Strengthening Kidney Care: Reducing Costs, Saving Lives

Chronic kidney disease affects more than 1 in 7 U.S. adults—about 35.5 million people. Yet as many as 90% don’t know they have chronic kidney disease, and many don’t receive the early screenings and care needed to help prevent serious complications. Each year, about 130,000 Americans develop kidney failure, requiring dialysis or a transplant to survive.

The financial burden is staggering. Medicare alone spends about $150 billion annually for beneficiaries with chronic kidney disease or kidney failure, including for avoidable emergency treatments where patients “crash into dialysis” unexpectedly rather than in a planned manner. Between 2019 and 2020, AIR research found that Medicare saw a 9.7% rise in these unplanned dialysis starts, which can increase costs and worsen health outcomes. 
 

AIR partners with Medicare, nephrologists, other providers, and patients with kidney disease to develop data-driven solutions that improve kidney care while reducing wasteful spending.

Our work includes:

• Tracking Unplanned Dialysis Starts – AIR created a Medicare claims-based measure to track dialysis trends, revealing that 1 in 3 Medicare beneficiaries with kidney failure crashed into dialysis between 2018 and 2022. Expanding preventive screenings could help lower these occurrences, reduce hospitalizations, and reduce costs.
   
• Improving Medicare Payment Models – AIR supports the implementation of the End-Stage Renal Disease Treatment Choices Model, which encourages cost-effective, high-quality care by expanding home dialysis and kidney transplants—offering patients better options while reducing Medicare costs. The model now includes care for 100,000 Medicare beneficiaries across 2,500 dialysis facilities and 3,000 clinicians.
   
• Supporting Expanded Access to Kidney Transplants – With more than 101,000 people waiting for a kidney and only 17,000 receiving transplants each year, AIR is helping modernize the governance of the nation’s Organ Procurement and Transplantation Network to increase transparency, streamline processes, and ensure more patients receive the organs they need.
   
• Exploring New Frontiers in Transplantation – AIR partnered with the American Society of Nephrology to study clinician and patient perspectives on xenotransplantation—the transplantation of organs, tissues, or cells from one species to another. Our research sheds light on key concerns, perceived benefits, and communication strategies to support informed decision making. 

By promoting proactive care, smarter spending, and innovative treatments for people with kidney failure, AIR’s evidence-based work is helping to:

• Improve patient outcomes by expanding early detection and preventive screenings —giving people a better chance to avoid kidney failure.
   
• Lower Medicare spending by reducing costly, unplanned dialysis starts and hospital visits.
   
• Enhance accountability through innovative payment models that reward better outcomes—not just more services—and modernizing the system that determines who gets organ transplants.
   
• Foster new treatments by exploring patient and clinician views about cutting-edge advances in organ transplantation.

With kidney disease costs contributing to a large share of Medicare spending for a relatively small patient population, we need smart investments that cut waste, improve efficiency, and deliver better care. AIR’s work helps ensure health care dollars are spent wisely, patients receive the care they need, and providers have the tools they need to succeed.