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Signals Recap: CMS Ends ETC, MedPAC Report, World Kidney Day, & More…
Your biweekly collection of news, research, funding & community voices shaping the future of global kidney health
Welcome back! We just marked World Kidney Day, a moment to reflect on the latest news, research, and policy shaping kidney health today. First, a huge thank you—to everyone working to advance kidney care and to this community for being part of the conversation. Putting this issue together was a powerful reminder not just of how many lives kidney disease touches, but of how many people are committed to making a difference.
We start with the biggest development out of CMS last week: the shutdown of the ETC Model. As the dust settles, reactions feel like a slow exhale—it was expected, and it could have been worse. We’ll break down what this means, highlight key takeaways from MedPAC’s latest dialysis capacity report, and round up the biggest World Kidney Day updates from Canada to Cyprus and everywhere in between.
A warm welcome to the 202 new subscribers who joined us this month! If you missed it, we covered the ETC model closure, sat down with Roivios CEO John Erbey, and have more on the way, including an updated ESRD/AKI device landscape, three new KOL interviews, and a deep dive into Fresenius earnings.
If you find this newsletter valuable, consider sharing it with 1-2 colleagues or friends who care about the future of kidney health. Thanks for reading—let’s dive in.
In this issue
CMS Ends the ETC Model
World Kidney Day Highlights
MedPAC Report: Dialysis Capacity & Consolidation
Novo Nordisk’s CagriSema REDEFINE 2 Results
China Performs First Pig Kidney Transplant
NYT Explores Ethics of Xenotransplantation
Biogen Starts Phase 3 Study for Late AMR in KT
UTMB Partners with NIPOKA on diagnostics
Fresenius Releases 2024 Annual Report
Strive Health Expands Partnership with Zing Health
Cincinnati Children’s Licenses Renal Angina Index
NephMadness 2025 Kicks Off with RFN Editors’ Picks
Renal Fellows Course at MDIBL Celebrates 18 Years
Kidney Foundation of Canada Awards Coronation Medal
VHC Health One-Year Experience with Renal Denervation
Open roles around the Kidneyverse
& More…
Signals
CMS Shuts Down ETC—What's Next for Kidney Payments?
Summary: CMS has announced the early termination of the ESRD Treatment Choices (ETC) Model, a mandatory program aimed at increasing home dialysis and transplant rates. This decision is part of a broader federal shift away from alternative payment models (APMs), with CMS shutting down eight payment models by year-end, citing cost savings and strategic realignment. ETC, which covered about 31% of dialysis providers, had not yet demonstrated significant improvements in outcomes or cost savings, according to CMS evaluations. With Medicare Advantage (MA) enrollment among ESRD patients rising, the move raises questions about whether private payers will now take on a larger role in shaping kidney care payment reforms (CMS).
Thoughts: The early termination of the ESRD Treatment Choices (ETC) Model marks a significant shift in kidney payment reform, raising questions about the future of value-based care (VBC) models. The decision wasn’t unexpected—ASN’s Daniel Weiner points out that ETC struggled to show meaningful differences in home dialysis and transplant rates, with both the intervention and control groups seeing only small increases. External challenges, including COVID-19 disruptions and peritoneal dialysis supply shortages, further complicated its impact.
At the same time, CMS has made clear that Kidney Care Choices (KCC), a voluntary model, will continue, and the Increasing Organ Transplant Access (IOTA) Model remains on track for its July launch. But with ETC’s shutdown, KCC is now the only kidney-specific APM left standing. As Kate de Lisle of Leavitt Partners noted, last week’s announcement offers the first real signal from the new administration on CMMI’s direction. While some VBC proponents may be relieved that more models weren’t cut, the end of Making Care Primary (MCP) has raised a few questions around what comes next.12
From a frontline perspective, Dr. Graham Abra shared that many VBC models are simply too complex. With delayed data, high startup costs, and difficult-to-explain benchmarks, even experts struggle to engage with these programs effectively. He says that simpler incentives and clearer guardrails are needed to encourage participation while curtailing bad actors. The history of demonstration projects, MA C-SNPs, ESCOs, and now ETC suggests that, at scale, many VBC models fail to meet expectations.
So where does kidney payment reform go from here? Is the future of risk-based kidney care shifting to Medicare Advantage and private-sector innovation, or does CMS have another strategy in mind? We'll be tracking responses from industry leaders, advocacy groups, and policymakers as this unfolds.
What do you think? What should we keep when it comes to KCC and IOTA? Join the discussion on Slack, LinkedIn, or the comments.
Visual of the Week
Dialysis facility growth slows as large providers consolidate. Last week’s MedPAC report highlights a decline in the number of dialysis facilities operated by the two largest providers (DaVita and Fresenius), which shrank by 3% between 2022 and 2023. Nonprofit facilities shrank by 7% over the same period. The trend reflects a shift in patient care, with lower in-center dialysis demand and increasing home dialysis adoption prompting facility closures and consolidations. While urban dialysis capacity slightly increased (0.4%), rural areas saw a 4% decline, raising concerns about access in less densely populated regions.
With 96% of dialysis delivered by freestanding centers and 90% by for-profit providers, I’m curious if home growth is making up for these closures. Is this a sign of greater efficiency, or do they pose risks to patient access—especially in rural areas?
Stay tuned, we'll be hearing industry perspectives on Signals KOLs this coming week—what’s your take? What questions do you have for the dialysis industry?
News
UTMB partners with NIPOKA to bring super-resolution kidney diagnostics to the U.S. The collaboration will introduce PEMP technology, enabling advanced biomarker analysis and high-resolution imaging for kidney disease detection (UTMB Health).
CareDx expands AlloSure to pediatric heart and pancreas-kidney transplant patients. The new validations broaden the use of its noninvasive rejection monitoring, potentially improving post-transplant care (CareDx).
China completes first pig kidney transplant in human patient. Surgeons at Xijing Hospital in Xi’an successfully transplanted a pig kidney into a 69-year-old woman, marking Asia’s first xenotransplantation (China Daily, h/t Raphael Meier).
Fresenius reports 18% operating income growth in 2024 annual report. The company highlights financial gains and its ongoing commitment to reducing its environmental footprint (Press release).
Pig kidney pioneers discuss next steps and first-ever clinical trials. Xenotransplantation leaders gathered in Orlando to assess progress and challenges as human trials advance (Healthcare Brew).
NYT explores the ethical tensions of xenotransplantation. While supporters highlight the life-saving potential, critics question animal cloning ethics and advocate for increased human organ donation (The New York Times).
Biogen has initiated the Phase 3 TRANSCEND study to evaluate felzartamab for treating late antibody-mediated rejection (AMR) in kidney transplant patients. AMR is a leading cause of transplant loss, affecting approximately 23,000 patients in the U.S. (Press release).
Strive Health expands kidney care partnership with Zing Health. The collaboration now covers Medicare Advantage members in Ohio, Tennessee, and Mississippi, in addition to existing markets in Illinois, Indiana, and Michigan (Strive Health, h/t Will Stokes).
Cincinnati Children’s licenses Renal Angina Index (RAI) to RAIDAR Health. The predictive tool for pediatric acute kidney injury (AKI) will help identify severe AKI within 72 hours of ICU admission, aiming to improve early intervention and reduce ICU stays (Cincinnati Children’s).
Novo Nordisk’s CagriSema shows 15.7% weight loss in phase 3 REDEFINE 2 trial. The obesity and type 2 diabetes treatment significantly outperformed placebo, with regulatory filings planned for 2026 (Press release).
Dr. Oz faces senators’ questions on healthcare cuts, calls CMS nomination a ‘monumental opportunity.’ Lawmakers grilled the former TV personality on Medicare policies and agency leadership (Healio Nephrology).
Research
Advancing Equitable Kidney Care Through Population Health Approaches in Los Angeles County's Safety Net System (CJASN, h/t Kam Kalantar-Zadeh)
The autoimmune architecture of childhood idiopathic nephrotic syndrome (Kidney International, h/t Davide Garrisi)
We Can Finally Stop Worrying About SGLT2 Inhibitors and Acute Kidney Injury (AJKD, h/t Edgar Lerma)
Long-Term Physical Exercise for Preventing CKD in Older Adults: A Randomized Clinical Trial (JASN, h/t Chang Alexander)
Expression of ENL YEATS domain tumor mutations in nephrogenic or stromal lineage impairs kidney development (Nature)
Prospective Cohort Study in Alport Syndrome Patients under Standard Therapy (Kidney International, h/t Julie Lin)
The Genetics of IgA Nephropathy: Implications for Future Therapies (Semin Nephrol)
Comparative assessment of the effects of dotinurad and febuxostat on the renal function in chronic kidney disease patients with hyperuricemia (scientific reports)
A Combination Approach to Improving Prognostication in Autosomal Dominant Polycystic Kidney Disease. Two Better Than One? (CJASN, h/t Sayna Norouzi)
IgA class-switched CD27−CD21+ B cells in IgA nephropathy (ndt)
Webinar: A new trial presented at Grand Rounds by Dr. F. Perry Wilson examined the impact of a "Kidney Action Team" for hospitalized patients with acute kidney injury (AKI). The study found that more personalized AKI alerts could lead to better clinical outcomes, addressing a condition that affects 15% of hospitalized patients and is linked to an 8.5% higher inpatient mortality rate (RCT).
Community
Advocacy & Innovation
Maze Tx launches Patient Advisory Committee. The PAC will amplify voices from the APOL1 kidney disease and CKD communities, featuring patient leaders Glenda Roberts, Curtis Warfield, Jamie Albright, Nichole Jefferson, Sharron Rouse, and Kevin Fowler (LinkedIn).
NIPOKA’s kidney diagnostics tech moves forward. Dr. Nicole Endlich confirmed UTMB Galveston will implement its PEMP method, allowing precise podocyte imaging and personalized disease prediction (LinkedIn, UTMB).
Radiofrequency renal denervation sees real-world validation. At CRT 2025, Dr. Jeremy Bock and VHC Health presented the largest U.S. patient cohort using this emerging hypertension treatment (LinkedIn).
Transplant pioneers reflect on progress. Charles Bearden shares how surgical PAs helped address transplant surgeon shortages in the 1970s, paying tribute to Dr. Bob Richie’s contributions (LinkedIn).
Alport Syndrome Foundation launches travel award. The new program aims to recruit and train more pediatric nephrologists, addressing a critical workforce shortage (ASPN Foundation).
Canada backs kidney tech innovation. Northernmost’s organ preservation pump, supported by Alberta Innovates, improves transplant viability by replacing traditional icebox storage (LinkedIn).
Education & Workforce Development
Dialysis & end-of-life care: Dr. Qasim Butt hosted a panel on DNR, palliative care, and "concurrent dialysis", a concept allowing patients to do both dialysis and hospice (Watch it here).
Renal Fellows Course continues to shape nephrology careers. Since 2008, MDIBL’s fellowship program has trained nearly 300 fellows, fully supported by NIDDK. A new Renal Fellow Network series highlights alumni reflections (Renalfellow.org).
NephMadness 2025 is live! The annual nephrology-themed tournament lets participants submit their brackets until March 31, with the champion revealed April 8 (Renal Fellow Network).
Inspiring the next generation of nephrology nurses. Teresa Villaran led a hands-on high school nephrology session, giving students their first venipuncture experience on simulated arms (LinkedIn).
The rising cost of middlemen in U.S. healthcare. The system spends $200B annually on billing, claims, and prior authorizations—as much as cancer treatment costs. Patients face growing financial barriers due to administrative complexity (Bloomberg).
World Kidney Day 🌍
Kidney Health Australia airs first national "End Dialysis by 2050" campaign. A television ad featuring Rodrigo, a dialysis patient, aims to raise awareness and drive kidney care momentum. (LBB)
Brazil sets records for World Kidney Day. With 1,200 activities nationwide and 10,000 point-of-care creatinine tests, this year’s campaign featured public walks, celebrity support, and illuminated landmarks (h/t Jose Moura-Neto).
Canadian kidney health leaders honored with King Charles III Coronation Medal. Dr. Clara Bohm, Ms. Shirley McLaren, Dr. Peter Nickerson, and Dr. Navdeep Tangri were recognized for their contributions to kidney health (h/t Nav Tangri).
Cross-border collaboration in transplantation. HLA & immunogenetics leaders from Cyprus, Greece, and Israel convened to expand patient access and improve outcomes, thanks to efforts by Chryso Pierides and Paul Costeas (Moshe Israeli).
Events Calendar
Annual Dialysis Conference (Mar 13-16)
LSI USA ‘25 (Mar 17-21)
RPA Annual Meeting (Apr 3-6)
NKF Spring Clinical Meetings (Apr 10-13)
KHI Kidney Innovation Conference (May 21-22)
Jobs
SVP Value-Based Care at Guaranteed
Transplant Manager (Remote) at Eurofins
VP, Healthcare at The Bliss Group
Director, Data Modernization at NNPHI
VP, Population Health at Interwell Health
Senior MSL, Nephrology (Eastern US) at Biogen
Manager, Life Science Partnerships at Flatiron Health
Dir, US Patient Marketing, Hem/Neph at AstraZeneca
Product Manager, Patient Engagement at Apellis Pharma
Palliative APP (Birmingham, AL) at Monogram Health
Head of Brand, Marketing, & Comms at Monogram Health
Sr. Director, Compliance & Privacy at Monogram Health
This issue is made possible by Guaranteed, the company optimizing end-of-life care experiences for CKD and ESRD patients at risk-bearing nephrology practices when conservative kidney management, dialysis and kidney transplants are no longer viable options. Email raihan@onguaranteed.com today to learn more. Thanks team!
Kidney Care Choices (KCC) Model: KCC builds upon the Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model structure – in which dialysis facilities, nephrologists, and other health care providers form ESRD-focused accountable care organizations to manage care for beneficiaries with ESRD – by adding strong financial incentives for health care providers to manage the care for Medicare beneficiaries with chronic kidney disease (CKD) stages 4 and 5 and ESRD, to delay the onset of dialysis and to incentivize kidney transplantation. The model has four payment options: CMS Kidney Care First (KCF) Option, Comprehensive Kidney Care Contracting (CKCC) Graduated Option, CKCC Professional Option, and CKCC Global Option. (cms.gov)
The Increasing Organ Transplant Access Model aims to increase access to life-saving transplants for patients living with end-stage renal disease and reduce Medicare expenditures. This model focuses on providing incentives to transplant hospitals to increase transplantation. Additionally, the model is designed to support greater care coordination, improved patient-centeredness in the process of being waitlisted for and receiving a kidney transplant, and greater access to kidney transplants. Through the model payments and policies, CMS aims to increase the care delivery capabilities and efficiency of kidney transplant hospitals selected for participation, with the goal of improving quality of care while reducing unnecessary spending. (cms.gov)