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Kidney Disease Statistics in Alabama, USA

Alabama faces one of the nation’s most serious and multifaceted kidney disease burdens. More than 13,600 residents are currently living with kidney failure — a fatal condition without dialysis or a transplant — and the state’s kidney disease mortality rate ranks 8th highest in the nation, with a five-year trend rising at 4.4% per year even as the national rate holds steady. At the same time, kidney and renal pelvis cancer incidence has climbed nearly 45% over two decades and continues to diverge from a falling national trend.

The crisis is rooted in Alabama’s high prevalence of the two leading causes of kidney failure: diabetes affects 14% of the adult population and high blood pressure afflicts 42.5%, together accounting for 73–77% of all kidney failure cases. These conditions fall most heavily on minority residents, who develop kidney failure at a rate 2.5 times higher than white Alabamians. The financial consequences are equally severe — dialysis patients face average out-of-pocket costs exceeding $10,000 per year against incomes that are on average below $25,000, and more than 80% are unable to work.

This article draws exclusively on publicly available state and national data to provide a comprehensive, year-by-year and county-by-county picture of kidney disease in Alabama. Coverage spans kidney failure prevalence and new cases, causes, risk factors, disease mortality, transplantation access and outcomes, transplant center performance, racial and financial disparities, charitable assistance, and kidney cancer incidence and mortality.

Chronic Kidney Disease (CKD)

CKD is the precursor condition to kidney failure. The following figures describe the known prevalence of diagnosed CKD among Alabama adults:

4.1% of Alabama adults report ever being told by a health professional that they have kidney disease (excluding kidney stones, bladder infections, and incontinence)
Alabama ranks 28th among states for self-reported kidney disease prevalence

A ranking of 28th places Alabama in the middle of the pack for self-reported CKD, but this figure likely understates the true burden given Alabama’s extremely high rates of diabetes and hypertension — the two leading risk factors.

Kidney Failure (ESRD)

Prevalence

The following table tracks the total number of Alabamians living with kidney failure across annual American Kidney Fund (AKF) reporting periods, along with how many are managed by dialysis versus a functioning transplant.

Fact Sheet Year	Total with Kidney Failure	On Dialysis	Living with Transplant
2021	13,598	10,210	3,388
2022	13,939	10,426	3,513
2023	13,906	10,310 (74.1%)	3,596 (25.9%)
2024	13,635	10,028	3,607
2025	13,636	9,947	3,689
2026	13,629	9,827	3,802

Overall prevalence peaked around 2022 (13,939) and has since plateaued near 13,600–13,630. The most encouraging trend is the steady increase in patients living with a transplant — from 3,388 in 2021 to 3,802 in 2026 — while the number on dialysis has declined from 10,426 to 9,827 over the same period.

New Cases of Kidney Failure

The table below compiles the most recently available data on new diagnoses, showing the share that received a transplant versus starting dialysis immediately.

Diagnosis Year	New Cases	Received Transplant	Started Dialysis
2018	2,309	41 (1.8%)	2,268 (98.2%)
2019	2,418	46 (1.9%)	2,372 (98.1%)
2020	2,397	48 (2.0%)	2,349 (98.0%)
2021	2,461	30 (1.2%)	2,431 (98.8%)
2022	2,332	39 (1.7%)	2,293 (98.3%)
2023	2,308	53 (2.3%)	2,255 (97.7%)

The overwhelming majority — 97–99% — of newly diagnosed kidney failure patients begin dialysis rather than receiving a transplant.

Leading Causes of Kidney Failure

Diabetes and high blood pressure are the dominant drivers of kidney failure in Alabama.

Data Year	Diabetes	High Blood Pressure
202	47%	30%
2023	47%	28%
2024	44%	29%
2025	43%	30%

Diabetes and high blood pressure together account for approximately 73–77% of all kidney failure cases in Alabama.

Risk Factors in the Alabama Population

14.0% of Alabamians have been diagnosed with diabetes
42.5% have high blood pressure
36.1% self-report as obese

More than four in ten Alabama residents have high blood pressure — the second leading cause of kidney failure — and over a third are obese.

ESRD Incidence by Race (2021)

Kidney failure falls disproportionately on Alabama’s minority and lower-income populations.

Non-white Alabamians: 813 per million per year
White Alabamians: 329 per million per year
Statewide average: 475 per million per year

The non-white incidence rate is approximately 2.5 times higher than the white rate.

Kidney and Renal Pelvis Cancer

In addition to kidney failure, Alabama carries an elevated burden of kidney and renal pelvis cancer (ICD codes C64–C65). The state’s incidence rate exceeds the national average and is rising while the U.S. trend falls.

State vs. National Comparison

Age-Adjusted Incidence Rate (per 100,000): Alabama 18.8 vs. United States 17.5
Annual Percent Change, 2002–2022: Alabama +1.8% (rising) vs. United States −1.0% (falling)

Year-by-Year Incidence Trend (All Races, Both Sexes, All Ages)

The table below shows both the observed incidence rate and the model-estimated trend rate for Alabama from 2002 to 2022.

Year	Observed Rate	Estimated Rate
2002	13.1	14.1
2003	13.7	14.3
2004	14.9	14.6
2005	15.2	14.8
2006	14.5	15.1
2007	15.0	15.4
2008	16.1	15.7
2009	17.1	15.9
2010	16.3	16.2
2011	15.8	16.5
2012	17.9	16.8
2013	17.2	17.1
2014	17.1	17.4
2015	18.2	17.8
2016	18.6	18.1
2017	18.5	18.4
2018	18.5	18.8
2019	19.8	19.1
2020	17.3	19.4
2021	19.4	19.8
2022	19.0	20.2

Over two decades, Alabama’s kidney cancer incidence has risen from 13.1 to 19.0 per 100,000 — a nearly 45% increase — at a pace of +1.8% per year. This trend runs directly counter to the national trajectory of −1.0% per year.

Incidence by Sex and Race

Sex and Race Comparison

Group	Case Count	MV (%)	DCO (%)	ASR-W
Male (All Races)	2,660	92.0%	2.9%	15.4
Female (All Races)	1,685	91.4%	—	8.2
Male, White	2,136	—	—	15.7
Female, White	1,293	91.7%	4.0%	8.4
Male, Black	513	88.3%	3.7%	15.0
Female, Black	389	90.2%	4.4%	8.4

MV = Microscopically Verified %; DCO = Death Certificate Only %; ASR-W = Age-Standardized Rate, World standard

Female Incidence

Racial Group	Rate (per 100,000)	10-Year Count
All Races	13.3	4,344
White	13.4	3,170
Black	14.0	1,123

Men bear nearly twice the kidney cancer incidence burden as women (ASR-W: 15.4 vs. 8.2). Racial disparities in kidney cancer incidence are modest: Black women have a slightly higher rate (14.0) than white women (13.4), while male ASR-W rates are nearly identical for white (15.7) and Black (15.0) patients.

County-Level Kidney and Renal Pelvis Cancer Incidence (2018–2022)

The table below shows age-adjusted incidence rates for kidney and renal pelvis cancer by Alabama county, sorted by recent 5-year annual percent change (AAPC). Counties marked with * have trend data suppressed due to insufficient case counts. Rural/urban classification is based on 2023 Rural-Urban Continuum Codes.

County	Rural/Urban	Rate (per 100,000)	95% CI	Avg Annual Count	Trend	5-Year AAPC
Alabama (Statewide)	—	18.8	(18.3, 19.3)	1,180	Rising	+1.8%
US (SEER+NPCR)	—	17.5	(17.5, 17.6)	70,592	Falling	−1.0%
Chambers	Rural	26.5	(20.0, 34.6)	12	Rising	+5.0%
Covington	Rural	17.9	(12.6, 24.8)	9	Rising	+3.9%
Colbert	Urban	25.8	(20.9, 31.6)	21	Rising	+3.7%
Crenshaw	Rural	35.4	(22.9, 52.5)	6	Stable	+3.6%
Barbour	Rural	23.3	(16.4, 32.3)	8	Stable	+3.5%
Pike	Rural	17.1	(11.6, 24.5)	7	Stable	+3.5%
Elmore	Urban	20.1	(16.4, 24.6)	21	Rising	+3.3%
Cullman	Rural	19.1	(15.4, 23.5)	21	Rising	+3.1%
Marengo	Rural	19.6	(12.5, 29.7)	5	Stable	+3.1%
Lauderdale	Urban	22.6	(18.7, 27.1)	27	Rising	+2.9%
Montgomery	Urban	19.9	(17.5, 22.6)	52	Rising	+2.9%
Etowah	Urban	20.4	(17.1, 24.3)	29	Rising	+2.7%
Monroe	Rural	18.3	(12.1, 27.1)	6	Stable	+2.7%
Pickens	Urban	20.2	(13.0, 30.5)	5	Stable	+2.7%
Mobile	Urban	20.5	(18.7, 22.4)	102	Rising	+2.6%
Coffee	Rural	21.4	(16.6, 27.3)	14	Stable	+2.4%
DeKalb	Rural	17.1	(13.3, 21.6)	15	Stable	+2.3%
Jackson	Rural	20.1	(15.7, 25.6)	15	Stable	+2.1%
Walker	Urban	23.2	(18.6, 28.7)	20	Rising	+2.1%
Autauga	Urban	20.3	(15.9, 25.8)	15	Stable	+2.0%
Clarke	Rural	18.5	(12.5, 26.9)	6	Stable	+2.0%
Dale	Rural	14.4	(10.4, 19.4)	9	Stable	+2.0%
Marshall	Rural	16.6	(13.3, 20.4)	19	Stable	+1.9%
Morgan	Urban	20.8	(17.6, 24.5)	32	Rising	+1.9%
Clay	Rural	20.8	(12.1, 33.7)	4	Stable	+1.8%
Houston	Urban	22.5	(18.9, 26.6)	30	Stable	+1.8%
Madison	Urban	19.2	(17.4, 21.1)	89	Rising	+1.8%
Tallapoosa	Rural	20.2	(15.0, 26.9)	12	Stable	+1.8%
Baldwin	Urban	19.2	(17.1, 21.6)	64	Rising	+1.6%
Franklin	Rural	19.4	(13.4, 27.3)	7	Stable	+1.4%
Escambia	Rural	18.7	(13.5, 25.4)	9	Stable	+0.7%
St. Clair	Urban	18.4	(15.0, 22.4)	22	Stable	+0.7%
Jefferson	Urban	17.3	(16.0, 18.7)	141	Stable	+0.6%
Lee	Urban	14.7	(12.2, 17.6)	25	Stable	+0.5%
Cherokee	Rural	20.4	(13.6, 29.7)	7	Stable	+0.4%
Lawrence	Urban	19.8	(14.1, 27.0)	9	Stable	+0.4%
Chilton	Urban	20.2	(15.0, 26.6)	11	Stable	+0.3%
Talladega	Rural	17.5	(14.0, 21.6)	19	Stable	+0.3%
Coosa	Rural	17.4	(9.6, 30.7)	3	Stable	+0.1%
Russell	Urban	14.4	(10.6, 19.1)	10	Stable	−0.1%
Tuscaloosa	Urban	16.3	(14.0, 18.8)	40	Stable	−0.1%
Shelby	Urban	15.1	(13.0, 17.3)	41	Stable	−0.3%
Conecuh	Rural	16.2	(9.3, 27.6)	3	Stable	−0.5%
Blount	Urban	16.5	(12.4, 21.4)	12	Stable	−0.8%
Randolph	Rural	14.6	(8.8, 23.0)	5	Stable	−1.3%
Hale	Urban	20.3	(12.1, 32.3)	4	Stable	−3.3%
Geneva	Urban	13.7	(9.1, 20.2)	6	Stable	−3.4%
Calhoun	Urban	23.1	(19.5, 27.1)	33	Falling	−5.7%
Henry	Urban	19.7	(12.9, 29.4)	6	Stable	−6.0%
Limestone	Urban	19.0	(15.6, 22.8)	24	Stable	−7.7%
Dallas	Rural	16.4	(11.6, 22.7)	8	Stable	−7.8%
Marion	Rural	13.8	(9.1, 20.2)	6	Stable	−13.6%
Bibb	Urban	16.1	(10.1, 24.5)	5	Falling	−18.9%
Fayette	Rural	22.4	(14.3, 33.9)	5	Stable	−31.7%
Butler	Rural	16.6	(9.9, 26.4)	4	*	*
Lamar	Rural	28.5	(18.1, 43.1)	5	*	*
Lowndes	Urban	23.8	(13.2, 40.1)	3	*	*
Macon	Urban	16.5	(9.7, 26.6)	4	*	*
Washington	Rural	19.7	(11.6, 31.7)	4	*	*
Winston	Rural	21.2	(14.3, 30.6)	7	*	*

*Trend data suppressed due to insufficient case counts.

Crenshaw County has the highest kidney cancer incidence rate at 35.4 per 100,000 — nearly double the national average of 17.5. Lamar (28.5), Chambers (26.5), Colbert (25.8), and Walker (23.2) are also well above state and national norms.

Kidney Transplantation Statistics

Waiting List

The number of Alabamians waiting for a kidney transplant has declined slightly in recent years, though demand far exceeds supply:

2021: 1,110 patients
2022: 984 patients
2023 (as of February 17, 2023): 1,049 patients
2024: 1,009 patients
2025: 1,001 patients
2026: 1,001 patients

With approximately 1,000 patients on the waiting list and roughly 260–310 transplants performed annually, the system can only serve about 25–30% of those waiting each year.

Kidney Transplants Performed Annually

The following table presents the number of kidney transplants performed in Alabama by year, divided between living and deceased donor procedures.

Year	Total Transplants	Living Donor	Deceased Donor
2020	361	—	—
2021	320	—	—
2021	339	57	282
2022	308	54	254
2023	276	58	218
2024	270	55	215
2025	262	52	210

Note: The 2021 discrepancy between SHPDA (320) and AKF (339) likely reflects different counting methodologies or included populations.

Kidney Transplant Centers in Alabama

Alabama has four kidney transplant centers. The following tables summarize their donor and recipient program features. (Data period: NKR transplants = last 12 months; prior-year living donor figures = 04/01/2025–03/31/2026.)

Donor Program Features

Rank	Center	NKR Tx (Last 12 Mo)	Deceased Donor Priority	Living Donor Priority	NKR Shield	Remote Donation	Voucher Program	NKR Member	Equal Access	Donor Referral Network
1	University of Alabama at Birmingham (UAB)	6	Y	Y	Y	Y	Y	Y	N	Y
2	Birmingham VA Medical Center	0	N	N	N	N	N	N	N	N
3	Children’s of Alabama	0	N	N	N	N	N	N	N	N
4	USA Health (USA Medical Center)	0	N	N	N	N	N	N	N	N
Totals	6	1	1	1	1	1	1	0	1

Recipient Program Features

Rank	Center	Living Donor Tx (Prior Year)	NKR Tx (Last 12 Mo)	NKR LD Tx (Prior Year)	NKR % of LD Tx	Low Eplet Tx (Last 12 Mo)	Voucher	NKR Member	Equal Access
1	UAB	52	6	1	2%	4	Y	Y	N
2	Birmingham VA	0	0	0	0%	0	N	N	N
3	Children’s of Alabama	3	0	0	0%	0	N	N	N
4	USA Health	0	0	0	0%	0	N	N	N
Totals	55	6	1	2%	4	1	1	0

UAB dominates Alabama’s transplant ecosystem, accounting for all NKR-linked transplant activity and nearly all living donor procedures (52 of 55 in the prior year). It is the only center participating in the NKR prioritization programs, Shield, Remote Donation, Voucher Program, and Donor Referral Network.

Transplant Outcomes

Only centers with sufficient transplant volume are reported; UAB is the only adult center with reportable data, and Children’s of Alabama is the only pediatric center.

Adult Outcomes — University of Alabama at Birmingham (UAB)

The following survival figures cover the most recent reporting period (NKR Tx last 12 months: 6; Living donor Tx prior year: 52).

Outcome Measure	Living Donor	Deceased Donor
1-Year Graft Survival	98%	95%
3-Year Graft Survival	96%	82%
1-Year Patient Survival	99%	97%
3-Year Patient Survival	97%	84%

(LD = Living Donor; DD = Deceased Donor)

Pediatric Outcomes — Children’s of Alabama

The following figures cover Children’s of Alabama (NKR Tx last 12 months: 0; Living donor Tx prior year: 3).

Outcome Measure	Living Donor	Deceased Donor
1-Year Graft Survival	100%	93%
3-Year Graft Survival	100%	88%
1-Year Patient Survival	100%	100%
3-Year Patient Survival	100%	100%

Transplant outcomes at Alabama’s reporting centers are strong. UAB’s 1-year graft and patient survival rates are excellent for both donor types.

Kidney Disease and Kidney and Renal Pelvis Cancer Mortality Statistics

Kidney Disease Mortality

The following table compares Alabama’s kidney disease mortality to national figures.

Metric	Alabama	United States
Age-Adjusted Death Rate (per 100,000)	18.7	13.4
Age-Standardized Rate	19.0	—
National Mortality Ranking	8th highest	—
Average Annual Deaths (2019–2023)	~1,176	~54,332
Annual Deaths (alternate count)	~1,236	—
Recent 5-Year Trend	Rising (+4.4%)	Stable (0.0%)

Alabama’s kidney disease death rate is approximately 40% above the national average and ranks 8th highest among all states.

County-Level Kidney Disease Death Rates (2019–2023)

The table below shows age-adjusted kidney disease (nephritis and nephrosis) death rates for all Alabama counties. “N/A” in the trend column indicates insufficient data for trend calculation.

County	Rate (per 100,000)	95% CI	Avg Annual Deaths	5-Year Trend
Alabama (Statewide)	18.7	(18.2, 19.2)	1,176	Rising (+4.4%)
United States	13.4	(13.3, 13.4)	54,332	Stable (0.0%)
Barbour	31.9	(23.9, 41.9)	11	N/A
Marshall	28.4	(24.2, 33.2)	34	Rising (+6.8%)
DeKalb	27.7	(22.9, 33.3)	24	Rising (+11.7%)
Macon	27.3	(18.5, 39.2)	7	N/A
Hale	27.0	(17.3, 40.4)	5	N/A
Perry	26.9	(15.8, 44.3)	4	N/A
Covington	26.5	(20.6, 33.7)	15	N/A
Greene	26.5	(14.0, 46.7)	3	N/A
Crenshaw	26.1	(15.9, 40.7)	4	N/A
Etowah	26.1	(22.3, 30.5)	34	Stable
Clarke	25.6	(18.4, 35.0)	9	N/A
Wilcox	24.8	(14.4, 40.5)	4	N/A
Mobile	24.5	(22.5, 26.5)	121	Rising (+7.6%)
Fayette	24.2	(15.9, 35.7)	6	N/A
Russell	23.8	(18.6, 30.0)	15	N/A
Marengo	23.7	(16.0, 34.1)	6	N/A
Washington	23.2	(14.7, 35.3)	5	N/A
Jackson	21.7	(17.2, 27.2)	17	Stable
Cherokee	21.3	(15.0, 29.8)	9	N/A
Autauga	20.9	(16.3, 26.4)	15	Rising (+12.9%)
Montgomery	20.7	(18.3, 23.4)	54	Rising (+2.7%)
Marion	20.4	(14.7, 27.9)	9	N/A
Morgan	20.4	(17.3, 23.9)	32	Falling (−1.6%)
Talladega	20.2	(16.5, 24.6)	22	Stable
Clay	20.0	(12.5, 31.3)	4	N/A
Cullman	20.0	(16.5, 24.1)	24	Stable
Monroe	19.5	(12.7, 29.1)	6	N/A
Dallas	19.4	(14.1, 26.2)	10	N/A
Randolph	19.3	(13.2, 27.8)	7	N/A
Colbert	19.0	(14.8, 24.0)	15	Stable
Houston	19.0	(15.8, 22.6)	26	Stable
Chambers	18.4	(13.4, 24.9)	9	N/A
Pike	18.4	(12.8, 25.9)	7	N/A
St. Clair	18.4	(15.0, 22.3)	22	Stable
Jefferson	18.3	(17.0, 19.7)	146	Falling (−1.9%)
Escambia	18.2	(13.2, 24.7)	9	N/A
Henry	18.0	(11.7, 27.4)	5	N/A
Lawrence	17.9	(12.8, 24.6)	8	N/A
Calhoun	17.6	(14.6, 21.0)	26	Falling (−2.1%)
Geneva	17.5	(11.9, 25.1)	7	N/A
Tuscaloosa	17.5	(15.1, 20.1)	40	Falling (−1.8%)
Tallapoosa	17.1	(12.6, 22.9)	11	N/A
Blount	17.0	(13.0, 21.9)	13	N/A
Coffee	17.0	(12.9, 22.1)	12	N/A
Dale	17.0	(12.6, 22.5)	10	N/A
Lamar	16.8	(10.0, 27.3)	4	N/A
Madison	16.5	(14.9, 18.3)	76	Stable
Bibb	16.4	(10.4, 25.0)	5	N/A
Elmore	16.4	(13.0, 20.4)	17	Stable
Walker	15.8	(12.2, 20.1)	14	Stable
Chilton	15.7	(11.3, 21.3)	9	N/A
Cleburne	15.4	(8.7, 25.8)	3	N/A
Butler	15.2	(9.2, 24.1)	4	N/A
Franklin	15.1	(10.1, 21.8)	6	N/A
Lauderdale	15.1	(12.2, 18.4)	21	Stable
Baldwin	14.8	(12.9, 16.9)	49	Stable
Pickens	14.8	(8.8, 23.7)	4	N/A
Winston	14.8	(9.9, 21.8)	6	N/A
Limestone	14.3	(11.3, 17.8)	17	Falling (−2.6%)
Choctaw	14.2	(8.1, 24.4)	3	N/A
Lee	13.4	(10.9, 16.2)	21	Falling (−2.4%)
Shelby	9.0	(7.5, 10.8)	24	Falling (−4.1%)

Geographic disparities are stark. Barbour County (31.9) has a death rate 3.5 times higher than Shelby County (9.0), the state’s lowest.

Kidney and Renal Pelvis Cancer — Mortality

The following mortality data covers the combined 2014–2023 period (rates per 100,000, age-adjusted):

Group	Rate (per 100,000)	Count (10-year total)
Male & Female, All Races	3.7	2,329
Male & Female, White	3.8	1,834
Male & Female, Black	3.6	479
Male, All Races	5.6	1,534
Male, White	5.6	1,225
Male, Black	5.5	299
Female, All Races	2.3	795
Female, White	2.3	609
Female, Black	2.3	180

Cross-check: Male count (1,534) + Female count (795) = 2,329 total ✓

Kidney cancer mortality in Alabama is strongly sex-differentiated: men die from kidney cancer at 5.6 per 100,000, approximately 2.4 times the female rate of 2.3 per 100,000. Notably, racial differences in mortality are minimal: white and Black males have essentially identical mortality rates (5.6 vs. 5.5), and white and Black females have the same rate (2.3).

Financial Assistance from the American Kidney Fund (AKF)

AKF provides charitable grants to low-income Alabama dialysis and transplant patients to cover insurance premiums and other health care costs not covered by insurance. The following table tracks grant recipients and total assistance by year.

AKF Grants to Alabama Patients

Year	Patients Assisted	Total Assistance
2020	1,997	~$5,400,000
2021	1,627	$5,502,798
2022	1,372	$4,801,138
2023	1,254	$4,348,149
2024	1,216	$4,691,804
2025	1,266	Not reported

Demographics of AKF-Assisted Patients

More than 60% of Alabamians receiving AKF charitable assistance are minorities:

Black: 34.7%
Hispanic/Latino: 20.9%
Native American/Asian/Pacific Islander: 5.2%

Financial Burden

Average annual income of AKF-assisted patients: less than $25,000
Average annual out-of-pocket costs for dialysis patients: more than $10,000
More than 80% of dialysis patients cannot work (kidney failure is classified as a disability)

Financial hardship compounds the medical burden: patients with incomes below $25,000 face out-of-pocket dialysis costs exceeding 40% of their annual income. Given that over 80% of dialysis patients cannot work, the financial strain is largely unaddressable without external assistance, making charitable and public insurance programs critical to patient survival.

Insurance Breakdown of AKF-Assisted Alabama Patients

The table below shows the insurance type distribution among patients receiving AKF charitable premium assistance.

Insurance Type	2021	2022	2023	2024
Medicare Part B	36.8%	40.9%	44.6%	25.0%
Medigap	31.1%	27.2%	23.4%	27.3%
Employer Group Health Plans (incl. COBRA)	18.9%	17.7%	17.2%	20.1%
Medicare Advantage	1.2%	1.3%	1.4%	0.6%
Commercial Plans	10.5%	—	—	—
Exchange	3.4%	—	—	—
Annuity	1.5%	—	—	—
Medicaid (states with premiums)	0.1%	—	—	—

AKF assistance to Alabama patients has declined substantially from a peak of 1,997 patients receiving ~$5.4 million in 2020 to 1,216–1,266 patients and $4.3–$4.7 million in 2024–2025. This reduction may reflect changes in eligibility criteria, improved insurance coverage, or reduced program capacity.

Conclusion

The data compiled here reveals a state confronting a deepening kidney disease crisis on every front simultaneously. Kidney failure prevalence has grown by 16–41% over the past 13–17 years depending on the baseline used, and while total case counts have plateaued near 13,600, this plateau is partly sustained by high mortality among existing patients rather than any genuine reduction in disease burden. Alabama’s kidney disease death rate — already 40% above the national average — continues to rise at 4.4% annually while the national trend is flat, and the state ranks 8th highest in the nation. County-level disparities add further depth to this picture: several rural Black Belt counties report death rates more than three times that of the state’s lowest-burden county, Shelby.

The transplant system is unable to meet the scale of need. With approximately 1,000 Alabamians on the kidney transplant waiting list and only 262 transplants performed in 2025, fewer than 30% of waiting patients receive an organ in any given year. The long-term decline in living donor transplants — down 33–51% compared to baseline years from a decade ago — compounds this shortfall, since living donor kidneys consistently deliver better long-term graft and patient survival than deceased donor organs, as the outcomes data from UAB clearly show. Alabama’s single dominant transplant center at UAB delivers strong clinical results but concentrates nearly all the state’s advanced matching programs, leaving patients at the other three centers with far fewer pathways to transplantation.

The upstream drivers of Alabama’s kidney disease burden show no signs of retreating. Rates of diabetes, hypertension, and obesity remain at very high levels; kidney and renal pelvis cancer incidence has risen continuously since 2002 at 1.8% per year and now exceeds the national rate, while the national trend moves in the opposite direction. With most Alabama counties showing stable to rising incidence trends, and a statewide kidney failure death rate on an upward trajectory, a meaningful reversal will require sustained investment in preventive care targeting diabetes and hypertension, expanded transplant access, targeted outreach in the highest-burden communities, and policies that address the severe financial hardship kidney failure imposes on patients and their families.