Silent Costs and Hidden Risks: Employers’ Role in Improving CKD Detection and Management

Chronic Kidney Disease (CKD) is one of the most underdiagnosed and costly health issues affecting today’s workforce. 35.5 million U.S. adults are living with CKD—and nearly 90% of them don’t even know it.¹ For employers, this silent epidemic can quietly drive up health care costs, reduce productivity, and diminish overall workforce well-being.

Roughly 1 in 10 working-age adults (18–65) have CKD, but most are unaware they’re affected.² People with diabetes, high blood pressure, or a family history of kidney disease are at heightened risk—factors common across many employee populations. 

These individuals are twice as likely to suffer costly cardiovascular events, such as heart attacks and strokes compared to their peers without CKD.³ Since the disease often progresses without symptoms, these complications arise unexpectedly and can significantly increase health care utilization and costs for employers. 

CKD is a significant but often overlooked contributor to employer-sponsored health care spending. It can account for up to 10% of annual health care costs due to poor detection and minimal management.⁴ Workers with CKD and type 2 diabetes—its most common cause—incur nearly double the annual costs compared to those with diabetes alone.⁴

The cost spike doesn’t stop there. If kidney disease progresses to failure dialysis or transplant becomes necessary. Transplant waitlists can extend 5 years or more, without an available living donor.  While Medicare will eventually cover these costs, employers bear the cost during the first 30 months—an average of $15,444 per month per employee, totaling nearly half a million dollars.⁵

CKD affects more than the bottom line—it impacts performance. Nearly half of employed individuals with CKD report work limitations. These include two to three times more sick days, reduced hours, slower work pace, and the need for job or schedule adjustments.⁶

The good news? CKD is manageable—and progression to end stage is often preventable—when caught early. But that’s not happening enough. Two low-cost tests can detect and assess CKD risk: estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR). Yet only 45% of people with diabetes and just 12% of those with hypertension get both tests annually.

This lack of testing is a major barrier to timely diagnosis and treatment. Urine albumin creatinine ration (uACR), a marker of kidney damage, can appear long before kidney function declines, but most people at risk don’t receive this test regularly because their providers are not ordering it and individuals don’t know to ask for it. The result is health care providers miss the window for early intervention, leading to worsening health and rising costs.

There is a clear call to action for employers: understand how many of your employees are at risk for CKD, prioritize early detection through benefits policy and employee education, support treatment—including new therapies that increase positive cardiovascular health outcomes and protect existing kidney function, and promote access to kidney transplant and home dialysis options. These steps not only control costs but also improve quality of life for employees.

As managing high-cost conditions becomes a top priority for employer-sponsored health plans, CKD should be on your radar. The National Kidney Foundation offers a suite of resources and tools to help organizations implement effective kidney health strategies. Connect with us to learn how you can better manage this expensive chronic health condition, protect your employees—and your bottom line.

1. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States. US Department of Health and Human Services, Centers for Disease Control and Prevention. Accessed 1/2/2025, 2025. https://www.cdc.gov/kidney-disease/php/data-research/index.html

2. United States Renal Data System. 2024 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. , 2024. https://adr.usrds.org/2024

3. van der Velde M, Matsushita K, Coresh J, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int. Jun 2011;79(12):1341-52. doi:10.1038/ki.2010.536

4. Chung H, Crowe CL, Kong SX, et al. Descriptive study of the economic burden among patients with type 2 diabetes mellitus, chronic kidney disease, and chronic kidney disease and type 2 diabetes mellitus in a large US commercially insured population. J Manag Care Spec Pharm. Jan 2023;29(1):80-89. doi:10.18553/jmcp.2023.29.1.80

5. League RJ, Eliason P, McDevitt RC, Roberts JW, Wong H. Variability in Prices Paid for Hemodialysis by Employer-Sponsored Insurance in the US From 2012 to 2019. JAMA Network Open. 2022;5(2):e220562-e220562. doi:10.1001/jamanetworkopen.2022.0562

6. Alma MA, van der Mei SF, Brouwer S, et al. Sustained employment, work disability and work functioning in CKD patients: a cross-sectional survey study. J Nephrol. Apr 2023;36(3):731-743. doi:10.1007/s40620-022-01476-w