Federal Investment

More than 37 million Americans have chronic kidney disease (CKD), including nearly 750,000 with irreversible kidney failure.  Another 80 million Americans are at risk for developing kidney disease from hypertension, diabetes, and other risk factors.  Unfortunately, 90 percent of those with CKD have not been diagnosed.

If we do not address kidney disease early and work to slow or stop the progression to kidney failure, the expense of treating kidney failure could bankrupt the Medicare Trust Fund. The Medicare program spends more than $130 billion – more than 24 percent of total spending – on patients with kidney disease. Further, end stage kidney disease, which affects only 1 percent of Medicare beneficiaries, accounts for 7 percent of Medicare spending.

To address this serious challenge, Congress must dramatically increase funding for public awareness, prevention [TZ1], early detection, and treatment of kidney diseases and significantly increase funding for kidney related research at the National Institutes of Health and CDC’s Chronic Kidney Disease Initiative.

CDC Chronic Kidney Disease Initiative

The CDC Chronic Kidney Disease (CKD) Initiative focuses on a comprehensive public health strategy, involving other public health agencies and national organizations, to address CKD. Activities funded under this program support disease surveillance, help raise awareness of CKD and its complications, promote early diagnosis and treatment, and improve the quality of life for people living with CKD. Unfortunately, at its current funding level of $2.6 million, the reach and impact of this program is limited.

With a significant increase in funding, CDC could accelerate and amplify the program’s activities to educate the public about their risk for kidney disease, educate clinical professionals and spur innovation by entities serving the kidney disease community. By increasing our investment in awareness, early detection and treatment, we can effectively slow the progression of kidney disease, reduce its costlier complications, and dramatically improve the quality of life of patients.


The National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) supports research that has led to significant discoveries and improvements in the treatment and understanding of kidney disease. Unfortunately, COVID-19 has disproportionately affected kidney patients, who have experienced some of the highest rates of COVID-19 hospitalization and mortality. Additionally, COVID-19 has been linked to acute kidney injury and kidney disease in recovering COVID-19 patients with no prior history of kidney disease.

The impact of COVID-19 plus the tremendous impact of kidney diseases on the 37 million Americans with CKD (750,000 of whom have end stage kidney failure), combined with unfunded, potentially high-impact research opportunities warrants an increase in funding going forward. In Fiscal Year 2021, NIDDK received a smaller percentage funding increase than all but one other Institute under NIH. Specifically, NKF requests that an increase in funding for NIDDK be greater than or commensurate with the increase to NIH as a whole. Improvements in prevention and care of kidney patients also can help address the disproportionate impact of CKD and ESRD on Medicare.

NKF has convened a group of leading nephrologists to assess and identify key areas of research that, through additional funding, can accelerate the development of new prevention and early detection measures and new therapies.to reduce the impact of CKD. This panel will be publishing its recommendations in Fall, 2021, which will serve as a roadmap for additional federal funding.

NKF Appropriations Request for FY 23

NKF Appropriations Testimony for FY2023