The US Department of Health and Human Services (HHS) launched a Kidney Care National Plan on Tuesday, 20 October 2026, aimed at detecting chronic kidney disease earlier, increasing competition in the dialysis market and reforming the organ transplant system. An estimated 37 million American adults have the condition, most without knowing it.

Most Americans With Kidney Disease Do Not Know It

An estimated 37 million American adults have chronic kidney disease, and an estimated 87 per cent do not know they have it. Kidney disease was the eighth leading cause of death in 2024. Roughly 831,000 people were living with kidney failure in 2023, and about 90,000 are waiting for a transplant.

Fewer than half of patients who start dialysis are alive five years later, the department says. It argues that prevention is neglected for structural reasons: most people with kidney disease do not qualify for Medicare until they reach kidney failure, so whoever pays for early care rarely benefits from it.

HHS says it will consider commissioning a systematic evidence review of kidney disease screening among at-risk populations, including people with diabetes, hypertension, cardiovascular disease or a family history of kidney failure or rare kidney disease. It will also consider facilitating earlier Food and Drug Administration approvals when there are clear indications that new treatments could benefit patients sooner. It also lists payment models that prioritise prevention and better care for dialysis patients.

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Kidney Care National Plan Targets Dialysis Market Dominance

According to HHS, two companies control roughly 74 per cent of the dialysis market. As of 2019, about one-third of the US population lived in areas where the only available dialysis provider was one of those companies. HHS says it will consider streamlining facility regulations, easing certification for home-based care and examining alternative dialysis settings.

The department describes the sector as resistant to innovation. It also proposes investigating potential anticompetitive payment and legal strategies used by the largest firms.

Shares in DaVita and Fresenius Medical Care traded lower on the day. DaVita said the plan reflected many of its priorities but disputed the suggestion that kidney care had lacked innovation or that the scale of major providers was an obstacle to progress.

Fresenius Medical Care welcomed the plan and said its priorities matched its own home dialysis and transplant referral work.

Transplant System Faces Scrutiny and Reform

Health Secretary Robert F. Kennedy Jr announced the plan at JPS Health Network in Fort Worth, Texas, where he said the 'organ transplant program had a monopoly that ended up corrupting the system'. According to HHS, no organ procurement organisation had been decertified before September 2025, when the department said it took that step for the first time in the programme's history.

The plan proposes competitive, multi-vendor contracting to modernise the national transplant network, tighter accountability for procurement organisations, fast-tracked certification for new entrants and a task force on organ donation corruption and safety. It also backs a public awareness drive for living donation.

Transplant hospitals are not currently required to tell patients whether their waitlist status is active or inactive, the plan notes. HHS says kidney transplants rose 24 per cent between 2019 and 2023, while home dialysis use climbed from 10.5 per cent in 2017 to 16 per cent in 2023.

The measures are proposals that HHS says it will consider, rather than binding rules, and the department describes them as representative of a fuller set of recommendations. Kennedy said the aim was to 'preserve kidney health' and give patients more choices. Whether the Kidney Care National Plan becomes regulation, and how quickly, remains to be seen.

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