Kidney disease affects more than 37 million Americans, yet approximately 90 percent don't realize they have it. This staggering gap between disease prevalence and awareness has prompted the National Kidney Foundation (NKF) to call for urgent policy reforms focused on early detection, prevention, and access to cost-effective treatment options. Why Is Kidney Disease So Often Missed? Chronic kidney disease (CKD) is one of the most underdiagnosed conditions in the United States, largely because it develops silently without obvious symptoms in its early stages. By the time most people receive a diagnosis, their kidney function has already declined significantly, making treatment more expensive and outcomes worse. The condition represents a major public health challenge and a growing driver of U.S. healthcare costs, particularly through Medicare spending on dialysis and kidney transplantation. The problem extends beyond individual health outcomes. Kidney failure care, including dialysis and transplantation, consumes a disproportionate share of Medicare resources. This financial burden underscores why policymakers are now focusing on shifting the healthcare system toward prevention and earlier intervention rather than waiting until patients need expensive end-stage treatments. Who Is Most at Risk for Kidney Disease? Kidney disease risk is not evenly distributed across the population. About 1 in 3 adults in the United States are at risk for developing kidney disease, with certain groups facing significantly higher rates. Several factors increase the likelihood of developing CKD: - Diabetes: One of the leading causes of kidney disease, affecting how the kidneys filter waste from the blood. - High Blood Pressure: Elevated blood pressure damages the delicate blood vessels in the kidneys over time. - Heart Disease: Cardiovascular and kidney health are closely interconnected, with heart problems increasing kidney disease risk. - Obesity: Excess weight puts additional strain on kidney function and increases disease progression risk. - Family History: Genetic factors play a role in determining who develops kidney disease. Racial and ethnic disparities in kidney disease are particularly stark. Black or African American people are approximately four times as likely as White people to develop kidney failure, while Hispanic individuals experience kidney failure at roughly double the rate of White people. People of American Indian, Alaska Native, Asian American, and Native Hawaiian or Pacific Islander descent also face elevated risk. What Policy Changes Is Congress Considering? Following a House Ways and Means Health Subcommittee hearing on kidney health, the National Kidney Foundation outlined five key priorities to improve kidney care and reduce long-term healthcare costs: - Early Testing and Diagnosis: Increase screening for chronic kidney disease to catch the condition before it progresses to kidney failure, when treatment becomes most expensive. - Kidney Transplantation Access: Expand access to kidney transplants, which represent the most cost-effective treatment option for kidney failure compared to lifelong dialysis. - Home Dialysis Options: Improve access to home-based dialysis and other patient-centered care options that enhance quality of life while reducing burden on healthcare systems. - Medicare Payment Reform: Align Medicare reimbursement policies to support prevention, innovation, and value-based care models rather than reactive treatment. - Workforce Development: Address critical shortages of nephrologists and kidney care specialists and remove systemic barriers that delay diagnosis and restrict access to optimal treatments. "Kidney disease is one of the most underdiagnosed and costly chronic conditions in the United States, and too many patients are identified only after it has progressed to kidney failure, when care becomes most expensive and outcomes are poorest," said Jesse Roach, M.D., Senior Vice President for Government Relations at NKF. "We cannot treat our way out of this problem. We must detect kidney disease earlier, prevent progression whenever possible, and ensure patients have access to treatments that improve outcomes and reduce long-term costs." Jesse Roach, M.D., Senior Vice President for Government Relations, National Kidney Foundation How to Reduce Your Kidney Disease Risk While policy changes take time to implement, individuals can take steps now to protect their kidney health and reduce their risk of developing CKD: - Get Regular Screening: If you have diabetes, high blood pressure, heart disease, or a family history of kidney disease, ask your doctor about kidney function tests to catch any problems early. - Manage Chronic Conditions: Keep blood pressure, blood sugar, and cholesterol under control through medication, diet, and lifestyle changes, as these conditions directly impact kidney health. - Maintain a Healthy Weight: Work toward a healthy body weight through balanced nutrition and regular physical activity to reduce strain on your kidneys. - Limit Sodium Intake: Reducing salt consumption helps lower blood pressure, which is critical for protecting kidney function. - Stay Hydrated Appropriately: Drink adequate water daily, but consult your doctor about the right amount for your individual health status. The National Kidney Foundation emphasized that transforming kidney care in the United States will require better alignment across payment policy, care delivery systems, and workforce capacity. The organization continues working with Congress, federal agencies, and stakeholders to advance nonpartisan policies that improve early detection, expand access to transplantation and home dialysis, and accelerate innovation in kidney disease treatment. For millions of Americans unknowingly living with kidney disease, the push for policy reform represents a critical opportunity to shift from expensive emergency care to preventive medicine. Early detection through simple blood and urine tests can identify kidney disease before significant damage occurs, potentially saving both lives and healthcare dollars.
