Protecting the Future of Kidney Disease Research

The Office of Management and Budget (OMB) recently proposed changes to federal financial assistance regulations that would alter how federal grants are reviewed, awarded, and managed. The rule will add another layer of obstacles for researchers to receive funding.

For example, it would require additional review of discretionary awards, expand agency authority to terminate discretionary awards, and restrict how funds can be used for publication and conference participation.

Other key changes include:

• Decision-making power may shift to political appointees 
• Grants will often require pre-issuance review to ensure topics align with the President’s priorities 
• Grant recipients will face increased compliance burdens  
• Researchers will face restrictions on international collaboration

These changes could reduce opportunities for kidney disease research and create additional barriers for a field that already faces significant funding and workforce limitations.

Scientific research is vital for advancing innovations in kidney disease treatments and addressing gaps in care. Not only does research save lives, but it can also reduce health disparities, strengthen the workforce, and safeguard our nation’s fiscal health. For these reasons, the National Kidney Foundation (NKF) strongly encourages the Office of Management and Budget (OMB) to rescind the proposed rule, Regulation for Federal Financial Assistance, in its entirety.  

Protecting scientific research today is essential for the future of kidney treatment options. The United States’ history of investment in scientific research has established a biomedical research ecosystem that advances scientific discovery, accelerates the development of new treatments, and improves patient outcomes. The proposed OMB rule would put this in jeopardy. 

Read NKF’s letter “Joint Letter on Proposed OMB Rule.

Economic Impact 

The government spends around $150 billion annually paying for dialysis treatments every year. By investing in federal grants to support innovations in dialysis treatments and transplantation methods, the government could save money.²

“The return on investment is potentially enormous," said Dr. Parikh, Chair of the Transforming Kidney Health Research Panel. "For example, spending just $1.8 billion per year over the next 10 years to develop scalable cures for kidney diseases that negate the need for dialysis would pay for itself within two weeks of Medicare spending for dialysis.”

Research Investment Gap

Kidney disease research is severely underfunded, even when it kills more people every year than most cancers.³

Workforce Challenges

Limited research funding is a notable factor contributing to declining interest in nephrology research careers. The number of doctoral-level researchers entering the kidney field dropped from thirty-five in 2017-2018 to zero in 2024.⁴ The decline in emerging researchers contributes to the underrepresentation of kidney projects in the national research portfolio.  

Federal funding is vital to the kidney community, driving new medicines and treatments. Some recent breakthroughs include⁵

New Treatments and Therapies 

• Glucagon-like peptide-1 receptor agonists (GLP1s) have been shown to improve outcomes for people with diabetes 
• Sodium-glucose cotransporter-2 inhibitors (SGLT2s) may help to slow kidney disease progression 
• Recently approved cell and gene therapies for sickle cell disease, a condition associated with kidney complications, highlight the potential for a “one-and-done” treatment 
• A new injection every 6 months can indefinitely forestall the need for a combined liver-kidney transplant 

Technology Improving Care 

• AI-driven screening technology used in Albertson’s grocery store health clinics can now screen for diabetic retinopathy through eye changes 
• Finger sensors on smartphone technologies can suggest a need for cardiovascular testing 
• Innovation in smaller, more portable home dialysis machines helps patients who struggle with home dialysis 
• Artificial, wearable, implantable kidneys are advancing toward future clinical applications

Federal support drives innovative solutions to kidney disease, demonstrating what is possible when scientific research is encouraged. 

Work in kidney innovation is only getting started. Currently, treatment works to manage kidney failure and dialysis. Future work aims for early detection and prevention, where instead of dialysis, patients receive the gold standard of care, transplantation.⁶

A Roadmap for the Future

1. Spotting the Silent Killer: Frequent screenings and AI-driven tools for earlier detection 

2. Finding the Causes and Creating Cures: Advances in electronic health record integration, new medicines, diagnostics, and intervention methods 

3. Transforming Transplantation: Developments in xenotransplantation and strategies to rejuvenate and utilize all donated kidneys 

4. Reimagining Dialysis: Flexible, patient-centered dialysis machines as well as expanded education on home dialysis 

5. Reviving the Research Workforce: Support for incoming nephrology students and new research programs 

Solutions are out there; many just need the support of the federal government to get started. 

Grants to promote kidney research could target: 

• Opportunities for American students to conduct breakthrough research

• New screening tools & platforms using molecules and liquid biopsies

• Other causes of kidney disease in addition to genetics and nutrition 

• Risk prediction tools to tailor dialysis prescriptions more efficiently

• Training opportunities in extramural research 

• New transplant methods including pioneering work in xenotransplantation 

• Innovative strategies for salvaging, rejuvenating, and transporting donor kidneys 

• Infrastructure to link and coordinate the vast amount of data sets on kidney disease 

In a letter with the American Kidney Fund, American Society of Nephrology, and the American Society of Pediatric Nephrology, NKF jointly sent its concerns on the proposed OMB rule, which would fundamentally alter long-standing policies that have made the United States the global leader in biomedical innovation.  

NKF strongly urges that the rule be rescinded. However, if OMB elects to proceed with a final rule, NKF and other kidney patient advocacy organizations strongly encourage the agency to: 

• Substantially revise the proposal to preserve scientific peer review

• Protect long-term research investments 

• Maintain support for scientific dissemination and collaboration 

To sustain and work towards a future where kidney disease is preventable, the federal government must commit to scientific endeavors in kidney research now. 

Act now. Protect NIH and NIDDK Health Research Funding here.