Sell your dialysis center
Operating or relocating, NN or absolute NNN. A national name on the sign and a joint venture on the lease.
Dialysis Center at a glance
- Typical deal size
- $1.5M – $7M
- Lease structure
- NN or Absolute NNN
- Typical term
- 10–15 years
- Escalations
- 10% every 5 years, or 1.5–2% annually
Overview
What dialysis centers are really worth
Our read
Dialysis centers are among the most durable tenants in medical net lease, for reasons that have nothing to do with the economy. Patients with kidney failure need treatment several times a week, Medicare covers end-stage renal disease regardless of age, and the water treatment and plumbing infrastructure make a clinic expensive to move.
That durability gets priced as corporate credit, and that is where owners are most often surprised. The operator on the sign is frequently not the entity on the lease. Clinics are commonly operated through subsidiaries or joint ventures with local nephrologists, and a parent guarantee is not a given.
The real risk is relocation. Operators consolidate underused clinics into newer facilities nearby, usually at lease expiration, and patients move with them. A clinic anchored to an active nephrology practice rarely faces that decision; one competing for referrals often does.
Valuation
How we underwrite it
The method
We underwrite who signed the lease first — parent, subsidiary, or joint venture — and whether a guarantee exists. That determines how the income should be priced, and in this sector it is the single most common gap between what an owner believes and what the lease says.
Next is the clinic's position in the operator's network: station count, how busy it is, the nephrologist relationship, and whether the same operator has a newer facility nearby. Those are better predictors of renewal than remaining term.
Landlord obligations get priced line by line. Many dialysis leases are NN, which leaves roof and structure with the owner, and we would rather put those costs in the first number than renegotiate later.
For dark or relocating clinics, we underwrite both a dialysis backfill and a general medical one, and price the specialized infrastructure as an asset in the first case and a demolition cost in the second.
What moves the number
- 01Which entity signed — the parent, an operating subsidiary, or a joint venture with local nephrologists — since the brand on the sign is often not the guarantor
- 02The nephrologist relationship behind the clinic, because patients follow their physician and referrals decide whether the center stays full
- 03Station count and utilization, since an underused clinic is the first one consolidated into a newer facility nearby
- 04Water treatment room and plumbing to every chair, which make relocation expensive and support renewal
- 05Lease form — many dialysis leases are NN with roof and structure on the landlord
- 06Proximity to the patient base, since patients come three times a week and many depend on transportation services
Capital markets today
- 10-yr Treasury
- 5.24%
- 4.12% a year ago
- SOFR
- 3.87%
- 4.2% a year ago
- 30-yr mortgage
- 7.28%
- 6.3% a year ago
- CRE loan delinquency
- 1.53%
- 1.57% a year ago
- CRE prices, YoY
- 6.58%
- -2.7% a year ago
Sources: FRED DGS10, 2026-10-01 · FRED SOFR, 2026-10-01 · FRED MORTGAGE30US, 2026-10-01 · FRED DRCRELEXFACBS, 2026-04-01 · FRED COMREPUSQ159N, 2026-01-01
Diligence
What a buyer actually looks at in a dialysis center
- Check 01
Tenant entity, guarantor, and joint venture structure
Many clinics are operated by joint ventures between the operator and local nephrologists. A lease signed by the JV is not the same credit as one guaranteed by the parent.
- Check 02
Lease form and landlord obligations
NN leases are common in this sector. Roof, structure, and sometimes parking lot replacement sit with the owner and need to be priced, not discovered.
- Check 03
Water treatment room, plumbing, and drain condition
Dialysis depends on purified water delivered to every station. That infrastructure is why tenants stay, and slab drain problems are expensive to fix under an operating clinic.
- Check 04
Station count and how the clinic compares with nearby facilities
Operators consolidate underused clinics into newer ones. A nearby facility from the same operator is the most direct risk to renewal.
- Check 05
Generator and power redundancy
Treatment cannot simply stop when the power does. Backup power capacity and condition matter to the operator and to the next one.
- Check 06
Equipment and improvement ownership at lease end
Water systems and chair-side plumbing are frequently tenant-owned. What stays and what leaves on expiration changes the backfill math considerably.
Backfill risk
What happens if the tenant leaves
The tenant-goes-dark scenario
A dialysis center is a modest building with very expensive guts. The water treatment room, plumbing and drains run to every treatment station, electrical capacity, and backup power are what make the clinic work, and they are also what make operators reluctant to move. Renewal rates in operating clinics tend to reflect that.
The risk is relocation rather than closure. Demand for dialysis is driven by chronic kidney disease, which does not respond to the economy, and Medicare covers end-stage renal disease regardless of age. What changes is where the operator wants to deliver it. When a clinic is underused or the building is aging, the operator can open a newer facility nearby and move patients over at lease expiration, and the old building goes dark with little warning.
Backfill by another dialysis operator is possible but not common, because the sector is concentrated in a small number of operators and the one who left usually still serves the area. More often the next user is general medical — primary care, therapy, or behavioral health — and much of the dialysis-specific infrastructure becomes demolition cost.
The strongest clinics are the ones anchored to an active nephrology practice. Patients follow their nephrologist, and a clinic with a stable physician relationship is far less likely to be consolidated than one competing for referrals.
Why this matters to you
Every buyer prices the tenant-goes-dark scenario, whether or not they say so out loud. It is the largest hidden input into the cap rate you get offered.
Understanding it before you go to market is the difference between negotiating and being negotiated with.
Who sells to us
Situations we see most often
- 1031 buyer whose clinic is approaching renewal and wants to sell before the operator decides
- Owner of a center where the operator opened a newer facility a few miles away
- Developer selling after a build-to-suit commenced rent
- Investor surprised to find the guarantor is a joint venture rather than the parent
- Owner holding an NN lease who does not want the roof and parking lot on their balance sheet
Buy box
What we buy
- 01Operating dialysis clinics, $1.5M to $7M
- 02NN and absolute NNN leases
- 03Short remaining term and pending renewals
- 04Dark clinics and relocation situations
Process
How selling to Dizposition works
Day 0
01Send us the property
Address, asset type, and the lease if there is one. That is enough for us to start.
- 02
We underwrite it
Our underwriting runs the income against current market pricing and the cost of capital. No lowball anchor.
10 minutes
03You get a firm offer
In 10 minutes, with the math shown. You will know exactly how we got there.
As fast as 30 days
04Close on your timeline
As fast as 30 days, or as slow as you need. We are the principal, so the date is yours.
FAQ
Selling a dialysis center
The sign says a national operator. Is that who guarantees my lease?
Often not. A great many clinics are leased by an operating subsidiary or a joint venture with local nephrologists, and the parent may not guarantee it. That does not make the lease bad, but it changes the pricing. Send us the lease and we will tell you exactly who signed.
My tenant opened a new clinic a few miles away. Should I worry?
It is worth taking seriously. Consolidating patients into a newer facility at lease expiration is the main way dialysis clinics go dark. Station counts at both clinics and how much term you have left tell us most of what we need to know.
My lease is NN. What does that mean for a sale?
It means the roof and structure, and sometimes the parking lot, are your cost rather than the tenant's. Buyers price that. We underwrite the remaining life of those systems directly rather than applying a blanket discount.
The clinic closed. Is the building worth more than a generic medical office?
Sometimes, if another dialysis operator wants the location and the water and plumbing infrastructure stayed. More often the next user is general medical, and the specialized systems are a cost. We price both paths and tell you which one we believe.
How long does it take to sell a commercial property to Dizposition?
You get a firm written offer within 10 minutes of sending us the property. If you accept, you can close in as little as 30 days — most of that is title work and your own timeline. There is no listing period, no marketing, and no waiting on a buyer's financing contingency.
Can I sell my property as-is?
Yes. We are the buyer, so there is no lender requiring repairs and no inspection contingency to renegotiate against you. Deferred maintenance, a failing roof, an aging tank system — we price it into the offer rather than asking you to fix it first.
Can I sell with a tenant in place?
Yes, and in most cases a tenant makes the property more valuable to us, not less. We will ask for the lease, a rent roll, and any estoppel certificates. You do not need to deliver the property vacant.
What if my lease is short-term or about to expire?
Short remaining term is one of the main reasons owners come to us. A conventional buyer needs lease term to get financing, which is why short-dated assets sit on the market. We underwrite the real estate and the backfill prospects rather than the remaining term alone.
Do I need a broker to sell to you?
No. We buy directly, and there is no commission because there is nothing to market. If you already have a broker, we will pay them. Selling without one saves the commission, but you should understand you are also giving up price discovery — a broker's job is to find out whether someone will pay more than we will.
What documents do I need to get an offer?
The address and the lease are enough to start. To finalize, we will want the rent roll, the last two years of operating statements, the title commitment, any existing survey, and any environmental reports you already have. You do not need an appraisal or a broker package.
How do you determine your offer?
We underwrite in-place income against what the space would re-lease for, adjust for capital needs and any environmental tail, and apply a cap rate supported by comparable transactions. We show you the inputs. If you disagree with an assumption, we would rather argue about the assumption than about the number.
What are typical seller closing costs?
Title and escrow fees, any transfer or recording tax owed in your state, prorated property taxes, and payoff of any existing debt. Because we are the buyer, there is no commission and no marketing cost. Transfer tax varies significantly by state and is often the largest single line.
Will I owe capital gains tax when I sell?
Usually yes, on the gain above your adjusted basis, and depreciation recapture is taxed separately from appreciation. State treatment varies. This is a question for your CPA before you sign, not after — the structure of the sale can change the answer.
Can I do a 1031 exchange?
Yes. A 1031 exchange lets you defer federal capital gains by reinvesting in like-kind property, subject to a 45-day identification window and a 180-day closing window from the date you sell. You must have a qualified intermediary in place before closing — it cannot be arranged afterward. Most states conform to federal treatment, but a few do not.
Can I sell if I am behind on payments or facing foreclosure?
Yes, and speed is the reason to move early rather than late. We can close on a defined date, which is what a lender or a receiver generally needs to see. Send us the payoff figure and any notices you have received.
Can I sell a property I inherited or that is in probate?
Yes. Probate sales take longer because the court timeline governs, not ours, and multiple heirs need to agree on the price before anything can close. We are used to working around both. Inherited property also generally receives a stepped-up basis, which can change the tax math substantially.
What if there is environmental contamination?
Send it anyway. Environmental history is one of the most common reasons a conventional sale falls apart, and it is one of the reasons owners call us. We price the remediation and the residual liability into the offer rather than walking away at the Phase II.
Is there any cost or obligation to get an offer?
None. There is no fee, no listing agreement, and no obligation to accept. If our number does not work for you, you keep the underwriting we showed you and we part ways.
Markets
Top markets we buy dialysis centers in
Where the inventory is
8,418 U.S. establishments · Kidney dialysis centers
- 01Sell a dialysis center in California839
- 02Sell a dialysis center in Texas830
- 03Sell a dialysis center in Florida636
- 04Sell a dialysis center in Georgia425
- 05Sell a dialysis center in Pennsylvania377
- 06Sell a dialysis center in Ohio363
- 07Sell a dialysis center in Illinois345
- 08Sell a dialysis center in New York331
- 09Sell a dialysis center in North Carolina265
- 10Sell a dialysis center in Tennessee253
Sources: U.S. Census Bureau, County Business Patterns, NAICS 621492, 2023
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10-minute offer
Ready to sell your dialysis center?
Send us the property and the lease. You'll have a firm offer, with the math shown, in 10 minutes.


