When hemodialysis was developed, it was revolutionary: it offered people with kidney failure a chance at survival. But only the very wealthy could afford to pay for dialysis treatment; the rest went before “life or death committees” to determine who would receive treatment. Many patients went bankrupt trying to pay for their life-sustaining care, and people saw the need for a charity to help with costs.

In 1971, a small group of friends founded the nonprofit American Kidney Fund to help dialysis patients afford the cost of care. Back then, kidney disease was a rare condition, most often caused by congenital or hereditary conditions.

In just four decades, kidney disease has emerged as one of the leading threats to our nation’s health. As the number of cases has grown, so has the need for our programs and services. We have helped more than 1 million low-income dialysis patients access medical treatment since our founding. Our grants for health insurance premiums have allowed these patients to maintain health insurance coverage, enabling them to receive life-saving dialysis care through the modality and setting that they and their physicians deem most appropriate, whether it is in-center hemodialysis, home hemodialysis or peritoneal dialysis. Our other grant programs have allowed these patients to pay for transportation to dialysis, purchase medications and nutritional supplements, and afford many other treatment-related expenses.

We have expanded the public’s access to vitally needed information about kidney disease prevention. We have funded clinical research training to advance the field of nephrology. We have provided screening services to tens of thousands of underserved at-risk individuals nationwide. We have developed advocacy outreach, public policy efforts, and strategic partnerships to support improvements in the quality of care for people living with kidney failure, and to advance awareness and prevention of chronic kidney disease.

Yet as we look to the next four years, we confront the reality that the challenge of kidney disease is greater than ever.

When the American Kidney Fund was founded, there were fewer than 20,000 Americans with kidney failure. Today more than 600,000 Americans have kidney failure. Kidney failure is an expensive condition to treat and posts an enormous financial burden on the nation and on patients. The Medicare program that covers most people with kidney failure cost taxpayers more than $34 billion in 2011, 6.3 percent of the total Medicare budget, though people with kidney failure constituted only about 1 percent of the total Medicare population. With kidney failure treatment costing private insurers an additional estimated $14.9 billion that same year, the total cost of kidney failure treatment totaled nearly $50 billion.

While the number of people with kidney failure is enormous, the number of people with its precursor, chronic kidney disease, is a staggering—37 million Americans. Diabetes and hypertension cause two-thirds of all cases of kidney disease.

One out of every 3 Americans is at risk for kidney disease, and kidney disease is now among the top 10 causes of death in the United States. Nine out of 10 people with early to moderate kidney disease don’t know they have it, putting their health in jeopardy.

These statistics point to the incredible need that exists for the American Kidney Fund’s programs, services and leadership. Despite the enormous toll this disease is taking on our nation’s health and economy, there is hope.

Chronic kidney disease is preventable in most cases. Increased awareness of risk factors is critical to preventing new cases.

For those who already have chronic kidney disease but are unaware, early detection can make all the difference—it is possible to slow or stop its progression and avoid kidney failure or other serious complications.

And for Americans who are living with kidney failure, better health outcomes and improved quality of life are possible with effective treatment-related financial support that ensures access to quality care, and with an intensified focus on strengthening public policies and programs to support the needs of these patients.

The American Kidney Fund’s 2015-2018 Strategic Plan is our roadmap that will allow us to tackle the challenge presented by this common, serious and widespread disease. The next four years present an enormous challenge, but even more importantly, an enormous opportunity. We will continually evaluate our progress, adjust our course as needed, and forge meaningful partnerships with people and organizations who share our commitment to the cause. Together, we will help people fight kidney disease and live healthier lives.