The Silent Epidemic: Why Kidney Disease is a Test of American Healthcare

World Kidney Day was March 12, and here in the U.S., the conversation must be elevated from awareness to action, because the numbers are staggering.

ANDREW O. BADDOO, MD

More than 37 million American adults are estimated to have chronic kidney disease (CKD), yet approximately 90 percent of them don’t know they have it. Another 80 million Americans are at risk due to hypertension, diabetes, and other factors.

This is not merely a health issue—it is a public health crisis with profound economic consequences. Medicare spends more than $130 billion annually on patients with kidney disease, representing over 24 percent of total program spending.

End-stage kidney disease, affecting only 1 percent of Medicare beneficiaries, consumes 7 percent of Medicare dollars.

To understand this crisis, we must recognize that chronic kidney disease is not an isolated condition—it is the downstream consequence of poorly managed non-communicable diseases. When blood pressure is poorly controlled, the kidneys are damaged over time.

When blood sugar remains high, kidney function gradually declines. By the time symptoms appear—fatigue, swelling, confusion—the disease is often advanced, and the window for prevention has closed.

The Silent Burden: Why Americans Don’t Seek Care

Kidney disease is a silent progression. It earns its reputation as a “silent killer” because it destroys without warning. This insidious nature explains why so many Americans only enter the healthcare system when the situation is dire—when dialysis becomes the only option.

At that stage, the burden is catastrophic and challenges include, but not limited to:

· Treatment is extraordinarily expensive: Dialysis costs the healthcare system billions annually.

· Health systems are strained: Nephrology specialists are in short supply, and dialysis centers are overwhelmed.

· Families face financial ruin: The cost of care pushes many households into medical debt.

Dialysis sustains life, but prevention protects it. Yet our current approach is backward: we invest heavily in late-stage treatment while dramatically underfunding the very programs that could prevent kidney disease from developing in the first place.

The federal investment in kidney disease research is just $19 per patient annually, lagging far behind that for cancer and Alzheimer’s research. The CDC’s Chronic Kidney Disease Initiative operates on a mere $2.6 million, a fraction of what is needed for meaningful public education.

The Real Public Health Question

If kidney disease is largely preventable, why are cases increasing? We must confront difficult questions about gaps in our health systems, such as:

· Are we detecting hypertension and diabetes early enough? Or are we waiting for complications before taking action?

· Are routine kidney function tests—eGFR and uACR—integrated into standard primary care? Evidence suggests that only 45 percent of individuals with diabetes and 30 percent of those with hypertension receive recommended annual kidney screening.

· Are high-risk populations screened annually? Black or African American individuals are almost four times more likely than white Americans to develop kidney failure, and Hispanic individuals are 1.3 times more likely. Yet screening rates in these communities remain inadequate.

The rising tide of kidney disease reflects gaps in our prevention systems. It is a failure of early detection, a failure of public education, and ultimately a failure to connect at-risk Americans with care before it’s too late.

The Education Gap: Why Patients Don’t Seek Checkups

Public knowledge of CKD is notoriously low, and this lack of awareness is perhaps the greatest barrier to prevention. 90 percent of those with CKD are undiagnosed because they don’t know they’re at risk and don’t seek testing.

When patients don’t understand their risk, they don’t request screening. When they don’t request screening, the disease progresses silently.

What prevents patients from seeking preventive care?

· Lack of perceived risk: Most Americans don’t know that diabetes and hypertension are kidney diseases waiting to happen.

· Asymptomatic nature: Without symptoms, there is no urgency.

· Medical jargon: Terms like “eGFR” and “uACR” mean nothing to the average person.

· Limited visit time: Primary care visits are brief, and kidney health often gets crowded out.

· Access barriers: Transportation, cost, and insurance complexities deter preventive visits.

Solutions: Meeting Americans Where They Are

The good news is that effective strategies exist to encourage patients to adopt preventive care. We must move from passive awareness campaigns to active patient engagement.

1. Simplify the Message

The National Kidney Foundation’s “Kidney Numbers and the CKD Heat Map” initiative demonstrates the power of clear communication. Through short animated videos in English and Spanish, patients learn what eGFR and uACR mean and how to interpret their risk.

When complex medical information is translated into visual, accessible formats, patients are empowered to take action.

2. Embed Education in Daily Life

Digital tools offer unprecedented reach. A recent campaign using the MyTherapy app delivered kidney health education to 55,000 at-risk users during their daily medication routines. The result? A 77 percent increase in intent to undergo kidney testing among exposed patients.

This approach works because it meets patients where they are in their daily lives, providing information when they are already engaged in their health.

3. Leverage Trusted Community Partners

The YMCA and DaVita collaboration brings kidney health education and screenings to seven communities across the country, targeting areas disproportionately affected by risk factors. The YMCA of the Capital Area in Louisiana hosted a screening event that welcomed more than 150 attendees—people who might never have visited a traditional clinic.

Similarly, the National Kidney Foundation of Michigan’s “bright orange table” outreach team reached 4,235 people at 54 community events in 2024, meeting individuals at health fairs, senior expos, and back-to-school events.

4. Apply Behavioral Science

A randomized clinical trial in Japan tested whether “nudge” letters could increase physician visits among individuals identified with CKD through screening. Compared to the control group, participants who received behavioral economics-informed messages were nearly 4 percentage points more likely to follow up with a physician.

While modest, this suggests that how we communicate matters. Simple changes in messaging can drive meaningful changes in behavior.

5. Equip Patients for Productive Conversations

The MyTherapy campaign included a “physician checklist” to help patients prepare for appointments. When patients arrive informed and ready to ask specific questions, they are more likely to receive appropriate testing and referrals.

This addresses the barrier of limited visit time by making those minutes more productive.

A Prevention-First Approach for America

Reducing the burden of kidney disease requires a fundamental shift in how we approach chronic disease. We must strengthen our NCD response with specific, actionable strategies:

✔ Improve blood pressure and diabetes control at the primary care level. Community health workers and local clinics must be equipped to manage these conditions before they cause end-organ damage.

✔ Ensure routine kidney function testing for high-risk patients. eGFR and uACR should be automated as blood pressure is in patients with diabetes and hypertension.

✔ Fund public awareness campaigns at scale. The CDC’s CKD Initiative requires significant investment to educate Americans about their risk.

✔ Support community-based screening programs. Partnerships with trusted organizations, such as the YMCA, bring services to underserved populations.

✔ Leverage digital tools for continuous engagement. Apps and text messaging can reinforce education and prompt action between visits.

✔ Simplify clinical guidelines for primary care providers. Clear, harmonized recommendations reduce confusion and increase screening rates.

Kidney health begins long before dialysis. It begins in community centers, pharmacies, digital apps, and the exam rooms of primary care providers who have the time and tools to make prevention a priority.

Moving from Awareness to Accountability

World Kidney Day should not simply be a day to share statistics on social media. It should drive action at every level—from federal policy to individual behavior change.

Every advanced kidney failure case represents:

✍️ A missed screening: The urine test that was never ordered.

✍️ A missed follow-up: The appointment that the patient couldn’t afford or access.

✍️ A missed education opportunity: The moment when a patient didn’t understand their risk.

The opportunity is clear: Investing $1.8 billion per year for 10 years in kidney research could lead to cures that negate the need for dialysis—and could be paid for with just two weeks of Medicare dialysis spending. The return on investment for prevention is enormous, both in dollars saved and lives improved.

As March 12 approached, the narratives should have been elevated. Let us ask the hard questions of our policymakers, our healthcare providers, and ourselves. Let us meet Americans where they are—in their communities, on their phones, in their languages—and give them the tools to protect their kidneys before it’s too late.

By protecting the kidneys, we protect the heart, the blood vessels, and the overall health of our nation. The question is no longer “How do we treat kidney failure?” It is “How do we stop it from starting? “

The writer, Andrew O. Baddoo is a New Jersey-based internist/nephrologist