Nephrocare Health Services
- Nephrocare Health Services is coming out with a 100% book building; initial public offering (IPO) of 1,93,29,961 shares of 2 each in a price band Rs 438-460 per equity share.
- Not more than 50% of the issue will be allocated to Qualified Institutional Buyers (QIBs), including 5% to the mutual funds. Further, not less than 15% of the issue will be available for the non-institutional bidders and the remaining 35% for the retail investors.
- The issue will open for subscription on December 10, 2025 and will close on December 12, 2025.
- The shares will be listed on BSE as well as NSE.
- The face value of the share is Rs 2 and is priced 219.00 times of its face value on the lower side and 230.00 times on the higher side.
- Book running lead managers to the issue are ICICI Securities, Ambit, IIFL Capital Services and Nomura Financial Advisory and Securities (India).
- Compliance Officer for the issue is Kishore Kathri.
Profile of the company
Nephrocare Health Services offers comprehensive dialysis care through its network of clinics - from diagnosis to treatment and wellness programs including haemodialysis, home and mobile dialysis, supported by pharmacy. The company is India’s largest dialysis service provider in terms of number of patients served, clinics, cities covered, treatments performed, revenue, and EBITDA (excluding other income) in Fiscal 2025, and it is 4.4 times the size of the next largest organized dialysis provider in India in terms of operating revenue in Fiscal 2024. In Fiscal 2025, the company served 29,281 patients and completed 2,885,450 treatments in India which represented approximately 10% of the total dialysis patients in India. Additionally, by September 30, 2025, the company served 31,046 patients and completed 1,591,377 treatments in India. The company is also the largest dialysis service provider in Asia in 2025 and the fifth largest globally based on the number of treatments performed in Fiscal 2025.
The company is the only Indian dialysis services provider that has scaled internationally with a global network of 519 clinics, with 51 clinics internationally across the Philippines, Uzbekistan and Nepal, as of September 30, 2025. The company is the most widely distributed dialysis network in India with an extensive Pan-India network of clinics across 288 cities, as of September 30, 2025 and 21 States and four Union Territories and in particular 77.35% of its clinics spread across tier II and tier III cities and towns, as of September 30, 2025.
Its endeavour is to enable people on dialysis worldwide to lead long, happy and productive lives. Dialysis is a vital, life sustaining chronic treatment, with patients typically visiting a clinic two to three times per week. Compared to most of the other acute medical conditions necessitating episodic or one-time treatment, dialysis is a recurring, life-sustaining medical service for individuals with End Stage Renal Disorder (ESRD). The company strives to ensure that patient care is accessible, high-quality, and offers value. Recognizing that dialysis patients can lead normal lives, it refers to them as ‘guests’ in its clinics as part of its operations to emphasize dignity and care.
Proceed is being used for:
- Capital expenditure by the company for opening new dialysis clinics in India
- Pre-payment, or scheduled repayment, in full or part, of certain borrowings availed by the company
- General corporate purposes
Industry Overview
Indian healthcare is a complex system that has traditionally been tethered between value and need-based care as both the public and private sectors play equally critical roles. The healthcare system is also heavily reliant on out-of-pocket payments, especially in the private sector. The Indian Healthcare industry is segmented into Hospitals, Pharmaceuticals, Diagnostic services, Medical Devices, and Others (Medical insurance, Telemedicine, etc.). The estimated market size of the Indian Healthcare industry is $443 billion in 2024, and it is expected to reach $1057 billion by 2029, growing at a CAGR of 19.0% over the next 5 years. The industry is expanding due to the country's rapid economic growth, increasing life expectancy, higher health awareness, government policy support, middle-class income gains, health insurance carriers' expanded market penetration and improving medical tourism. The Indian Healthcare market is dominated by the Hospital segment with about 74% share ($327.6 billion, 2024), followed by Pharmaceutical with about 11.6% Share ($50.7 billion, 2024), Medical Devices with about 4.4% share ($21.9 billion, 2024), and Diagnostics with about 2.6% share ($13.1 billion, 2024).
Non-communicable diseases (NCDs) are a huge burden globally, accounting for 43 million deaths annually, roughly 75% of the total deaths as per WHO reports published in 2021. Diabetes, hypertension, cardiovascular diseases, cancers, and chronic respiratory diseases are a few of the common NCDs. There is a significant impact of hypertension and diabetes on overall global mortality, as the two conditions combinedly accounted for nearly 20% of mortality in 2021. Chronic Kidney Disease (CKD) is one of the unique conditions that is caused by both diabetes and hypertension. In addition to diabetes and hypertension, other causes of CKD include infections, kidney inflammation, polycystic kidney disease, long-term pain killers usage and others. The global prevalence of CKD is estimated to be between 9% and 10% of the overall population (more than 750 million people), and the prevalence is expected to grow at a much faster rate in the coming years due to increasing lifestyle diseases such as diabetes and hypertension.
Growing global demand for dialysis services has highlighted the need for a greater number of standalone dialysis clinics or advancements in home HD dialysis and PD services globally. Except for a few established countries, the majority of the dialysis hotbed countries are yet to focus on growing the home HD and PD dialysis segment. Thus, in a highly sizeable, underpenetrated and fast-growing global dialysis market, the growth in the dialysis service is going to be driven by the adoption of in-clinic dialysis services due to the scaling up of standalone clinics, which have higher return on investment potential when successful. These clinics are the means to reduce the rural and urban divide and have the ability to reduce overall cost per treatment to patients. Hence, during the forecast period, the growth of standalone dialysis clinics, especially in emerging economies, is expected to narrow the demand-supply gap in dialysis services.
Pros and strengths
India’s and Asia’s largest dialysis chain with leadership across its markets: The company is India’s largest dialysis service provider in terms of number of patients served, clinics, cities covered, treatments performed, revenue, and EBITDA (excluding other income) in Fiscal 2025, and it is 4.4 times the size of the next largest organized dialysis provider in India in terms of operating revenue in Fiscal 2024. It is also the largest dialysis service provider in Asia in 2025 and the fifth largest globally based on the number of treatments performed in Fiscal 2025. In India, the company is leader in dialysis services in Fiscal 2025, with a market share of over 50% of the organized market (in terms of number of treatments) and approximately 50% share in terms of revenue generated by organized dialysis service providers.
Scale coupled with asset-light model driving cost efficiencies and operational excellence: Given the nature of dialysis, which requires patients to frequently visit a dialysis clinic for treatment, it is imperative to ensure easy access to treatment. The company has scaled its operations from one clinic in India in 2010 to 519 clinics, across India, Nepal, the Philippines and Uzbekistan as of September 30, 2025 and have a well-diversified network with presence in 328 cities. The company operates an asset-light business model, ensuring that the establishment and operation of the clinics incur lower costs compared to other healthcare services, such as tertiary care or other single-specialty services such as eye care and in-vitro fertilization. By adopting an asset-light approach, it operates efficiently, focusing on delivering high-quality care without excessive capital expenditure. As of September 30, 2025, 52.41% of its 519 clinics are on a revenue-sharing model with limited investment in space, demonstrating its commitment to lean operations.
Driving clinical excellence and quality through protocols and advanced technology: The company has been able to drive such clinical outcomes through its consistent focus on quality. Its protocol-led approach plays a crucial role in improving the average life expectancy. For instance, its RenAssure protocols cover every aspect of the dialysis treatment. These protocols are reviewed to ensure new research findings are incorporated and are then implemented across all its clinics. As it expands its operations outside India, its clinical team interacts with local personnel in countries where it intends to expand to understand the protocol differences that are prevalent. The company then adopts the RenAssure protocols to suit the country’s dialysis system.
Organic growth augmented by proven track record of acquisitions and integration in India and internationally: The company has scaled its operations in India from one clinic in 2010 to 519 clinics, across India, Nepal, the Philippines and Uzbekistan as of September 30, 2025, and have a well-diversified network with presence in 288 cities in India. Its expansion strategy includes greenfield and brownfield operations, along with PPP collaborations, allowing it to scale efficiently and cater to diverse patient needs. As of September 30, 2025, it had 80, 259, and 180 clinics operating through greenfield, brownfield, and PPP collaborations, respectively. The company’s approach to acquisitions is process-driven and structured. It undertakes a comprehensive evaluation of potential targets based on parameters such as patient volumes, quality of infrastructure, clinical outcomes, regulatory compliance, and operational synergies.
Risks and concerns
Revenue concentration risk from captive clinics: The company derived significant portion of its revenue from operations from its captive clinics, which are defined as its dialysis clinics operated within private hospital premises under contractual arrangement, and such captive clinics accounted for 36.51%, 43.30%, 51.96% and 62.23% of its revenue from operations in the six months period ended September 30, 2025 and Fiscals 2025, 2024 and 2023, respectively. If its contracts for operating captive clinics are cancelled or if the company is unable to renew or retain similar revenue and operational arrangements, its business may be materially and adversely affected.
Revenue exposure to government PPP agreements: The company operates a number of its dialysis clinics under public private partnership (PPP) contracts awarded by government agencies through a competitive bidding process. Such contracts accounted for 30.96%, 32.62%, 29.24% and 22.39% of its revenue from operations in the six months period ended September 30, 2025 and Fiscals 2025, 2024 and 2023, respectively. There can be no assurance that it will qualify for, or that it will successfully compete and win such tenders, which could have an adverse impact on its business prospects, results of operations, financial condition and cash flows.
Workforce availability and retention risk: The company’s performance and growth strategy depends substantially on its ability to attract and retain experienced healthcare professionals. The demand for healthcare professionals is competitive and their availability is limited due to the significant training period involved. It competes with other healthcare providers, including public and private hospitals and home health care service providers, to attract and retain healthcare professionals. The key factors affecting their choice of employer include compensation, professional growth, the reputation of the healthcare provider, the quality of the medical infrastructure and facilities, the ability to attract patients, research and teaching opportunities. It may not compare favourably with its competitors on one or more of these factors.
Capital requirements and credit rating vulnerability: The company’s ability to remain competitive and deliver quality dialysis services depends significantly on its capacity to adapt to rapidly evolving medical technologies and secure sufficient financing to support these advancements. The company’s business requires significant amount of working capital. It relies on financing from banks or financial institutions to carry on its business operations, and inability to obtain additional financing on terms favourable to it or at all could have an adverse impact on its financial condition. A downgrade in credit rating could also adversely impact interest costs or access to future borrowings.
Outlook
Nephrocare Health Services provides end-to-end dialysis care through a wide network of clinics across India and select international markets. The company offers services including diagnosis, haemodialysis, home and mobile dialysis, and wellness programs, supported by an in-house pharmacy. It is India’s and Asia’s largest dialysis chain with leadership across its markets. The company is driving sustainable dialysis leadership with environmental, social and governance measures. On the concern side, the company derived significant portion of its revenue from operations from its captive clinics, which are defined as its dialysis clinics operated within private hospital premises under contractual arrangement. If its contracts for operating captive clinics are cancelled or if the company is unable to renew or retain similar revenue and operational arrangements, its business may be materially and adversely affected. Moreover, the company is dependent on healthcare professionals and its business will be impacted significantly if it is unable to attract or retain such professionals.
The issue has been offering 1,93,29,961 shares in a price band of Rs 438-460 per equity share. The aggregate size of the offer is around Rs 846.65 crore to Rs 889.18 crore based on lower and upper price band respectively. Minimum application is to be made for 32 shares and in multiples thereon, thereafter. On performance front, the company’s revenue from operations increased by 33.50% from Rs 5,661.55 million in Fiscal 2024 to Rs 7,558.12 million in Fiscal 2025, primarily due to an increase in income from dialysis and related services. Moreover, profit for the year was Rs 670.96 million in Fiscal 2025 compared to profit for the year of Rs 351.33 million in Fiscal 2024.
The company intends to continue expanding its presence in India by establishing new dialysis clinics, thereby deepening patient access and strengthening its geographic footprint. The company’s expansion is underpinned by a proven track record and a capital-efficient asset light model. It identifies new micro-markets or clusters based on factors such as patient density, market growth potential, existing dialysis infrastructure, competitive landscape, and operational scalability. Its cluster-specific teams actively monitor local dynamics, including CKD incidence rates, nephrologist availability, government health schemes, infrastructure readiness, and unmet patient needs. These insights guide site selection and network optimization. A broader geographic footprint allows it to reach new patient cohorts while improving utilization across its clinics. The company’s model enables centralized resource management, operational efficiency, and shared logistics, thereby enhancing overall profitability. In select high-volume clinics, it also plans to upgrade its clinics, through additional dialysis bays, isolation areas, and optimised patient flow zones to accommodate growing demand and enhance the patient experience through better infrastructure and capacity.
