The HHS Kidney Care National Plan: prevention, transplant and the dialysis market
The federal plan, released October 20, sets out what HHS should consider in kidney care, and devotes a section to how dialysis chains build financial ties with nephrologists. DaVita, Fresenius Medical Care and Kidney Care Partners responded.
🎧 Listen: Weekly · Oct 26, from 17:37.
What it is
The Department of Health and Human Services released its Kidney Care National Plan on October 20, 2026, as part of the Make America Healthy Again initiative, building on the 2019 executive order on Advancing American Kidney Health. It is a 17-page federal policy plan, not a regulation: its recommendations are phrased as what HHS "should consider."
Our take on why it matters to nephrologists: federal policy shapes how we practice, what is allowed, encouraged or discouraged, and how care is paid for. This plan also names nephrologists directly.
The picture it paints
- About 37 million US adults have CKD, and about 87% don't know it. Kidney disease was the eighth leading cause of death in 2024.
- About 831,000 Americans were living with kidney failure in 2023, and about 90,000 are on the transplant waiting list, many waiting three to five years.
- Life expectancy on dialysis has not improved since 2009, and five-year survival is under 50%.
- Medicare spending on kidney failure reached $24.4 billion in Original Medicare and $27.7 billion in Medicare Advantage in 2023, plus $141.1 billion on CKD before kidney failure. Home dialysis rose from 10.5% in 2017 to 16% in 2023.
The dialysis market
In a section titled "Exploiting Market Power to Concentrate Patients and Profits," the plan says two companies provide about three-quarters of US dialysis (up from about 59% in 2006), and that in 2019 about a third of the population lived where the only supplier was one of the two. It describes medical directorships, joint ventures and value-based partnerships that can lock nephrologists in, sometimes with terms that restrict working with other suppliers after the contract ends; possible all-or-nothing bargaining with Medicare Advantage plans; and charitable premium assistance that may steer patients toward ACA exchange plans, where spending per new dialysis patient was about 2.5 times Medicare's. The plan itself says additional evidence is needed on these practices.
What it proposes
Recommendation areas include a review of screening; holistic disease management; prevention models and a multi-payer summit; alternative dialysis settings; competition, including easier entry for new providers; reviewing charitable premium programs for fraud; living donation (the HOLD Act and the National Living Donor Assistance Center); organ procurement organization accountability; patient safety oversight; and research, including identifying additional validated surrogate endpoints, with the goal of earlier FDA approvals.
The responses (Healio)
DaVita said it shares the plan's goals; where it differs is "the suggestion that kidney care has lacked innovation or that scale stands in its way." Fresenius Medical Care welcomed the focus and pointed to its work on home dialysis, hemodiafiltration and transplant referral. Kidney Care Partners (Colin Roskey) said "the core problem is the payment system, which only Congress can change," and backed two bills.
Why it matters
Nothing changes on Monday: it's a plan, not a rule. Our take for fellows: if you're signing your first contract, read the directorship terms, and any limits on where you can work after the contract ends, carefully. The federal plan now describes them.
Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board.
The source: U.S. Department of Health and Human Services. Kidney Care National Plan. 2026 (released October 20, 2026) Read the original
Also discussed:
- Healio, October 22, 2026: HHS launches new Kidney Care National Plan Link
🎧 Listen: Weekly · Oct 26, from 17:37.
Physician-led, AI-assisted. Dr. Wael Hussein chooses every item NephSpace covers and reviews and edits every story before it is published. The first draft was written in our own words with AI (Claude, by Anthropic) from the full text of the plan and Healio's report and checked against our reading notes; Dr. Hussein then reviewed and edited it. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. See our disclaimer and disclosures. Spotted an error? Tell us.
