Current Challenges and Future Directions in US Maintenance Dialysis Care: A Policy-Innovation Perspective

Dialysis care for patients with End-Stage Kidney Disease (ESKD) has seen minimal improvement in outcomes over the past decade, despite substantial advancements in other chronic disease fields. This article explores enduring challenges and future opportunities in outpatient dialysis care from a policy-innovation perspective. The current landscape is defined by clinical limitations and a profound economic strain on the healthcare system. However, a period of cautious optimism may be emerging. This is driven by promising innovations, including the development of wearable and implantable artificial kidneys, advanced hemodiafiltration techniques, biologically inspired therapies like bioartificial kidneys, and the integration of artificial intelligence for personalized care. Realizing the full potential of these advancements requires a multi-pronged approach involving a greater emphasis on the patient's voice, payment reforms that incentivize value over volume throughout a person's journey with kidney disease, and supportive policy changes. Yet, hurdles remain, including supply chain vulnerabilities, a growing nephrology workforce crisis, and the need to ensure equitable access to new technologies to avoid amplifying existing health disparities. A collaborative effort is essential to move toward a future where dialysis is less burdensome and facilitates a better quality of life for all people with kidney diseases.