Anthony Tuggle faced a dangerous public health enemy hiding in plain sight.
Suffering flu-like symptoms, he went to the doctor expecting medication and a quick trip home. Instead, he received a life-changing diagnosis: his kidneys were failing. He needed emergency dialysis.
As Tuggle recounted in an April 2024 National Kidney Foundation profile, he had been diagnosed with high blood pressure in his late teens. But he had not understood that it could damage his kidneys. By the time he learned the connection, he was already facing kidney failure.
His experience illustrates the consequences of a disease that can advance unnoticed. An estimated 37 million American adults have chronic kidney disease, and nearly nine in 10 do not know they have it.
Closing the gap between having the disease and knowing about it should be central to America’s response. So should education about risk factors and the steps patients can take to protect their kidneys.
The Trump Administration has taken bold steps to address this growing chronic disease.
In 2019, President Trump signed a first-of-its-kind executive order geared toward Advancing American Kidney Health.
Since then, home dialysis use has climbed from 10.5 percent in 2017 to 16 percent in 2023 — its highest level in more than a decade — and kidney transplants increased 24 percent from 2019 to 2023.
Last year, the President signed another historic executive order, Establishing the President’s Make America Healthy Again Commission. This executive order directed the federal government to combat the chronic disease crisis crippling the American people by elevating prevention as a top priority across our health care continuum.
Under this Administration, great strides have been made, but more needs to be done.
That is why, on October 20, U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. announced the Kidney Care National Plan. Its emphasis on prevention will help more patients receive a diagnosis and treatment before kidney disease progresses to kidney failure.
The new HHS plan organizes federal efforts around three priorities: preventing kidney failure, improving competition and choice in dialysis, and reforming the organ transplant system.
Taken together, these three pillars offer a framework for reaching patients before kidney failure — and improving care for those already living with it.
First, we must prioritize prevention and align our approach with the principles of the Make America Healthy Again (MAHA) movement. HHS proposes a systematic review of evidence on screening people at increased risk. Those at increased risk include people with diabetes, high blood pressure, cardiovascular disease, or a family history of kidney failure or rare kidney disease. The purpose is practical: help clinicians find kidney disease earlier and connect patients with care that can slow its progression.
The plan also identifies opportunities to advance research on new kidney treatments and improve the delivery of existing therapies. It proposes working with researchers and clinicians to identify scientifically validated measures that provide earlier, reliable signals of whether a therapy is working. These measures could support earlier FDA approvals while preserving standards for safety and substantial evidence of effectiveness. Earlier detection is most valuable when patients can obtain effective treatment.
Second, patients who need dialysis deserve more choices. The Trump Administration has recognized that effective kidney care must encompass more than just in-center dialysis. While great progress has been made in the use of home dialysis, systemic challenges remain. HHS reports that two companies control roughly 74 percent of the entire dialysis market and, as of 2019, about one-third of Americans lived in areas served by only one of those firms. The Kidney Care National Plan identifies possible changes to certification and other requirements to expand home dialysis and support new technologies. It also calls for examining potentially anticompetitive payment and legal practices. For patients, the test is whether these changes produce safe, accessible care that better fits their lives.
Third, the transplant system needs greater accountability and transparency. Proposed steps include modernizing transplant information technology and establishing an Organ Donation Corruption and Safety Task Force to investigate safety and fraud concerns. The plan also entails stronger oversight of organ procurement organizations, which recover donated organs, and faster certification of new organizations. To strengthen living kidney donation, it proposes expanding public awareness, broadening reimbursement eligibility through the National Living Donor Assistance Center and simplifying administrative requirements. Together, these reforms will help patients navigate the system and improve access to kidney transplantation.
The HHS plan sets a clear vision for earlier kidney disease diagnosis, more dialysis choices, and broader access to transplantation. Anthony Tuggle’s story shows what is at stake when patients do not understand the danger to their kidneys until a crisis arrives. A different system might have prevented his kidney failure. Patients deserve a system that prioritizes prevention in addition to treatment. The promise of the new HHS plan is to bring a disease hiding in plain sight into focus — and give patients better options before and after kidney failure.
The writer is the Assistant Secretary for Legislation at the U.S. Department of Health and Human Services.
