in the decade and no published loss rate, the lender has nothing else to measure the request against.
How many SBA loans have gone to dialysis centers?
Since FY1991, 135 7(a) loans for $103.7 million and 31 504 loans for $31.0 million, by the FOIA aggregation behind this page's year table. In FY2017 to FY2026 the figures are 28 7(a) loans for $31.9 million and 5 504 loans for $7.0 million. The busiest 7(a) years were FY1997 and FY2009, with 8 loans each; FY2011 and FY2014 had 0 in both programs, and since FY2019 no year has carried more than 3. Years marked not measured or withheld carry no number, and the early 504 years are incomplete, so the long-run totals count the loans that could be placed in the class.
Which states lead SBA lending to dialysis centers?
California, by a wide margin: 14 loans for $22.2 million in FY2017 to FY2026. Texas follows with 6 loans for $5.8 million. New York has 3 loans and Florida, Hawaii and Michigan 2 each; Arizona, Georgia, Ohio and Virginia recorded 1 loan each, and no other state appears in the table for the decade. Below Texas the table prints no state dollar total, since a figure resting on so few loans could reveal a single borrower's loan. No state has enough loans for a median or a loss floor, so a study in any state uses the national figures for context and builds its case from the local market.
Which banks make SBA loans to dialysis centers?
This page names no lender. Loan Analytics lists a lender for an asset class only where it has made at least 5 loans in that class, and with 28 7(a) loans and 5 504 loans in the decade spread over the states in the ranking, no lender's SBA dialysis book is large enough to list. For a sponsor that means the lender is chosen on its appetite for healthcare credit and on the program it offers, not on a record in the class, and the study is written to give that lender the evidence its own loan book cannot.
How large are SBA loans to dialysis centers?
The 7(a) median for FY2017 to FY2026 is $291,750; the lower quartile is $150,000 and the upper quartile $2.0 million. By band, 8 loans were $150,000 or less, 8 sat in the next band up, 3 and 2 fell in the middle bands, and 7 were above $2.0 million, carrying $24.2 million. The 504 loans of the decade sat in the middle band and above $2.0 million, none in the smaller bands. A dialysis loan is usually either a modest equipment and fit-out loan or a large project loan, and the study is scoped to whichever the request is.
Can a dialysis center be financed with an SBA 504 loan?
The record shows it has been: 31 504 loans for $31.0 million since FY1991, and 5 for $7.0 million in FY2017 to FY2026. The most recent were 1 loan in each of FY2019, FY2020 and FY2021, and the table shows 0 504 dialysis loans in every year from FY2022 through FY2026. The decade's 504 loans fell in the middle size band and above $2.0 million. A sponsor planning a 504 structure for a dialysis building will find the lender's questions centered on the real estate, and the study supports it with the build-out budget, the rent the operator can carry and the specialized nature of the improvements.
What is the default rate on SBA dialysis center loans?
It cannot be published. The cancellation and charge-off measures, and the share charged off within 5 years, each need at least 30 loans in their cohort, and the dialysis cohorts are smaller, so the page reports none of them. That is not a zero and not a sign of a clean record; it means the class is too small to measure. A lender therefore has no loss benchmark for dialysis, and a study should not invent one. It tests the subject's own risk instead: coverage if patients arrive more slowly, if fewer of them carry commercial coverage, if staff cost more and if the opening slips.
Is the dialysis market near my site already saturated?
Nothing on this page can settle that; it carries SBA loan figures, not patient or clinic counts. The study answers it at the level of the service area: the existing units within the travel time patients will accept, their stations and the shifts they run, how full those shifts are, how many of the area's patients treat at home rather than in a center, and how many patients of the referring nephrologists live closer to the subject than to the unit they use now. A new unit that only draws patients from an established one is a transfer of volume, not new demand, and the study says which the subject is.
How does the study project patient census and the ramp to break-even?
It builds the census from named sources rather than from a population ratio: the patients the referring practice already treats, those who would be closer to the subject than to their current unit, and the new patients the practice expects to start on treatment. It converts that census into stations and shifts, then into treatments and revenue by payer, and lays the result out month by month from the first treatment, since a new unit takes months to fill. Debt service coverage is tested at each step, and the study states the month in which coverage reaches the lender's requirement and what happens to it if the ramp runs slower.
How does the payer mix affect a dialysis loan?
It decides how much of the census turns into margin. Medicare governs the revenue on much of a unit's treatment volume, while commercially insured patients provide much of what is left after costs, so two units with the same census can cover their debt very differently. The study therefore models revenue by payer rather than at an average rate, using the operator's own payer history where it has one and the referring practice's patient mix where it does not, and it tests coverage if the commercial share comes in below plan. With no published loss rate for the class, that test is one of the few ways a lender can see how much room the loan has.
How should the appraisal treat a dialysis clinic build-out?
As specialized improvements whose value depends on the operator. The water treatment room and the plumbing and electrical upgrades a treatment floor needs have little use to a tenant outside dialysis, so the appraisal leans on the lease and the operator's credit rather than on what a buyer would pay for the space. The study supports it with the rent the operator can carry from the projected census and with the build-out budget. For the larger loans, the 7 7(a) loans above $2.0 million in the decade and the 504 loans in the same band, these are the sections the lender reads first.
Can Loan Analytics write the study for a USDA-guaranteed dialysis loan?
It can, and it does for Business and Industry files just as it does for SBA and bank credit. The site's 2026 fee survey places dialysis work written to USDA's standard in the survey's USDA band, $7,500 to $18,750 and up. Every loan figure on this page is an SBA figure and the page holds no USDA dialysis record, so a USDA study builds demand from the clinic's own catchment, the referring practice and the units already operating there, and treats the SBA record, with its 28 7(a) loans and 5 504 loans in the decade, as national context only.
Can I put the figures from this page in my loan package?
Yes, as national and state context, cited the way the page gives them: each data table in the sections above offers a CSV download and a cite-as line naming Loan Analytics and the table's anchor on this page. Quote the counts and dollars exactly as printed, explain that the rate columns stay blank because each dialysis cohort counts under 30 loans, and leave a withheld year or a missing state measure blank rather than estimating it. The study itself uses the same figures, from the 135 7(a) loans since FY1991 to California's 14 loans in the decade, and adds the local evidence a lender will weigh more heavily.
Is a study for buying an existing dialysis clinic different from one for a new unit?
Yes. An acquisition comes with a treatment history, a payer record and a patient roster, so the study tests whether those hold under the new owner instead of building them up from the referral base. As the site's 2026 fee survey observes, a study of an operating business that has financial statements is shorter than a ground-up one, since so much of a ground-up study goes into establishing the ramp. This page's SBA files do not tell purchases apart from new units, so neither can be counted here; a lender sees only the loan sizes, with the 7(a) median at $291,750 and 7 loans above $2.0 million.
Can one study cover several dialysis units?
Yes, with a market section for each site, because every unit's referral base, competing units and payer mix are local. Loan Analytics' 2026 fee survey counts multi-site projects among complex studies, priced at $10,000 to $25,000. The national record offers no guide to operators of several units: its 7(a) median of $291,750 and its state counts describe single loans, and the largest band any dialysis loan reached in the decade is the one above $2.0 million, so a lender financing a group of units is beyond anything the table shows and will rely on the study for each site.
What information do you need from me to scope a dialysis study?
The site address or target area; whether the unit is new, an expansion or an acquisition; the stations and shifts planned; the referring nephrology practice and its letter of support if one exists; the operator and its payer history; whether the space is leased or owned and, for a building, the construction budget; and which program and which lender, how much you plan to borrow and when the lender needs the study. From that our reply fixes the scope, the timing and the fee, and says which of this page's figures the study will set the project against.
Loan Analytics prepares the feasibility study a lender reads before it commits: for a dialysis center project anywhere in the United States, financed under SBA 7(a), SBA 504, USDA Business and Industry or a conventional bank loan. Tell us the project and the lender's deadline, and we reply with scope, timeline and fee.
Daniel Smith, MAI
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