Advancing American Kidney Health

The United States has the largest number of patients treated for kidney failure in the world. Over the last 2 decades, the incidence of kidney failure in the country has plateaued and the mortality rate has declined, but the number of organs available for kidney transplant has largely remained unchanged. As a result, there is an unrelenting, year-on-year increase in the number of patients treated with long-term dialysis in the United States. Although the number of patients treated with home dialysis has doubled over the last decade, the overwhelming majority of patients are still treated with in-center hemodialysis.

On July 10, 2019, President Trump announced a sweeping set of initiatives collectively called Advancing American Kidney Health, designed to reduce the incidence of kidney failure, make more treatment options for dialysis available to a larger number of patients, and increase the number of available organs for kidney transplantation (Figure 1). This initiative is bold and comprehensive albeit ambitious. If successful, the proposals under the aegis of “Advancing American Kidney Health” have the potential to fundamentally transform the lived experience of patients with kidney failure in the United States and substantially change the entire scope of the clinical practice of nephrology. For the initiative to achieve its stated goals, it requires the buy-in and support of a wide range of stakeholders. With this series of 10 articles, CJASN wishes to communicate to its readers the opinion on the proposal of a wide range of stakeholders including governmental agencies, physicians including the American Society of Nephrology, patients, and dialysis providers. Furthermore, we anticipate communicating the scope of the final proposal and eventually the effect of the proposal on the health and well being of patients with kidney failure in the future.

Figure 1.

Overview of key components of the Advancing American Kidney Health Initiative.

Disclosures

Dr. Mehrotra is the Editor-in-Chief of CJASN. Dr. Mehrotra also reports a consultancy agreement with Zytoprotec GmbH and positions on the Exam Committee of the American Board of Internal Medicine, the Editorial Boards for Journal of Renal Nutrition and Peritoneal Dialysis International, and the Board of Trustees for Northwest Kidney Centers.