NKF Statement on the ESRD Treatment Choices Model (ETC) and Policies to Improve Kidney Patient Choice

September 18, 2020

All quotes for attribution to the National Kidney Foundation

“The National Kidney Foundation (NKF) is pleased to support the three linchpin policies of the Advancing American Kidney Health (AAKH) initiative finalized this morning. On behalf of 37 million adults in the U.S. affected by kidney disease, we express our sincere appreciation to the Administration, U.S. Department of Health and Human Services (HHS) and HHS Secretary Alex Azar for their efforts to radically change how kidney failure, also known as end stage renal disease, is treated in our country.” 

“NKF has long championed policies that are patient-centered, increase access to transplantation, and assure that patients have the information, resources and support they need to access the care that is right for them and their families. We were proud that many of our priorities were reflected in the Advancing American Kidney Health initiative when it was first proposed last year; and are even more excited that many of those proposals are becoming reality today.” 

“The End Stage Renal Disease (ESRD) Treatment Choices Model finalized by the Center for Medicare and Medicaid Innovation (CMMI) today will dramatically increase the ability of patients to access kidney transplant and home dialysis, which are essential steps toward improving patient centric kidney care.”

“Kidney transplant is the gold standard treatment for kidney failure for most patients, providing better health outcomes, an improved quality of life, and cost savings when compared to dialysis. Home dialysis can also provide a patient with more freedom and flexibility to live life on their own terms. Although kidney transplant and home dialysis are preferred by most patients, both are underutilized.”

“Nearly 90 percent of patients whose kidneys have failed begin their treatment in dialysis facilities and many are unaware that a kidney transplant or dialyzing at home are even options. The ETC model will ensure that dialysis facilities and nephrologists are educating and empowering patients to make the treatment choice that is right for them.” 

“Two additional final regulations announced this morning will ensure that more of those who wish to donate a kidney to a family member, friend, or stranger are more easily able to make that gift of life. The policies, which will increase the income eligibility threshold for assistance from the National Living Donor Assistance Center (NLDAC) and allow for more categories of expenses to be reimbursed by the program, are essential steps in increasing patient access to kidney transplant by providing more support to living donors.”

“In January, 2019, NKF released a comprehensive path forward for increasing kidney transplantationMany of our recommendations were integrated into the Advancing American Kidney Health initiative including proposals to expand financial assistance offered to living organ donors, align Medicare and Medicaid Reimbursement to healthcare providers to ensure earlier treatment and care for CKD patients, implement a demonstration program at CMMI that would take a patient-centered approach to testing changes in payment and care delivery, permanently extend Medicare coverage of immunosuppressive drugs for kidney transplant recipients, reduce the discard of kidneys that could be used to provide better outcomes and quality of life for patients, and make key improvements to organ procurement organization (OPO) procedures.”

“NKF applauds the Administration and the leadership of the U.S. Department of Health and Human Services for their bold efforts on behalf of patients, especially the more than 750,000 living with kidney failure right now. NKF stands ready to support the implementation of the policies finalized today and the ongoing efforts of the Advancing American Kidney Health initiative to improve the lives of all patients living with kidney disease.” 


Kidney Disease Facts

In the United States, 37 million adults are estimated to have chronic kidney disease—and approximately 90 percent don’t know they have it.  1 in 3 adults in the U.S. are at risk for chronic kidney disease.  Risk factors for kidney disease include: diabeteshigh blood pressureheart diseaseobesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Blacks or African Americans are almost 4 times more likely than White Americans to have kidney failure.  Hispanics are 1.3 times more likely than non-Hispanics to have kidney failure.


The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org.