Blog post

How prioritizing upstream care policies for kidney disease can save lives and save our system billions

A new white paper from AKF examines the dire kidney disease trends in the U.S. as well as the potential for significant societal and economic benefits of implementing policies that prioritize upstream interventions and care.
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A new white paper from the American Kidney Fund (AKF) examines the dire kidney disease trends in the United States as well as the potential for significant societal and economic benefits of implementing policies that prioritize upstream interventions and care.

"Reimagining Kidney Care: From Crisis to Opportunity," developed in partnership with the Health Capital Group, was published as part of our ongoing work with the AKF Patient Access Initiative (PAI), a collaboration with stakeholders from patient, provider, payer and pharmaceutical industry communities that seeks to support data-driven, common-sense solutions to combat this devastating disease.

"Upstream care" is an approach to health care that puts an emphasis on addressing the root of a medical problem rather than the symptoms; focusing on earlier detection and intervention of a disease rather than treating it once it has become more advanced.

Upstream care would be particularly beneficial for treating kidney disease as it often has no symptoms in the early stages. Over 37 million Americans have chronic kidney disease (CKD), yet 9 in 10 are unaware of their condition. About 40% of people who are on dialysis were unaware they had kidney disease until they suddenly became very ill and had to begin dialysis immediately to survive. Kidney disease puts people at higher risk for stroke, heart disease and, in some cases, death.  

Fortunately, the treatment landscape has evolved significantly in recent years. Innovative diagnostics and treatments that are key to lowering CKD's burden have become available. Recent research from the Stanford School of Medicine has shown that better upstream care, like national kidney disease screening, is cost-effective and can slow progression of disease. And slowing the progression of disease could dramatically change the trajectory for Americans living with kidney disease.

In addition to saving lives and improving patient quality of life, providing financial incentives for both earlier diagnosis and treatment has the potential to save billions in taxpayer dollars. Our white paper outlines how reducing the share of people who progress to later stages of kidney disease can save Medicare an estimated $9 billion per year and commercial payers and employers an additional $2.8 billion annually.

It is clear that our current approach to kidney care delivery faces several challenges contributing to poor CKD outcomes. In keeping with the objectives of our Patient Access Initiative, our white paper encourages policymakers to explore provisions that:

  • Improve education for people living with kidney disease and their caregivers
  • Support earlier and complete diagnosis
  • Enable better access to kidney disease treatment.

To learn more about the gaps in the kidney care delivery system — and the economic opportunity of evolving this system, visit

"Reimagining Kidney Care: From Crisis to Opportunity" was published in part thanks to support from Novartis Pharmaceuticals Corporation


Holly Bode

Holly Bode is the vice president of government affairs at the American Kidney Fund.