What makes a dialysis clinic property different — water, drainage, power and floor load

In short: a hemodialysis clinic property cannot be chosen with the feel of an internal-medicine clinic. The use-zoning treatment is the same — both are "clinics" — but what bites on the property side is not the Medical Care Act, it is the building's infrastructure. Three things: (1) large water use and large drainage — the supply pipe size and pressure, the water contract, where to place the RO (reverse-osmosis) water-treatment unit, the drainage volume and whether a pretreatment facility is required under the Sewerage Act; (2) the power capacity to run the dialysis consoles and the RO unit together, and the emergency power that protects patient safety during an outage; (3) the floor load for lining up tanks, machines and beds. Specific figures (required water volume, floor load, incoming power) vary with the equipment and the building, so this article does not fix them and treats them as unverified, assuming an architect and facility engineer will calculate them. The clinic opening notification is for the public health centre (the drafting of the documents is supported by an administrative scrivener, engaged separately as an independent entity); structural, water and power design and the building confirmation are for an architect and facility engineer; incorporation as a medical corporation, financing and tax are for a licensed tax accountant; medical disputes are for a lawyer. We, as a licensed real estate agent, handle the organising of the property requirements and the brokerage.

This is for the property officers of physicians and medical corporations considering opening a hemodialysis clinic, so they do not commit to a tenancy with the feel of an ordinary internal-medicine clinic and then have to backtrack. It sets out the infrastructure points to check first on the property side, drawing on the framework of the Medical Care Act, the Building Standards Act and the Sewerage Act, and public materials. What we handle is the property investigation and the sale/lease brokerage; the drafting of permit documents, the design, the building confirmation, tax and disputes are each routed to the qualified professional or specialist contractor concerned. This article does not judge or guarantee individual conformity or the required figures.

How is a dialysis property different from an internal-medicine clinic?

The legal classification (it is a clinic) and the use-zoning treatment do not differ from an internal-medicine clinic. What differs is the infrastructure load the property must carry. Dialysis uses a large volume of water, drains a lot, draws large power, and loads the floor with machines, tanks and beds. Sign on floor area and location alone, with the feel of internal-medicine fit-out, and the water, power and floor come up short — and you backtrack.

Aspect	Ordinary internal-medicine clinic	Hemodialysis clinic
Legal classification	Clinic (Medical Care Act)	Clinic (Medical Care Act) — same
Use-zoning	Buildable in all use zones (Appended Table 2, item (i)-8)	Same (it is a clinic, so unchanged)
Water supply	Within an ordinary range	Large, for RO pretreatment and making dialysate
Drainage	Ordinary range	Large volume; check whether a Sewerage Act pretreatment facility is needed
Power	Ordinary office/shop range	Large incoming capacity, dialysis consoles plus RO unit running together
Floor load	Ordinary range	Check — machines, water tanks and beds lined up

Almost all of this difference is about building performance, not the Medical Care Act. That is exactly why the point is to check with an architect and facility engineer in parallel while you are still narrowing down properties. Because the use-zoning and the opening notification are shared with an internal-medicine clinic, the way to read an ordinary clinic property is set out in What to check before signing on a clinic property; this article is confined to the infrastructure specific to dialysis.

What should the property provide for water, drainage and the RO water-treatment unit?

In hemodialysis, dialysate is made from water purified by an RO (reverse-osmosis) water-treatment unit. The tap water is not used as is — it goes through pretreatment (filtration, softening, etc.) and then the RO unit — so the water volume and pressure bear on the choice of property. Because the water used, plus the unit's reject water, makes the drainage large, the drainage route and volume are checked too.

Item to check	What to look at	Where to confirm
Water supply	Service-pipe size and pressure, the water contract (meter size), where to place the pretreatment/RO unit and the piping route	Architect / facility engineer / water bureau
Need for a receiving tank	Whether a receiving tank and pump are needed given pressure and simultaneous use, and the space for them	Architect / facility engineer
Drainage	Drainage volume, drain-pipe size and gradient, public sewer or septic tank	Architect / facility engineer / sewerage manager
Pretreatment facility	Whether a pretreatment facility is needed where effluent exceeds the sewer standard (Sewerage Act Art. 12)	Sewerage manager (municipality) / facility engineer
RO-unit placement	Where to put the unit and pretreatment tanks, waterproofing and floor drainage, the carry-in route	Architect / facility engineer

The Sewerage Act (Act No. 79 of 1958) sets a framework (Art. 12, etc.) under which, where effluent to the public sewer may exceed the standards set by cabinet order or by-law, the operator may be required to install a pretreatment facility or take other measures. Whether a dialysis clinic's effluent falls within this, and what measure is needed, splits by the water quality and volume of the effluent and by the municipal sewerage by-law, so this article does not fix applicability (the need for a pretreatment facility is unverified; fix the effluent premises and then confirm with the sewerage manager and facility engineer).

On dialysate water quality, the Japanese Society for Dialysis Therapy publishes "water-quality standards for dialysis fluid," but that is a medical/clinical management standard, not a figure that decides whether a property is good. On the property side, stop at "can the building provide the needed water, drainage, power and space," and route clinical water-quality management to the physician and clinical engineer. The way to read a property for a trade with heavy water and drainage loads is also informed by the water supply, drainage and effluent treatment for a laundry-plant property.

How much power capacity, emergency power and floor load are needed?

Because the dialysis consoles and the RO water-treatment unit run at the same time, confirm early whether the property's incoming power capacity suffices. Because an outage during dialysis bears directly on patient safety, the placement and route of emergency power (an on-site generator, UPS, etc.) and the floor load when machines, water tanks and beds are lined up are also building-side conditions.

Item to check	What to look at	Where to confirm
Incoming capacity	Whether the existing contracted power / switchboard suffices, or an upgrade / changed service is needed	Architect / facility engineer / power company
Emergency power	Space and route for a generator / UPS to keep machines running and allow blood return during an outage	Architect / facility engineer
Air-conditioning	AC load for the machines and patient numbers, where to place the outdoor units	Architect / facility engineer
Floor load	Whether the structure bears the load of machines, receiving/water tanks and beds together	Architect (structural)
Carry-in / floor	The carry-in route for machines and tanks, lift size, which storey to place them on	Architect / facility engineer

The specific figures — required incoming capacity (kVA), floor live load (N/m²), water volume per station — vary greatly with the number and models of machines and the building's structure. This article does not state them (required capacity, load and water volume are unverified; once the equipment is decided, an architect and facility engineer calculate them). Pinning down before signing whether the building can be upgraded or reinforced, and if so how the owner's consent and the cost share are arranged, prevents backtracking. These are the domain of design and construction, which neither we nor an administrative scrivener perform.

How do use-zoning, barrier-free access and the pick-up route affect the choice of property?

In use-zoning, a dialysis clinic, being a "clinic," rarely gets stuck. The Building Standards Act (Act No. 201 of 1950) Appended Table 2 sets out what may be built in each use zone, and a "clinic" may be built even in the most restrictive Category 1 low-rise exclusive residential zone (Appended Table 2, item (i)-8). On the other hand, a change of use from another use to a medical use may, by scale, require a change-of-use building confirmation under Art. 87; confirm the need with an architect and the designated administrative agency.

What bears practically on the choice of property is rather ease of attendance.

• Barrier-free access: many patients are elderly or use wheelchairs — can they use steps, a lift, handrails and an accessible toilet? The building's barrier-free provision ties directly to the choice of location.
• Pick-up and parking route: many patients attend regularly and often — is there space for pick-up vehicles to pull in, and a parking route? Whether it is on the ground floor, and whether a wheelchair can enter from the front road, matter.
• Neighbours and storey: do the noise of the machines' and AC's outdoor units, the carry-in, and the placement of the receiving tank and emergency power clash with neighbours or the management rules?

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These are conditions of the property itself, so they are within what we can organise as a property investigation. Whether a change-of-use confirmation is needed, and whether the structure allows it, are in the judgment domain of an architect and the designated administrative agency, so confirm them in parallel while narrowing down. Business and investment property generally is at investment and business property consultation; office and shop property at office and shop property consultation. The basics of use-zoning and the opening notification are at the points to check on an ordinary clinic property; the property requirements where a dispensing pharmacy is attached are at the requirements for a dispensing-pharmacy property.

Once the property is settled, how does the opening notification and the routing to each professional work?

The property investigation, the lease contract and the important-matters explanation are ours (the licensed real estate agent); support for drafting the clinic opening notification is an administrative scrivener's; the structural, water and power design and the building confirmation are an architect's and facility engineer's; incorporation as a medical corporation, financing and tax are a licensed tax accountant's; clinical judgment and medical disputes are a physician's and a lawyer's. Each is an independent business entity, and you engage each separately.

The clinic opening procedure changes with who the opener is. When a physician who has completed clinical training opens a clinic, they notify the prefectural governor (in a city or special ward with a public health centre, its mayor) within ten days of opening (Medical Care Act Art. 8(1)). By contrast, where one who is not such a physician — a medical corporation falls here — seeks to open, the governor's permission is required (Medical Care Act Art. 7(1)). Where beds (inpatient facilities) are set up, the governor's permission is further required (Art. 7(3)).

Who	What they handle
Yotsuba Real Estate Co., Ltd.	Property investigation (organising water, drainage, power, floor load, use-zoning and routes), sale/lease brokerage, important-matters explanation
Yotsuba Administrative Scrivener Office (separate engagement)	Support for drafting documents submitted to authorities, such as the clinic opening notification/permission
Architect / facility engineer	Structural (floor load), water, power and AC design; building confirmation and change-of-use confirmation; calculation of required figures
Public health centre	Conformity check of the clinic's structural facilities; acceptance of the notification/permission
Physician / clinical engineer	Clinical judgment such as dialysate water-quality management
Judicial scrivener	Registration of rights, such as transfer of ownership
Licensed tax accountant	Medical-corporation incorporation, financing, capital investment and tax
Lawyer	Medical and contract disputes

We and our office, and each professional and specialist contractor, are each independent business entities. Where roles overlap, we make clear before the contract who does what, and you engage each separately. We neither pay nor accept referral fees or introduction commissions. Consultation is free of charge. For consultation on drafting permit documents, see consultation with an administrative scrivener.

Frequently asked questions

Q. Can a dialysis clinic be impossible to build because of use-zoning?
A. As a "clinic," a dialysis clinic rarely gets stuck on use-zoning. Building Standards Act Appended Table 2, item (i)-8 lists a "clinic" as a building that may be built even in a Category 1 low-rise exclusive residential zone. What gets stuck is not use-zoning but the building's infrastructure — water, drainage, power and floor load. Where you change from another use, a change-of-use confirmation under Art. 87 may be needed by scale; make the final check with an architect and the designated administrative agency.

Q. Why are the property constraints stricter than for an internal-medicine clinic?
A. Hemodialysis uses an RO (reverse-osmosis) water-treatment unit to purify water for making dialysate, uses a large volume of water and drains a lot. Running the dialysis consoles and the RO unit together draws large power, and lining up machines, water tanks and beds loads the floor. These are matters of building performance, not of the Medical Care Act, so signing on floor area and location alone with an ordinary internal-medicine fit-out feel leaves the water, power and floor short, and you backtrack. The point is to check with an architect and facility engineer in parallel before signing.

Q. Is a pretreatment facility always needed for the drainage?
A. Not uniformly. Sewerage Act Art. 12 and the like set a framework under which an establishment whose effluent to the public sewer may exceed the standards is required to install a pretreatment facility or take other measures. Whether a dialysis clinic's effluent falls within this, and what measure is needed, splits by the water quality and volume of the effluent and by the municipal sewerage by-law. This article does not fix applicability. Fix the effluent premises and confirm with the sewerage manager (municipality) and the facility engineer.

Q. Can you tell me the required power capacity and floor load figures?
A. The specific figures vary greatly with the number and models of dialysis machines, the presence of an RO unit or receiving tank, and the building's structure, so this article does not state them (required capacity, floor load and water volume are treated as unverified). Once the equipment is decided, an architect and facility engineer calculate them per property. We organise property-side points such as "is this a building that looks able to be upgraded or reinforced" and "how to arrange the owner's consent and cost share," and route the design and construction itself to an architect and facility engineer, each consulted directly.

Sources (primary)

• e-Gov "医療法" (Medical Care Act) — Act No. 205 of 1948. Art. 1-5(1)(2) (definitions of hospital and clinic); Art. 7(1) (opening permission for one who is not a clinical-training-completed physician); Art. 7(3) (permission to set up beds at a clinic); Art. 8(1) (notification within ten days of opening by a clinical-training-completed physician). Current text per the amendment by Act No. 31 of 2026, in force 5 June 2026. Accessed 6 October 2026.
• e-Gov "建築基準法" (Building Standards Act) — Act No. 201 of 1950. Art. 48 and Appended Table 2, item (i)-8 (a "clinic" may be built even in a Category 1 low-rise exclusive residential zone); Art. 87 (change of use). Current text per the amendment by Act No. 23 of 2026, in force 27 May 2026. Accessed 6 October 2026.
• e-Gov "下水道法" (Sewerage Act) — Act No. 79 of 1958. Art. 12, etc. (framework of a pretreatment facility and other measures for the quality of effluent to the public sewer); applicability and standards follow cabinet order and the municipal sewerage by-law. Accessed 6 October 2026.
• Japanese Society for Dialysis Therapy, "water-quality standards for dialysis fluid" — a society standard for dialysate water-quality management; a medical/clinical management standard, not a figure deciding a property's conformity. Accessed 6 October 2026.

The specific figures for a dialysis clinic — water volume, incoming capacity (kVA), floor live load (N/m²), drainage volume — vary greatly with the number and models of machines and the building's structure. This article does not fix them and treats them as unverified, assuming per-property calculation by an architect and facility engineer. Whether a dialysis clinic's effluent falls within a Sewerage Act pretreatment facility, and what measure is needed, varies with the water quality and volume of the effluent and the municipal sewerage by-law; this article does not fix applicability, assuming confirmation by the sewerage manager and facility engineer. The forms, attachments and operation of the clinic opening notification/permission vary by the municipal public health centre; at the outset, confirm the clinic-opening guide of the health centre with jurisdiction over the intended site directly. Confirm the need for a change-of-use confirmation with an architect and the designated administrative agency. This article is general information and does not state or guarantee individual conformity, acceptance of the notification/permission, or medical judgment. Structural, water and power design and the building confirmation are by an architect and facility engineer; the conformity check of the structural facilities by the public health centre; clinical judgment by a physician and clinical engineer; registration of rights by a judicial scrivener; medical-corporation incorporation and tax by a licensed tax accountant; disputes by a lawyer. Property investigation, sale/lease brokerage and the important-matters explanation are undertaken by Yotsuba Real Estate Co., Ltd. (licensed real estate agent), which proceeds with each professional and specialist contractor as independent business entities engaged separately. There are no referral or introduction fees.

About the author

Joji Uramatsu — licensed real estate transaction specialist (Tokyo Governor registration No. 293544) and administrative scrivener (registration No. 25087022). Representative Director, Yotsuba Real Estate Co., Ltd. (licensed real estate agent, Tokyo Governor (1) No. 113304); principal, Yotsuba Administrative Scrivener Office. Kohinata, Bunkyo, Tokyo, about five minutes' walk from Myogadani station. For a dialysis clinic property, placing the Medical Care Act points of use-zoning and the opening notification and the building-infrastructure points of water, drainage, power and floor load on one table, and organising the property investigation and the routing to each professional. Full profile: author page.