Every day in hospitals across America, patients are blindsided with devastating news: Their kidneys have failed.
Barry Smith, Ph.D., M.D.
Director-at-Large, American Association of Kidney Patients
For more than half of the people who start life-saving and grueling dialysis treatments, their first introduction to kidney disease occurs in the emergency room (ER) as a medical crisis. For these Americans, their lives, livelihoods, and economic stability are destabilized in an instant. Many become trapped in a resulting cycle of dependency, disability, and unemployment that they may never have imagined. As a doctor, one of the saddest realizations for me is that so much of this burden and suffering is avoidable.
Why is this still happening in America in 2025? Simply stated, it is a result of the failure to educate the public about the nature and risks of often subliminal chronic illnesses and to prioritize prevention strategies that better align screening with the remarkable advances in disease detection and intervention now available. Kidney disease is, of course, important in and of itself, but it also is important because it points the way to what can be done as well for the often-associated and underlying chronic illnesses, such as those of the cardiovascular system and metabolism (type 2 diabetes and obesity) that affect the life expectancy, healthspan (length of life lived without significant health issues),” and overall well-being of all Americans.
The silent epidemic
Kidney disease (apart from its highly specific, genetically determined forms) is a silent epidemic. It affects 37 million Americans. Federal spending on kidney care, courtesy of the American taxpayer, exceeds $100 billion annually, with dialysis alone costing the Medicare program over $30 billion. The real extent of the underlying, but more general, problem is that of biological aging and chronic illnesses, with cardiovascular disease (i.e., high blood pressure, abnormal lipid levels) and abnormal body metabolism (i.e., type 2 diabetes and obesity) at the top of the list. Being major problems in and of themselves, but also significant contributors to the development of kidney disease, these all-too-common conditions highlight the fact that the problems are actually numerically and fiscally far greater than what the statistics for chronic and end-stage kidney disease, viewed in isolation, suggest. In any case, the total disease burden falls the hardest on vulnerable communities, including communities of color, those in rural areas with limited access to regular care, and the elderly.
Beyond taxpayer expenditures, the human and societal consequences of kidney disease alone are profound. They include the destruction of personal aspirations and dreams, loss of household incomes and careers, destabilization of retirement security, massive increases in Social Security Disability Insurance costs, and premature deaths. All of this weakens America. Beyond that, to allow this to happen is simply wrong because it does not have to be so.
The fact is that new innovations are now available for detecting and intervening in chronic diseases in general — and kidney disease in particular — so that patients and professionals working together can delay and even avoid kidney failure. Yet, the problem is that our current system remains overly focused on the repair of tissue and organ damage that has already occurred and doesn’t educate and empower Americans to avoid medical crises and reactionary, high-cost treatments by undergoing screening and early preventative interventions.
A national call for prevention
In 2019, a historic Executive Order under the first Trump Administration entitled “Advancing American Kidney Health” charted a bold and bipartisan-supported vision: earlier prevention, innovation, and patient-centered medicine. However, since 2019, progress on prevention has stalled completely. The U.S. Preventive Services Task Force (USPSTF), the federal body responsible for screening recommendations, has refused to update its approach to match national policy and innovations in disease detection and treatment. It also has failed to recognize the integral place of kidney disease in the overall context of chronic illnesses and the associated interdependence and integration of all types of body systems.
Despite overwhelming evidence on the burdens of kidney disease among patients and taxpayers, USPSTF has remained ineffective in the battle against it. The result? Millions remain undiagnosed until it’s too late, and taxpayers foot the bill for a reactive system that traps patients in dialysis, instead of working to preserve their kidney function so that dialysis is not needed and they can remain people fully engaged with, and contributors to, their families, their communities, and American society.
Why upstream care matters
Upstream kidney care is not just about cutting costs; it’s about human dignity and survival. It is about human wholeness and quality of life. It is about understanding the nature and pervasiveness of chronic illnesses, and the toll they exact on interdependent biological systems over time and/or the aging process. A diagnosis of kidney failure should not come as a shock in an ER. Families should not face crisis decisions about dialysis or transplants in the middle of the night. Patients should not lose their livelihood because the “system” waited too long to act.
Our understanding of kidney disease must evolve to view it as both a healthcare and workforce issue. Too many working-age Americans are sidelined by disability and forced into Social Security Disability Insurance because of late-stage kidney failure, while earlier screening and intervention could keep people healthy, productive, and engaged in their communities.
The way forward
We need leaders in Washington to act with urgency. That means replacing outdated advisory structures with bodies that include both kidney patients and frontline medical professionals. Patients bring lived experience, and clinicians bring practical expertise. Together, they can craft solutions that policymakers alone cannot. Other agencies like the FDA and CMS already incorporate patient input into decision-making. USPSTF should be no different. Education of the public as to the nature of chronic illnesses (and kidney disease in particular) is a critical element in all of this.
The time is now
The American Association of Kidney Patients (AAKP), the nation’s largest and oldest fully independent kidney patient organization, has long sounded the alarm. Its message is clear: Preventing kidney disease progression is not only sound public policy, but also a moral imperative.
As a healthcare professional, I know firsthand the difference education, early detection, and action can make. When we catch kidney disease upstream, we give patients years of health, independence, and hope. When we wait, we condemn them to crisis, suffering, and shortened lives.
America faces a stark choice. We can continue spending billions on dialysis and organ failure, or we can invest in education, prevention, and new innovations that give Americans with kidney disease (and the often-associated other underlying chronic illnesses) better choices and access to the options that will help them successfully manage the disease and often avoid the need for dialysis and an organ transplant altogether.
When it comes to kidney disease alone, the time is now to support our fellow Americans most at risk of progressive disease — before more suffer and die unnecessarily.
