The Increasing Health & Economic Burden of Kidney Disease Approximately 26 million Americans have some evidence of chronic kidney disease and are at risk to develop kidney failure. – Another 20 million are at increased risk for developing kidney disease. The number of people diagnosed with kidney disease has doubled during each of the last two decades. – Although it can occur at any age, older Americans are at higher risk. As the baby-boomers enter their 60s and 70s, the number of Americans with kidney disease is expected to increase significantly. When chronic kidney disease progresses, it may lead to kidney failure or end stage renal disease (ESRD). – Currently, approximately 485,000 Americans have been diagnosed with kidney failure and require ongoing, expensive and life-altering treatments – such as frequent dialysis treatments or kidney transplantation – to stay alive. The annual cost of treating ESRD is currently over $32 billion. – The number of Americans with this advanced stage of the disease is expected to grow to 785,000 by 2020. The annual costs to treat kidney disease are more than one quarter (27.6 percent) of Medicare’s expenditures, and this will increase in the years to come. – While the expenditures are significant, many patients do not receive all of the treatment they need because of reimbursement system flaws: Medicare does not fully cover all cost of dialysis treatments. Life-sustaining immunosuppressant drugs for kidney transplant patients are only covered for three years. Acute kidney injury is diagnosed in over 300,000 Americans each year, and is associated with increased death rates and health care costs, and may accelerate progression to ESRD. More Research & Information about Kidney Disease is Needed Primary care physicians and nephrologists need evidence-based guidelines to effectively treat early stage kidney disease and to help prevent its progression. Government guidance is needed on tracking data based on patient race and ethnicity in order to quantify the considerable racial disparities in kidney disease incidence, and ensure that appropriate measures are designed. Federally funded medical research is needed to help physicians learn more about the best treatment for kidney disease. Catastrophic Health Expenditure and Distress Financing Among Patients With Nondialysis Chronic Kidney Disease in Uddanam, India Balaji Gummidi1 , Oommen John1,2 , Renu John1,2 , Susmita Chatterjee1,2 , Anubhuti Jha1 , Arpita Ghosh1,2 and Vivekanand Jha1,2,3 1 The George Institute for Global Health, University of New South Wales, New Delhi, India; 2 Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India; and 3 School of Public Health, Imperial College, London, UK Correspondence: Vivekanand Jha, The George Institute for Global Health, University of New South Wales, 308-309, 3rd Floor, Elegance Tower, Plot Number 8, Jasola District Centre, New Delhi 110025, India. E-mail: vjha@georgeinstitute.org.in Received 24 August 2021; revised 7 October 2021; accepted 13 October 2021; published online 30 October 2021 Kidney Int Rep (2022) 7, 319–321; https://doi.org/10.1016/j.ekir.2021.10.015 ª 2021 International Society of Nephrology. Published by Elsevier Inc. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). INTRODUCTION Chronic kidney disease (CKD) is the third fastest growing cause of death worldwide and projected to rise to fifth place in the list of causes of death in 2040.1 The burden is particularly high and growing rapidly in transitional countries, especially among rural communities of tropical countries. Treatment of CKD is expensive. An estimated 188 million people experience catastrophic health expenditure (CHE) annually because of kidney diseases across low- and lower middle-income countries, the greatest of any disease group.2 Studies have focused on costs of treating advanced stages of CKD with dialysis and/or transplantation. Patients with earlier stages of CKD need long-term care, have multiple comorbidities that require specific treatment, and likely incur substantial health care expenditure, which has not yet been quantified. In one study, patients with CKD made 10.8 physician visits per year.3 Another study reported that 60% of patients with stage 3 CKD consumed $5 medications/d.4 Uddanam is a high CKD-burden region in India with an adult population prevalence of CKD of 21%,5 almost 3 times that described from elsewhere in the country, but it has scarce kidney care services. Despite the commitment to provide universal health coverage to the population, outpatient care for chronic disease management including CKD has remained excluded from the ambit of the universal health coverage. We undertook this study to understand the household financial burden in the care of patients with predialysis