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市场调查报告书
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1716381

透析设备市场预测至 2032 年:按产品类型、疾病类型、透析类型、最终用户和地区进行的全球分析

Dialysis Equipment Market Forecasts to 2032 - Global Analysis By Product Type (Dialysis Machines, Dialyzers, Dialysis Concentrates, Bloodlines, Catheters and Other Product Types), Disease Type, Dialysis Type, End User and By Geography

出版日期: | 出版商: Stratistics Market Research Consulting | 英文 200+ Pages | 商品交期: 2-3个工作天内

价格

根据 Stratistics MRC 的数据,全球透析设备市场预计在 2025 年达到 1,089 亿美元,到 2032 年将达到 2,205 亿美元,预测期内的复合年增长率为 10.6%。

透析设备由专门的医疗设备组成,当肾臟无法再有效地发挥这些功能时,用于过滤和清除血液中的废物、多余的液体和毒素。该设备对于患有慢性肾臟病和肾衰竭的患者来说必不可少。主要部件包括透析设备、透析器(人工肾臟)以及促进血液和透析液流动的管道系统。透析可以在医疗机构或家中进行。透析设备有助于维持体内化学平衡并支持整体健康。

根据美国肾臟基金会统计,3700万美国人患有肾臟疾病。近808,000名美国人患有肾衰竭。超过 557,000 名美国人正在接受透析治疗。肾臟疾病正以惊人的速度增加。

慢性肾臟病(CKD)和末期肾功能衰竭(ESRD)盛行率上升

慢性肾臟病(CKD) 和终末期肾病 (ESRD) 盛行率的上升正在推动市场的成长。人口老化、糖尿病和高血压盛行率上升以及久坐不动的生活方式等因素导致 CKD 和 ESRD 病例不断增加。因此,对透析治疗和相关设备的需求增加。这种不断增长的需求正在推动技术进步,并增加全球对更有效率、更便利、以患者为中心的透析解决方案的投资。

限制性报销政策

限制性报销政策限制了患者获得先进疗法的机会,并对市场产生负面影响。缺乏保险覆盖和低报销率导致医疗保健提供者不愿意采用更新、更昂贵的透析技术。这限制了技术创新并减缓了家庭透析治疗系统的普及,尤其是在中低收入地区。患者面临自付费用增加的问题,并且可能会遭遇延迟或不理想的照护。这可能会导致市场成长受阻以及肾臟病患者的健康状况恶化。

家庭透析治疗的偏好日益增加

人们对家庭透析治疗的日益偏好正在对市场产生重大影响。由于家庭治疗方便、灵活且能提高生活质量,越来越多的患者选择家庭治疗。自动腹膜透析 (APD) 和携带式血液透析机机等家庭透析治疗系统的技术进步使得家庭治疗更加方便和有效。此外,保险报销政策和政府措施正在推动家庭透析治疗的采用,进一步推动市场成长。

缺乏熟练的医疗保健专业人员

熟练医疗保健专业人员的短缺对市场构成了重大挑战。全球肾臟病专家、透析护理师、技术人员和支援人员的短缺阻碍了透析中心的有效运作,尤其是在中低收入地区。这些劳动力缺口导致患者照护优化不佳、死亡率上升以及先进透析技术未充分利用。在印度等国家,肾臟病专家分布不均和训练机会有限加剧了这些问题,限制了许多患者获得挽救生命的治疗。

COVID-19的影响

COVID-19 疫情对市场产生了重大影响,最初导致患者照护和供应链中断。由于医院关闭和资源重新分配导致包括常规透析治疗在内的选择性治疗被推迟,疫情初期对透析设备的需求下降。此外,供应链中断和原材料短缺也影响了製造能力。然而,疫情凸显了对先进透析解决方案的需求,从而增加了对家庭透析治疗技术和远端医疗整合的投资。随着医疗保健系统的适应,这些技术创新有望推动透析设备市场的长期成长。

预计透析设备部分将成为预测期内最大的部分。

由于慢性肾臟病率上升和肾臟治疗需求增加,预计透析设备领域将在预测期内占据最大的市场占有率。可携式和家用透析设备等技术进步透析设备提高患者的舒适度和可及性。此外,将人工智慧和数据分析整合到透析设备中以实现更好的监控和管理正在推动创新。老年人口的增加和医疗保健基础设施的改善进一步促进了全球透析设备市场的扩张。

预计血液透析机领域在预测期内将达到最高复合年增长率

由于全球慢性肾臟病(CKD) 和末期肾功能衰竭(ESRD) 患病率不断上升以及人口老化,预计血液透析机领域将在预测期内实现最高增长率。以提高安全性、缩短治疗时间和改善患者治疗效果为重点的技术进步是主要趋势。家庭血液透析机需求的不断增长和携带式设备的发展进一步推动了市场扩张。因此,血液透析机设备市场预计将持续成长。

比最大的地区

预计亚太地区将在预测期内占据最大的市场占有率。由于糖尿病和高血压发生率上升,中国和印度等国家的肾臟问题盛行率尤其高。政府倡议和医疗保健基础设施的改善进一步推动了市场扩张。可携式和家用透析设备的开发等技术进步正在提高其可及性。然而,设备和治疗成本高、缺乏意识以及熟练专业人员短缺等挑战可能会阻碍某些地区的市场成长。

复合年增长率最高的地区:

在预测期内,由于慢性肾臟病盛行率的上升,预计北美将呈现最高的复合年增长率。注重家庭透析治疗和使用者友善设备的技术进步是突出的趋势。发达的医疗保健基础设施和优惠的报销政策也促进了市场的成长。然而,高昂的治疗费用和长期透析相关的併发症风险仍然是个挑战。人们对携带式和穿戴式透析设备的兴趣日益浓厚,对治疗肾臟疾病的远端医疗的投资也在增加。

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目录

第一章执行摘要

第二章 前言

  • 概述
  • 相关利益者
  • 研究范围
  • 调查方法
    • 资料探勘
    • 数据分析
    • 数据检验
    • 研究途径
  • 研究材料
    • 主要研究资料
    • 次级研究资讯来源
    • 先决条件

第三章市场走势分析

  • 驱动程式
  • 限制因素
  • 机会
  • 威胁
  • 产品分析
  • 最终用户分析
  • 新兴市场
  • COVID-19的影响

第四章 波特五力分析

  • 供应商的议价能力
  • 买家的议价能力
  • 替代品的威胁
  • 新进入者的威胁
  • 竞争对手之间的竞争

5. 全球透析设备市场(依产品类型)

  • 透析设备
  • 透析器
  • 透析浓缩液
  • 血统
  • 导管
  • 其他产品类型

6. 全球透析设备市场(依疾病类型)

  • 慢性肾臟病(CKD)
  • 末期肾病(ESRD)
  • 急性肾损伤(AKI)
  • 多囊性肾病变(PKD)
  • 高血压肾臟病
  • 糖尿病肾臟病
  • 其他类型的疾病

7. 全球透析设备市场(依透析类型)

  • 血液透析机
  • 腹膜透析

第八章全球透析设备市场(按最终用户)

  • 医院
  • 门诊手术中心(ASC)
  • 透析中心
  • 诊所
  • 居家照护
  • 其他最终用户

9. 全球透析设备市场(按地区)

  • 北美洲
    • 美国
    • 加拿大
    • 墨西哥
  • 欧洲
    • 德国
    • 英国
    • 义大利
    • 法国
    • 西班牙
    • 其他欧洲国家
  • 亚太地区
    • 日本
    • 中国
    • 印度
    • 澳洲
    • 纽西兰
    • 韩国
    • 其他亚太地区
  • 南美洲
    • 阿根廷
    • 巴西
    • 智利
    • 南美洲其他地区
  • 中东和非洲
    • 沙乌地阿拉伯
    • 阿拉伯聯合大公国
    • 卡达
    • 南非
    • 其他中东和非洲地区

第十章 重大进展

  • 协议、伙伴关係、合作和合资企业
  • 收购与合併
  • 新产品发布
  • 业务扩展
  • 其他关键策略

第十一章 公司概况

  • Fresenius Medical Care
  • Baxter International Inc.
  • B. Braun Melsungen AG
  • Nipro Corporation
  • Nikkiso Co., Ltd.
  • Asahi Kasei Corporation
  • DaVita Inc.
  • Medtronic plc
  • Rockwell Medical Inc.
  • Becton Dickinson and Company
  • Dialife SA
  • Isopure Corp.
  • Quanta Dialysis Technologies Ltd.
  • NxStage Medical
  • Medivators Inc.
  • Allmed Medical Products Co., Ltd.
  • Atlantic Biomedical.
Product Code: SMRC29192

According to Stratistics MRC, the Global Dialysis Equipment Market is accounted for $108.9 billion in 2025 and is expected to reach $220.5 billion by 2032 growing at a CAGR of 10.6% during the forecast period. Dialysis equipment comprises specialized medical devices used to filter and remove waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. This equipment is essential for patients with chronic kidney disease or kidney failure. Key components include a dialysis machine, dialyzer (artificial kidney), and tubing system that facilitates the flow of blood and dialysate. The process can be performed in medical facilities or at home. Dialysis equipment helps maintain the body's chemical balance and supports overall health.

According to American Kidney Fund, up to 37 million Americans have kidney disease. Nearly 808,000 Americans are living with kidney failure. More than 557,000 Americans are on dialysis. Kidney disease is increasing at an alarming rate.

Market Dynamics:

Driver:

Rising Prevalence of Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD)

The rising prevalence of Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) is fueling the growth of the market. Factors such as aging populations, increasing rates of diabetes and hypertension, and sedentary lifestyles contribute to the growing number of CKD and ESRD cases. As a result, there is a higher demand for dialysis treatment and related equipment. This surge is encouraging technological advancements and greater investments in more efficient, accessible, and patient-centric dialysis solutions worldwide.

Restraint:

Limited reimbursement policies

Limited reimbursement policies negatively impact the market by restricting patient access to advanced treatment options. Inadequate insurance coverage and low reimbursement rates discourage healthcare providers from adopting newer, more expensive dialysis technologies. This limits innovation and slows the adoption of home dialysis systems, especially in low- and middle-income regions. Patients may face increased out-of-pocket costs, leading to treatment delays or suboptimal care. Consequently, market growth is hindered, and health outcomes for individuals with kidney disease may worsen.

Opportunity:

Growing preference for home dialysis

The growing preference for home dialysis is significantly influencing the market. Patients are increasingly opting for home-based treatments due to their convenience, flexibility, and improved quality of life. Technological advancements in home dialysis systems, such as automated peritoneal dialysis (APD) and portable hemodialysis devices, have made at-home treatments more accessible and effective. Additionally, supportive reimbursement policies and government initiatives are encouraging the adoption of home dialysis, further driving market growth.

Threat:

Shortage of skilled healthcare professionals

The shortage of skilled healthcare professionals poses a significant challenge to the market. A global deficit in nephrologists, dialysis nurses, technicians, and support staff hampers the effective operation of dialysis centers, particularly in low- and middle-income regions. This workforce gap leads to suboptimal patient care, increased mortality rates, and underutilization of advanced dialysis technologies. In countries like India, the unequal distribution of nephrologists and limited training opportunities exacerbate these issues, limiting access to life-saving treatments for many patients.

Covid-19 Impact

The COVID-19 pandemic significantly impacted the market, initially causing disruptions in patient care and supply chains. Lockdowns and hospital resource reallocations led to postponed elective procedures, including routine dialysis treatments, resulting in decreased demand for dialysis equipment during the early stages of the pandemic. Additionally, supply chain interruptions and raw material shortages affected manufacturing capabilities. However, the pandemic also highlighted the need for advanced dialysis solutions, leading to increased investments in home dialysis technologies and telehealth integration. As healthcare systems adapt, these innovations are expected to drive long-term growth in the dialysis equipment market.

The dialysis machines segment is expected to be the largest during the forecast period

The dialysis machines segment is expected to account for the largest market share during the forecast period, due to the rising prevalence of chronic kidney diseases and the increasing demand for renal therapies. Technological advancements, such as portable and home-use dialysis machines, are enhancing patient comfort and accessibility. Additionally, the integration of artificial intelligence and data analytics in dialysis equipment for better monitoring and management is driving innovation. The growing elderly population and improved healthcare infrastructure are further contributing to the expansion of the dialysis machines market globally.

The hemodialysis segment is expected to have the highest CAGR during the forecast period

Over the forecast period, the hemodialysis segment is predicted to witness the highest growth rate, driven by the rising global prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD), coupled with an aging population. Technological advancements focusing on enhanced safety, reduced treatment times, and improved patient outcomes are key trends. The increasing demand for home-based hemodialysis and the development of portable devices are further propelling market expansion. Consequently, the hemodialysis equipment market is expected to continue its upward trajectory in the coming years.

Region with largest share:

During the forecast period, the Asia Pacific region is expected to hold the largest market share. Countries like China and India are witnessing a particularly high prevalence of kidney disorders due to rising rates of diabetes and hypertension. Government initiatives and improving healthcare infrastructure are further boosting market expansion. Technological advancements, including the development of portable and home-based dialysis equipment, are enhancing accessibility. However, challenges such as the high cost of equipment and treatment, lack of awareness, and shortage of skilled professionals could potentially hinder market growth in some areas.

Region with highest CAGR:

Over the forecast period, the North America region is anticipated to exhibit the highest CAGR, owing to rising prevalence of chronic kidney disease. Technological advancements focusing on home dialysis and user-friendly devices are prominent trends. A well-established healthcare infrastructure and favorable reimbursement policies further contribute to market growth. However, high treatment costs and the risk of complications associated with long-term dialysis remain challenges. The market is also witnessing a growing focus on portable and wearable dialysis devices and increasing investments in telehealth for kidney disease management.

Key players in the market

Some of the key players profiled in the Dialysis Equipment Market include Fresenius Medical Care, Baxter International Inc., B. Braun Melsungen AG, Nipro Corporation, Nikkiso Co., Ltd., Asahi Kasei Corporation, DaVita Inc., Medtronic plc, Rockwell Medical Inc., Becton Dickinson and Company, Dialife SA, Isopure Corp., Quanta Dialysis Technologies Ltd., NxStage Medical, Medivators Inc., Allmed Medical Products Co., Ltd. and Atlantic Biomedical.

Key Developments:

In January 2025, BD (Becton, Dickinson and Company), a leading global medical technology company, and Biosero, a developer of laboratory automation solutions to orchestrate scientific discoveries, today announced a framework collaboration agreement to enable and facilitate robotic arm integration with BD flow cytometry instruments to accelerate drug discovery and development.

In March 2024, AW Technologies and Asahi Kasei Medical, a core operating company of the Asahi Kasei Group, have entered into an exclusive distribution agreement in Japan for AW Technologies' TrachFlush(TM) device. Developed by AW Technologies based on an invention by an intensivist, the TrachFlush is a medical device to reduce the discomfort of ventilated patients while lightening the workload on healthcare professionals during tracheal suctioning.

Product Types Covered:

  • Dialysis Machines
  • Dialyzers
  • Dialysis Concentrates
  • Bloodlines
  • Catheters
  • Other Product Types

Disease Types Covered:

  • Chronic Kidney Disease (CKD)
  • End-Stage Renal Disease (ESRD)
  • Acute Kidney Injury (AKI)
  • Polycystic Kidney Disease (PKD)
  • Hypertensive Nephropathy
  • Diabetic Nephropathy
  • Other Disease Types

Dialysis Types Covered:

  • Hemodialysis
  • Peritoneal Dialysis

End Users Covered:

  • Hospitals
  • Ambulatory Surgical Centers (ASCs)
  • Dialysis Centers
  • Clinics
  • Home Care Settings
  • Other End Users

Regions Covered:

  • North America
    • US
    • Canada
    • Mexico
  • Europe
    • Germany
    • UK
    • Italy
    • France
    • Spain
    • Rest of Europe
  • Asia Pacific
    • Japan
    • China
    • India
    • Australia
    • New Zealand
    • South Korea
    • Rest of Asia Pacific
  • South America
    • Argentina
    • Brazil
    • Chile
    • Rest of South America
  • Middle East & Africa
    • Saudi Arabia
    • UAE
    • Qatar
    • South Africa
    • Rest of Middle East & Africa

What our report offers:

  • Market share assessments for the regional and country-level segments
  • Strategic recommendations for the new entrants
  • Covers Market data for the years 2024, 2025, 2026, 2028, and 2032
  • Market Trends (Drivers, Constraints, Opportunities, Threats, Challenges, Investment Opportunities, and recommendations)
  • Strategic recommendations in key business segments based on the market estimations
  • Competitive landscaping mapping the key common trends
  • Company profiling with detailed strategies, financials, and recent developments
  • Supply chain trends mapping the latest technological advancements

Free Customization Offerings:

All the customers of this report will be entitled to receive one of the following free customization options:

  • Company Profiling
    • Comprehensive profiling of additional market players (up to 3)
    • SWOT Analysis of key players (up to 3)
  • Regional Segmentation
    • Market estimations, Forecasts and CAGR of any prominent country as per the client's interest (Note: Depends on feasibility check)
  • Competitive Benchmarking
    • Benchmarking of key players based on product portfolio, geographical presence, and strategic alliances

Table of Contents

1 Executive Summary

2 Preface

  • 2.1 Abstract
  • 2.2 Stake Holders
  • 2.3 Research Scope
  • 2.4 Research Methodology
    • 2.4.1 Data Mining
    • 2.4.2 Data Analysis
    • 2.4.3 Data Validation
    • 2.4.4 Research Approach
  • 2.5 Research Sources
    • 2.5.1 Primary Research Sources
    • 2.5.2 Secondary Research Sources
    • 2.5.3 Assumptions

3 Market Trend Analysis

  • 3.1 Introduction
  • 3.2 Drivers
  • 3.3 Restraints
  • 3.4 Opportunities
  • 3.5 Threats
  • 3.6 Product Analysis
  • 3.7 End User Analysis
  • 3.8 Emerging Markets
  • 3.9 Impact of Covid-19

4 Porters Five Force Analysis

  • 4.1 Bargaining power of suppliers
  • 4.2 Bargaining power of buyers
  • 4.3 Threat of substitutes
  • 4.4 Threat of new entrants
  • 4.5 Competitive rivalry

5 Global Dialysis Equipment Market, By Product Type

  • 5.1 Introduction
  • 5.2 Dialysis Machines
  • 5.3 Dialyzers
  • 5.4 Dialysis Concentrates
  • 5.5 Bloodlines
  • 5.6 Catheters
  • 5.7 Other Product Types

6 Global Dialysis Equipment Market, By Disease Type

  • 6.1 Introduction
  • 6.2 Chronic Kidney Disease (CKD)
  • 6.3 End-Stage Renal Disease (ESRD)
  • 6.4 Acute Kidney Injury (AKI)
  • 6.5 Polycystic Kidney Disease (PKD)
  • 6.6 Hypertensive Nephropathy
  • 6.7 Diabetic Nephropathy
  • 6.8 Other Disease Types

7 Global Dialysis Equipment Market, By Dialysis Type

  • 7.1 Introduction
  • 7.2 Hemodialysis
  • 7.3 Peritoneal Dialysis

8 Global Dialysis Equipment Market, By End User

  • 8.1 Introduction
  • 8.2 Hospitals
  • 8.3 Ambulatory Surgical Centers (ASCs)
  • 8.4 Dialysis Centers
  • 8.5 Clinics
  • 8.6 Home Care Settings
  • 8.7 Other End Users

9 Global Dialysis Equipment Market, By Geography

  • 9.1 Introduction
  • 9.2 North America
    • 9.2.1 US
    • 9.2.2 Canada
    • 9.2.3 Mexico
  • 9.3 Europe
    • 9.3.1 Germany
    • 9.3.2 UK
    • 9.3.3 Italy
    • 9.3.4 France
    • 9.3.5 Spain
    • 9.3.6 Rest of Europe
  • 9.4 Asia Pacific
    • 9.4.1 Japan
    • 9.4.2 China
    • 9.4.3 India
    • 9.4.4 Australia
    • 9.4.5 New Zealand
    • 9.4.6 South Korea
    • 9.4.7 Rest of Asia Pacific
  • 9.5 South America
    • 9.5.1 Argentina
    • 9.5.2 Brazil
    • 9.5.3 Chile
    • 9.5.4 Rest of South America
  • 9.6 Middle East & Africa
    • 9.6.1 Saudi Arabia
    • 9.6.2 UAE
    • 9.6.3 Qatar
    • 9.6.4 South Africa
    • 9.6.5 Rest of Middle East & Africa

10 Key Developments

  • 10.1 Agreements, Partnerships, Collaborations and Joint Ventures
  • 10.2 Acquisitions & Mergers
  • 10.3 New Product Launch
  • 10.4 Expansions
  • 10.5 Other Key Strategies

11 Company Profiling

  • 11.1 Fresenius Medical Care
  • 11.2 Baxter International Inc.
  • 11.3 B. Braun Melsungen AG
  • 11.4 Nipro Corporation
  • 11.5 Nikkiso Co., Ltd.
  • 11.6 Asahi Kasei Corporation
  • 11.7 DaVita Inc.
  • 11.8 Medtronic plc
  • 11.9 Rockwell Medical Inc.
  • 11.10 Becton Dickinson and Company
  • 11.11 Dialife SA
  • 11.12 Isopure Corp.
  • 11.13 Quanta Dialysis Technologies Ltd.
  • 11.14 NxStage Medical
  • 11.15 Medivators Inc.
  • 11.16 Allmed Medical Products Co., Ltd.
  • 11.17 Atlantic Biomedical.

List of Tables

  • Table 1 Global Dialysis Equipment Market Outlook, By Region (2024-2032) ($MN)
  • Table 2 Global Dialysis Equipment Market Outlook, By Product Type (2024-2032) ($MN)
  • Table 3 Global Dialysis Equipment Market Outlook, By Dialysis Machines (2024-2032) ($MN)
  • Table 4 Global Dialysis Equipment Market Outlook, By Dialyzers (2024-2032) ($MN)
  • Table 5 Global Dialysis Equipment Market Outlook, By Dialysis Concentrates (2024-2032) ($MN)
  • Table 6 Global Dialysis Equipment Market Outlook, By Bloodlines (2024-2032) ($MN)
  • Table 7 Global Dialysis Equipment Market Outlook, By Catheters (2024-2032) ($MN)
  • Table 8 Global Dialysis Equipment Market Outlook, By Other Product Types (2024-2032) ($MN)
  • Table 9 Global Dialysis Equipment Market Outlook, By Disease Type (2024-2032) ($MN)
  • Table 10 Global Dialysis Equipment Market Outlook, By Chronic Kidney Disease (CKD) (2024-2032) ($MN)
  • Table 11 Global Dialysis Equipment Market Outlook, By End-Stage Renal Disease (ESRD) (2024-2032) ($MN)
  • Table 12 Global Dialysis Equipment Market Outlook, By Acute Kidney Injury (AKI) (2024-2032) ($MN)
  • Table 13 Global Dialysis Equipment Market Outlook, By Polycystic Kidney Disease (PKD) (2024-2032) ($MN)
  • Table 14 Global Dialysis Equipment Market Outlook, By Hypertensive Nephropathy (2024-2032) ($MN)
  • Table 15 Global Dialysis Equipment Market Outlook, By Diabetic Nephropathy (2024-2032) ($MN)
  • Table 16 Global Dialysis Equipment Market Outlook, By Other Disease Types (2024-2032) ($MN)
  • Table 17 Global Dialysis Equipment Market Outlook, By Dialysis Type (2024-2032) ($MN)
  • Table 18 Global Dialysis Equipment Market Outlook, By Hemodialysis (2024-2032) ($MN)
  • Table 19 Global Dialysis Equipment Market Outlook, By Peritoneal Dialysis (2024-2032) ($MN)
  • Table 20 Global Dialysis Equipment Market Outlook, By End User (2024-2032) ($MN)
  • Table 21 Global Dialysis Equipment Market Outlook, By Hospitals (2024-2032) ($MN)
  • Table 22 Global Dialysis Equipment Market Outlook, By Ambulatory Surgical Centers (ASCs) (2024-2032) ($MN)
  • Table 23 Global Dialysis Equipment Market Outlook, By Dialysis Centers (2024-2032) ($MN)
  • Table 24 Global Dialysis Equipment Market Outlook, By Clinics (2024-2032) ($MN)
  • Table 25 Global Dialysis Equipment Market Outlook, By Home Care Settings (2024-2032) ($MN)
  • Table 26 Global Dialysis Equipment Market Outlook, By Other End Users (2024-2032) ($MN)

Note: Tables for North America, Europe, APAC, South America, and Middle East & Africa Regions are also represented in the same manner as above.