lower the cost of care. HHS therefore supports efforts to develop and bring to market novel treatments such as wearable, implantable, and/or biohybrid artificial kidneys as well as other biological and drug-based alternatives to current dialysis treatments. HHS aims to reduce morbidity and mortality among people living with advanced kidney disease and increase the proportion of those with kidney failure receiving optimal treatment aligned with their individual needs and preferences, based on informed patient choice. OBJECTIVE 1. Improve care coordination and patient education for people living with kidney disease Page 8 | Advancing American Kidney Health and their caregivers, enabling more person-centric transitions to safe and effective treatments for kidney failure OBJECTIVE 2. Introduce new value-based kidney disease payment models that align health care provider incentives with patient preferences and improve quality of life OBJECTIVE 3. Catalyze the development of innovative therapies including wearable or implantable artificial kidneys with funding from government, philanthropic and private entities through KidneyX, and coordinating regulatory and payment policies to incentivize innovative product development Goal 3: Increase Access to Kidney Transplants Nearly 95,000 patients are on the waiting list to receive a kidney transplant.26 Kidney transplantation is generally associated with better outcomes compared to dialysis,27 but only 30 percent of individuals who have experienced kidney failure are living with a functioning kidney transplant.28 Many Americans never have the chance to receive a kidney transplant due to shortages of available kidneys. Objectives to improve access to kidney transplants are: OBJECTIVE 1. Increase the utilization of available organs from deceased donors by increasing organ recovery and reducing the organ discard rate OBJECTIVE 2. Increase the number of living donors by removing disincentives to donation and ensuring appropriate financial support Page 9 | Advancing American Kidney Health III. HHS INITIATIVES By coordinating across HHS and partnering with people living with kidney disease, their caregivers, organ donors, health care providers, and other stakeholders, HHS will enhance the ability of people with kidney disease to improve their day-to-day well-being and quality of life. The specific activities and initiatives HHS is undertaking to address the goals of this vision are described below. Goal 1: Reduce the Risk of Kidney Failure OBJECTIVE 1. Advance public health surveillance capabilities and research to improve identification of populations at risk and those in early stages of kidney disease In recent years, HHS has increasingly focused on developing better capabilities to identify kidney disease early among high-risk patient populations and to support new research to uncover clinically-useful biomarkers that allow better prediction of the course of CKD and identify patients who could be helped by particular therapies, or who should not be given specific drugs. ▶ CDC created and manages the national CKD Surveillance System, the only interactive and most comprehensive collection of CKD-related data in the United States, helpful for monitoring progress toward achieving national Healthy People29 objectives. Through its investments in the CKD Surveillance System and innovative epidemiological research, CDC continues to strengthen understanding of kidney disease prevalence, risk factors, and health consequences. Find more information on the CKD Surveillance System at: https://nccd.cdc.gov/ckd/default.aspx ▶ The NIH-funded Chronic Renal Insufficiency Cohort (CRIC) Study is examining risk factors for progression of CKD and cardiovascular disease among patients with established CKD. Additionally, the study is developing predictive models to identify high-risk subgroups, informing future treatment trials, and examining the effect of ongoing clinical management on outcomes. For example, CRIC researchers defined mortality risk subgroups in patients with CKD based on whether levels of the hormone FGF23 in the blood change over time. FGF23 levels in the blood were stable over time in most patients with CKD, but distinct subpopulations with rising FGF23 levels over time were linked to higher risk of death. Find more information about CRIC at: https://www.niddk.nih.gov/about-niddk/research-areas/ kidney-disease/effects-chronic-kidney-disease-adults-study-cric ▶ Hypertension is a leading cause of kidney disease and is the second leading cause of ESRD, accounting for 26 percent of ESRD cases.30 Heart disease can lead to and exacerbate CKD. Hypertension can lead to kidney disease, which in turn can lead to worsened hypertension. It is a dangerous cycle that, if not stopped, can lead to a heart attack, stroke, heart failure, or kidney failure. The landmark NIH-funded Systolic Blood Pressure Intervention Trial (SPRINT) study showed that lower blood pressure targets decrease the risk of death in high-risk patients with cardiovascular disease (CVD) and CKD.31 Find more information on the SPRINT trial at: https://www.nhlbi.nih.gov/science/ systolic-blood-pressure-intervention-trial-sprint-study ▶ Diabetes is another major risk factor for kidney disease. Although testing for kidney disease is recommended for people with diabetes, almost 60