Kidney disease is one of the most pressing public health challenges facing Iowa today. The term encompasses a wide spectrum of conditions — from early-stage chronic kidney disease (CKD) through end-stage renal failure (ESRD) requiring lifelong dialysis or a transplant, as well as kidney cancer. These conditions collectively affect thousands of Iowans, impose an enormous financial burden, and place growing pressure on the state’s transplant system and health care infrastructure.
Iowa is home to more than 5,500 residents currently living with kidney failure, a number that has climbed steadily over the past decade. The state’s kidney cancer incidence rate exceeds the national average and continues to rise even as national rates decline. Meanwhile, kidney disease death rates are trending upward in Iowa while falling nationally — a troubling divergence that points to the need for greater attention to prevention, early detection, and access to care.
This article presents a comprehensive statistical overview of kidney diseases in Iowa, drawing on data from transplant center reporting, state and national cancer registries, Medicare records, and disease surveillance systems. It covers CKD prevalence, kidney failure trends, new diagnoses, transplant activity and outcomes, cancer incidence and mortality, county-level geographic variation, and the financial impact on patients.
Chronic Kidney Disease (CKD)
Chronic kidney disease is the gradual loss of kidney function over time. The figures below reflect the percentage of Iowa adults who reported ever being told by a health professional that they have kidney disease, explicitly excluding kidney stones, bladder infection, and incontinence.
- Percentage of Iowa adults ever diagnosed with kidney disease: 3.8%
- Iowa’s national ranking among all states: 19th
Iowa’s CKD prevalence rate of 3.8% places it near the national midpoint (19th), indicating a moderate disease burden relative to other states.
Kidney Failure (ESRD)
Kidney failure (end-stage renal disease, or ESRD) is the most severe stage of kidney disease. Without treatment — either dialysis or a transplant — it is fatal. The following data covers the scale and growth of the kidney failure population, the volume of new diagnoses each year, and the systemic conditions driving the disease.
Scale and Trends
Statewide Kidney Failure Population
The table below tracks the kidney failure population in Iowa across available years.
| Year | Iowans Living with Kidney Failure | On Dialysis | Living with Transplant | On Transplant Waiting List |
| 2021 | 5,297 | 2,996 | 2,301 | 519 |
| 2024 | 5,410 | 2,970 | 2,440 | 552 |
| 2026 | 5,513 | 3,030 | 2,483 | 560 |
The kidney failure population in Iowa has grown steadily — from 5,297 to 5,513 over roughly five years. Dialysis consistently accounts for the majority of treatment, while transplant recipients represent approximately 44–45% of those living with kidney failure.
Medicare-Specific Data
The following figures reflect Iowa patients covered under Medicare specifically:
- Patients on Medicare diagnosed with CKD: 1,918
- Medicare patients on dialysis: 2,761
- Medicare patients living with kidney transplant: 3,676
- Medicare patients on transplant waitlist: 604
- Patients who died while on transplant waitlist (2016): 1
New Diagnoses
Each year, hundreds of Iowans receive a new kidney failure diagnosis. The figures below track the volume of new cases and how patients entered treatment across available data years.
| Year | New Cases | Received Transplant | Began Dialysis |
| 2018 | 896 | 46 | 850 |
| 2021 | 964 | 46 | 918 |
| 2023 | 897 | 33 | 864 |
Among newly diagnosed kidney failure patients, the overwhelming majority begin dialysis rather than receiving a transplant. In 2023, only 33 out of 897 newly diagnosed Iowans — roughly 1 in 27 — received a kidney transplant at the time of diagnosis.
Leading Causes and Risk Factors
Kidney failure rarely arises in isolation. Two systemic conditions — diabetes and high blood pressure — are responsible for the large majority of kidney failure cases, and both are widespread in the Iowa population.
Leading Causes of Kidney Failure
- Diabetes: 44%
- High blood pressure: 29%
- Combined share: ~73%
Iowa Population Risk Factors
- Diagnosed with diabetes: 10.3% of Iowa adults
- Have high blood pressure: 31.8% of Iowa adults
- Self-report as obese: 33.9% of Iowa adults
Diabetes and hypertension together account for nearly three-quarters of all kidney failure cases in Iowa. With more than 31% of Iowans having high blood pressure and over 10% having diabetes — plus nearly 34% reporting obesity, a major driver of both conditions — the risk factors fueling future kidney failure are deeply embedded in the state’s population.
Kidney Cancer
Kidney and renal pelvis cancer is a significant and growing component of Iowa’s overall cancer burden, with incidence and mortality rates that exceed the national average and are moving in the opposite direction. The following data covers estimated new cases, deaths, survivors, statewide rates versus the U.S., and county-level geographic variation.
New Cases
| Year | Estimated New Cases | % of All Iowa Cancers | Total Iowa Cancer Cases |
| 2025 | 860 | 4.0% | 21,200 |
| 2026 | 950 | 4.4% | 21,700 |
Cancer Deaths
Estimated deaths from kidney and renal pelvis cancer among Iowa residents:
- 2025: 170 deaths — 2.7% of all Iowa cancer deaths (total: 6,300)
- 2026: 200 deaths — 3.1% of all Iowa cancer deaths (total: 6,400)
Cancer Survivors
| Year | Survivors | % of All Cancer Survivors | Total Iowa Cancer Survivors |
| 2025 | 7,200 | 4.2% | 171,535 |
| 2026 | 7,500 | 3.9% | 191,560 |
Among all cancer types, kidney and renal pelvis cancer ranks 9th for number of survivors in Iowa in 2026.
Iowa vs. U.S. Rates
Incidence Rate (2018–2022)
- Iowa: 21.2 per 100,000 — 839 average annual cases — trend: Rising (+1.6%/yr)
- United States: 17.5 per 100,000 — 70,592 average annual cases — trend: Falling (−1.0%/yr)
Mortality Rate (2020–2024)
- Iowa: 4.1 deaths per 100,000
- United States: 3.4 deaths per 100,000
Iowa’s kidney cancer incidence rate of 21.2 per 100,000 is approximately 21% higher than the national rate of 17.5 — and the divergence is growing.
County Cancer Incidence Rates (2018–2022)
The following table presents age-adjusted incidence rates for kidney and renal pelvis cancer by Iowa county, sorted from lowest to highest rate. Iowa’s overall rate (21.2) substantially exceeds the U.S. rate (17.5).
| County | Urban/Rural | Incidence Rate (per 100,000) | 95% CI | Avg. Annual Cases | 5-Year Trend |
| Mahaska County | Rural | 14.2 | (8.5–22.6) | 4 | * |
| Sioux County | Rural | 15.1 | (10.3–21.4) | 7 | Stable |
| Henry County | Rural | 15.3 | (9.2–24.1) | 4 | * |
| Story County | Urban | 15.4 | (11.9–19.6) | 14 | Rising |
| Dallas County | Urban | 16.1 | (12.8–20.0) | 17 | Stable |
| Clay County | Rural | 16.5 | (9.9–26.4) | 4 | * |
| Johnson County | Urban | 17.0 | (14.1–20.3) | 25 | Stable |
| Des Moines County | Rural | 17.1 | (12.3–23.2) | 9 | Stable |
| Webster County | Rural | 17.1 | (12.0–23.8) | 8 | Stable |
| Cerro Gordo County | Rural | 17.2 | (12.7–23.0) | 11 | Rising |
| Carroll County | Rural | 17.2 | (10.9–26.2) | 5 | Stable |
| Delaware County | Rural | 17.7 | (10.6–28.1) | 4 | * |
| Grundy County | Urban | 18.0 | (10.5–29.6) | 4 | * |
| Jones County | Urban | 18.0 | (11.8–26.8) | 6 | Stable |
| Poweshiek County | Rural | 18.2 | (11.0–28.7) | 4 | * |
| Page County | Rural | 18.2 | (11.0–29.1) | 4 | Stable |
| Warren County | Urban | 18.3 | (13.7–24.0) | 11 | Stable |
| Allamakee County | Rural | 18.5 | (11.4–29.3) | 4 | Stable |
| Hardin County | Rural | 18.5 | (11.4–28.9) | 5 | Stable |
| Cedar County | Rural | 19.2 | (12.1–29.4) | 5 | * |
| Mills County | Urban | 19.3 | (11.6–30.8) | 4 | * |
| Tama County | Rural | 19.4 | (11.7–30.6) | 4 | Stable |
| Madison County | Urban | 19.7 | (12.2–30.7) | 4 | * |
| Iowa County | Rural | 19.8 | (12.3–30.5) | 5 | Stable |
| Jasper County | Urban | 20.0 | (14.8–26.6) | 10 | * |
| Wapello County | Rural | 20.0 | (14.4–27.3) | 9 | Rising |
| Dubuque County | Urban | 20.2 | (16.7–24.2) | 26 | Rising |
| Black Hawk County | Urban | 20.3 | (17.1–23.9) | 31 | Rising |
| Washington County | Urban | 20.6 | (13.5–30.1) | 6 | * |
| Bremer County | Urban | 20.6 | (14.0–29.5) | 7 | * |
| Lyon County | Rural | 20.8 | (11.9–34.4) | 3 | * |
| Louisa County | Rural | 20.9 | (11.5–35.5) | 3 | * |
| O’Brien County | Rural | 21.0 | (12.4–33.5) | 4 | * |
| Dickinson County | Rural | 21.0 | (13.2–32.1) | 6 | * |
| Scott County | Urban | 21.1 | (18.4–24.2) | 45 | Rising |
| Clayton County | Rural | 21.1 | (13.3–32.3) | 5 | Stable |
| Polk County | Urban | 21.5 | (19.7–23.4) | 113 | Rising |
| Buchanan County | Rural | 21.5 | (14.1–31.5) | 6 | Stable |
| Linn County | Urban | 21.5 | (19.1–24.2) | 58 | Rising |
| Wright County | Rural | 21.8 | (12.6–35.6) | 4 | * |
| Harrison County | Urban | 22.4 | (13.7–34.9) | 5 | * |
| Winneshiek County | Rural | 22.7 | (15.0–33.2) | 7 | * |
| Shelby County | Rural | 22.8 | (12.9–37.7) | 4 | * |
| Fayette County | Rural | 22.8 | (15.1–33.3) | 6 | Stable |
| Jackson County | Rural | 23.1 | (15.6–33.4) | 7 | * |
| Woodbury County | Urban | 23.4 | (19.5–27.7) | 27 | Rising |
| Jefferson County | Rural | 23.6 | (14.8–36.3) | 5 | * |
| Chickasaw County | Rural | 23.6 | (14.2–37.7) | 4 | * |
| Cherokee County | Rural | 23.8 | (13.5–39.2) | 4 | * |
| Pottawattamie County | Urban | 24.3 | (20.4–28.8) | 30 | Rising |
| Marshall County | Rural | 24.5 | (18.4–32.0) | 12 | Rising |
| Humboldt County | Rural | 24.7 | (13.7–41.8) | 3 | * |
| Guthrie County | Urban | 24.8 | (14.1–41.1) | 4 | * |
| Kossuth County | Rural | 25.1 | (16.2–37.7) | 6 | Rising |
| Hamilton County | Rural | 25.7 | (16.1–39.0) | 5 | Rising |
| Butler County | Rural | 25.7 | (16.2–39.1) | 5 | Stable |
| Marion County | Rural | 25.9 | (19.2–34.3) | 11 | Stable |
| Muscatine County | Rural | 25.9 | (20.0–33.2) | 14 | Rising |
| Union County | Rural | 26.7 | (16.0–42.1) | 4 | * |
| Benton County | Urban | 26.6 | (19.2–36.1) | 9 | Rising |
| Crawford County | Rural | 26.9 | (17.6–39.6) | 6 | Stable |
| Plymouth County | Rural | 27.1 | (19.6–36.6) | 9 | * |
| Boone County | Urban | 27.1 | (19.8–36.4) | 10 | * |
| Cass County | Rural | 27.5 | (17.0–42.3) | 5 | * |
| Floyd County | Rural | 28.0 | (18.4–41.0) | 6 | * |
| Keokuk County | Rural | 28.3 | (16.6–45.7) | 4 | * |
| Franklin County | Rural | 28.7 | (16.8–46.3) | 4 | * |
| Lee County | Rural | 28.9 | (22.0–37.5) | 13 | Rising |
| Clinton County | Rural | 29.0 | (23.0–36.1) | 18 | Rising |
| Monona County | Rural | 31.4 | (18.3–51.2) | 4 | * |
| Decatur County | Rural | 32.8 | (18.2–55.2) | 3 | * |
| Montgomery County | Rural | 33.3 | (19.6–53.0) | 4 | * |
| Clarke County | Rural | 34.9 | (21.0–54.9) | 4 | * |
| Greene County | Rural | 35.1 | (20.8–56.0) | 4 | * |
| Appanoose County | Rural | 38.3 | (26.3–54.6) | 7 | * |
*Trend data insufficient or statistically unreliable.
Iowa’s statewide kidney cancer incidence rate of 21.2 per 100,000 is already 21% above the national average of 17.5, and while the U.S. rate is falling, Iowa’s continues to rise.
Kidney Transplants
Kidney transplantation is the preferred long-term treatment for kidney failure, offering better patient outcomes and lower long-term costs than dialysis. The following data covers annual transplant activity statewide, the features of Iowa’s three transplant centers, and patient outcomes by center.
Transplant Activity in Iowa
| Year | Total Transplants | Living Donor | Deceased Donor | Change from Baseline |
| 2016 | 180 | — | — | — |
| 2020 | 253 | — | — | — |
| 2023 | 200 | 62 | 138 | −1% from 2013 |
| 2025 | 133 | 39 | 94 | −22% from 2015 |
Iowa’s transplant volume has declined sharply in recent years. Despite long-term growth in living donor transplants (up 48% since 2011), total transplants in 2025 (133) were 22% below 2015 levels and dramatically lower than the 2020 peak of 253.
Iowa Kidney Transplant Centers
Iowa has three kidney transplant centers. The data below compares each center’s program features and patient outcomes.
Donor Program Features
| Feature | UI Health Care Medical Center | Iowa Methodist Medical Center | Iowa City VA Health Care System |
| NKR Transplants (Last 12 Months) | 7 | 0 | 0 |
| Prioritization for Deceased Kidney Donor | ✓ | ✗ | ✗ |
| NKR Prioritization for Living Donor | ✓ | ✗ | ✗ |
| Donor Shield Through NKR | ✓ | ✗ | ✗ |
| NKR Remote Donation | ✓ | ✗ | ✗ |
| Voucher Program | ✓ | ✗ | ✗ |
| NKR Member Center | ✓ | ✗ | ✗ |
| Equal Access Commitment Center | ✗ | ✗ | ✗ |
| Donor Referral Network | ✗ | ✗ | ✗ |
| Kidney for Life Participant | ✗ | ✗ | ✗ |
| Donor Care Network Center | ✗ | ✗ | ✗ |
| Nutcracker Care Network | ✗ | ✗ | ✗ |
Recipient Program Features (Period: 06/01/2025 – 05/31/2026)
| Feature | UI Health Care Medical Center | Iowa Methodist Medical Center | Iowa City VA Health Care System |
| NKR Transplants (Last 12 Months) | 7 | 0 | 0 |
| Low Eplet Transplants (Last 12 Months) | 2 | 0 | 0 |
| Kidney for Life Participant | No | No | No |
| Patient Microsites | No | No | No |
| Microsite Center of Excellence | No | No | No |
| Non-Steroidal Protocol | Yes | Unknown | Unknown |
| Voucher Program | Yes | No | No |
| NKR Member Center | Yes | No | No |
| Equal Access Commitment Center | No | No | No |
Patient Outcomes
Adult Outcomes
| Outcome Metric | UI Health Care Medical Center | Iowa Methodist Medical Center |
| Living Donor — 1-Year Graft Survival | 98% | 100% |
| Living Donor — 3-Year Graft Survival | 95% | 83% |
| Living Donor — 1-Year Patient Survival | 99% | 100% |
| Living Donor — 3-Year Patient Survival | 97% | 88% |
| Deceased Donor — 1-Year Graft Survival | 91% | 92% |
| Deceased Donor — 3-Year Graft Survival | 79% | 78% |
| Deceased Donor — 1-Year Patient Survival | 93% | 98% |
| Deceased Donor — 3-Year Patient Survival | 85% | 85% |
Pediatric Outcomes
Pediatric transplant data is available only for UI Health Care Medical Center:
- Living Donor — 1-Year Graft Survival: 100%
- Living Donor — 3-Year Graft Survival: 100%
- Living Donor — 1-Year Patient Survival: 100%
- Living Donor — 3-Year Patient Survival: 100%
- Deceased Donor — 1-Year Graft Survival: 100%
- Deceased Donor — 3-Year Graft Survival: 91%
- Deceased Donor — 1-Year Patient Survival: 100%
- Deceased Donor — 3-Year Patient Survival: 100%
UI Health Care Medical Center is Iowa’s most active transplant center, accounting for all 7 NKR transplants performed in Iowa in the last 12 months, and is the only center participating in major NKR programs.
Kidney Disease and Kidney and Renal Pelvis Cancer Mortality
Iowa tracks kidney disease mortality through multiple overlapping datasets. The following data presents kidney disease and kidney cancer deaths at the statewide level, in comparison with national rates and other major causes of death, and broken down by county.
Statewide Mortality Summary
- Kidney Disease Death Rate: 11.5 per 100,000
- Annual Deaths from Kidney Disease: 512
Iowa vs. U.S. Rates — Nephritis & Nephrosis (2020–2024)
| Area | Rate (per 100,000) | Avg. Annual Deaths | 5-Year Trend |
| Iowa | 10.9 | 474 | Rising (+3.0%/yr) |
| United States | 13.2 | 55,035 | Falling (−1.7%/yr) |
Iowa’s kidney disease (nephritis & nephrosis) death rate of 10.9 per 100,000 is currently below the national average of 13.2 — a relatively favorable position. However, Iowa’s rate is rising at +3.0% per year while the national rate is falling at −1.7% per year.
Comparison with Other Major Causes of Death (2020–2024)
| Cause of Death | Iowa Rate | U.S. Rate |
| Heart Disease | 174.5 | 166.4 |
| Accidents & Adverse Effects | 48.8 | 60.3 |
| Chronic Lower Respiratory Disease | 39.0 | 34.5 |
| Cerebrovascular Diseases | 32.0 | 39.7 |
| Hypertension | 29.2 | 31.3 |
| Alzheimer’s Disease | 29.6 | 29.8 |
| Diabetes Mellitus | 23.6 | 23.7 |
| Suicide & Self-Inflicted Injury | 17.3 | 13.9 |
| Kidney Disease (Nephritis & Nephrosis) | 10.9 | 13.2 |
| Parkinson’s Disease | 10.6 | 9.8 |
| Pneumonia | 9.4 | 10.3 |
| Septicemia | 8.8 | 9.9 |
| Influenza | 1.6 | 1.1 |
| Asthma | 1.1 | 1.0 |
Comparison with Cancer Mortality by Site (2020–2024)
| Cancer Site | Iowa Rate | U.S. Rate |
| Lung & Bronchus | 33.7 | 30.2 |
| Prostate | 19.2 | 18.9 |
| Breast | 17.1 | 18.9 |
| Colon & Rectum | 13.3 | 12.7 |
| Pancreatic | 11.2 | 11.3 |
| Leukemia | 6.2 | 5.7 |
| Ovarian | 5.8 | 5.7 |
| Liver & Bile Duct | 5.8 | 6.6 |
| Non-Hodgkin Lymphoma | 5.4 | 4.8 |
| Uterine | 5.4 | 5.4 |
| Esophageal | 4.6 | 3.7 |
| Brain & ONS | 4.5 | 4.4 |
| Kidney & Renal Pelvis | 4.1 | 3.4 |
| Bladder | 4.0 | 4.1 |
| Melanoma of the Skin | 2.5 | 2.0 |
| Oral Cavity & Pharynx | 2.6 | 2.7 |
| Cervical | 1.5 | 2.1 |
| Stomach | 1.7 | 2.7 |
| Thyroid | 0.5 | 0.5 |
County-Level Kidney Disease Death Rates (2020–2024)
The table below presents age-adjusted death rates for kidney disease (nephritis and nephrosis) — distinct from kidney cancer — by Iowa county, sorted from highest to lowest.
| County | Death Rate (per 100,000) | 95% CI | Avg. Annual Deaths | 5-Year Trend |
| Wright County | 21.2 | (12.9–33.6) | 4 | N/A |
| Chickasaw County | 20.1 | (12.3–32.1) | 4 | N/A |
| Cherokee County | 19.8 | (12.5–31.4) | 5 | N/A |
| Buena Vista County | 18.1 | (11.6–27.4) | 5 | N/A |
| Calhoun County | 17.9 | (10.5–30.5) | 4 | N/A |
| Clay County | 17.0 | (10.6–26.6) | 5 | N/A |
| Woodbury County | 17.0 | (13.8–20.7) | 20 | N/A |
| Pottawattamie County | 16.4 | (13.2–20.0) | 20 | Rising (+2.7%/yr) |
| Buchanan County | 15.9 | (9.9–24.6) | 4 | N/A |
| O’Brien County | 14.4 | (8.4–24.0) | 4 | N/A |
| Mahaska County | 14.1 | (8.9–21.8) | 5 | N/A |
| Cerro Gordo County | 13.9 | (10.4–18.5) | 11 | N/A |
| Lee County | 13.8 | (9.7–19.3) | 8 | N/A |
| Jefferson County | 13.5 | (7.7–22.8) | 4 | N/A |
| Warren County | 13.0 | (9.5–17.6) | 9 | N/A |
| Linn County | 12.7 | (11.0–14.7) | 37 | Rising (+4.3%/yr) |
| Benton County | 12.6 | (8.1–19.3) | 5 | N/A |
| Clinton County | 12.2 | (8.8–16.7) | 8 | N/A |
| Jasper County | 12.0 | (8.4–17.0) | 7 | N/A |
| Washington County | 12.0 | (7.4–19.0) | 4 | N/A |
| Black Hawk County | 11.1 | (8.9–13.7) | 19 | Rising (+1.8%/yr) |
| Wapello County | 10.8 | (7.0–16.0) | 5 | N/A |
| Dickinson County | 10.7 | (6.6–17.7) | 4 | N/A |
| Story County | 10.7 | (8.0–14.1) | 10 | N/A |
| Scott County | 10.6 | (8.8–12.7) | 24 | Stable |
| Des Moines County | 10.5 | (7.2–15.2) | 6 | N/A |
| Muscatine County | 10.5 | (7.0–15.2) | 6 | N/A |
| Polk County | 10.5 | (9.3–11.9) | 54 | Rising (+3.7%/yr) |
| Henry County | 10.3 | (5.9–17.3) | 3 | N/A |
| Marshall County | 10.2 | (6.7–15.0) | 6 | N/A |
| Webster County | 9.9 | (6.4–14.8) | 5 | N/A |
| Jackson County | 9.8 | (5.6–16.8) | 3 | N/A |
| Carroll County | 9.6 | (5.7–15.8) | 4 | N/A |
| Boone County | 9.1 | (5.1–15.2) | 3 | N/A |
| Sioux County | 8.2 | (4.9–13.2) | 4 | N/A |
| Bremer County | 7.9 | (4.5–13.4) | 3 | N/A |
| Dubuque County | 7.7 | (5.8–10.1) | 11 | N/A |
| Marion County | 7.0 | (4.0–11.6) | 3 | N/A |
| Dallas County | 6.4 | (4.4–8.9) | 7 | N/A |
| Johnson County | 5.5 | (4.0–7.5) | 8 | N/A |
While Iowa’s overall rate (10.9) remains below the national average (13.2), the +3.0% annual rising trend is a serious concern — particularly when set against the national decline of 1.7% per year.
County Cancer Death Rates (2019–2023)
The following data presents age-adjusted kidney and renal pelvis cancer death rates by Iowa county, sorted from highest to lowest rate. All counties shown met the Healthy People objective threshold.
| County | Urban/Rural | Death Rate (per 100,000) | 95% CI | Avg. Annual Deaths | 5-Year Trend |
| Clinton County | Rural | 5.9 | (3.5–9.4) | 4 | * |
| Pottawattamie County | Urban | 5.2 | (3.6–7.5) | 6 | Stable |
| Des Moines County | Rural | 5.0 | (2.8–8.5) | 3 | * |
| Warren County | Urban | 5.0 | (3.0–8.1) | 4 | * |
| Cerro Gordo County | Rural | 4.6 | (2.7–7.8) | 3 | * |
| Black Hawk County | Urban | 4.6 | (3.2–6.3) | 8 | Stable |
| Woodbury County | Urban | 4.4 | (2.9–6.5) | 5 | * |
| Polk County | Urban | 4.1 | (3.3–4.9) | 22 | Stable |
| Linn County | Urban | 3.9 | (2.9–5.1) | 11 | Stable |
| Scott County | Urban | 3.0 | (2.1–4.3) | 7 | Stable |
*Trend data insufficient or not available for reliable estimate.
Iowa’s statewide kidney cancer death rate of 3.9 per 100,000 modestly exceeds the national average of 3.4, though it is on a falling trend that mirrors the national direction.
Financial Burden and Patient Support
Kidney failure imposes severe financial hardship on patients. The data below illustrates the cost of care, the assistance available to low-income Iowans, and the socioeconomic and demographic profile of those most affected.
Cost of Care to Medicare
- Dialysis patient: $85,979 per year
- Transplant recipient (after first year): $32,586 per year
- Kidney disease test: $80–$143
American Kidney Fund (AKF) Grants to Iowa Patients
The American Kidney Fund provides charitable assistance to help dialysis and transplant patients afford insurance premiums and health care costs not covered by insurance.
| Year | Iowa Patients Receiving Grants | Total Charitable Assistance |
| 2020 | 433 | $1,700,000 |
| 2023 | 378 | $1,645,756 |
| 2025 | 360 | Not reported |
Insurance Coverage of AKF-Assisted Patients (2023)
- Medicare Part B: 44.6%
- Medigap: 23.4%
- Employer Group Health Plans (incl. COBRA): 17.2%
- Medicare Advantage: 1.4%
Patient Financial Profile and Demographics
Kidney failure patients nationwide — including in Iowa — face an extraordinarily difficult financial situation:
- ESRD patients unable to work: >80%
- Average annual income of AKF-assisted patients: <$25,000
- Average annual out-of-pocket costs (dialysis patients): >$10,000
- Patients who are minorities (among AKF-assisted): >60%
Racial/Ethnic Breakdown of AKF-Assisted Patients
- Black: 34.7%
- Hispanic/Latino: 20.9%
- Native American / Asian / Pacific Islander: 5.2%
The cost disparity between dialysis ($85,979/year per Medicare patient) and transplantation ($32,586/year after the first year) makes transplantation the significantly more cost-effective long-term solution — yet most patients spend years on dialysis awaiting a transplant.
Conclusion
Iowa’s kidney disease statistics paint a picture of a state under increasing strain. The number of Iowans living with kidney failure has grown by 15–17% since the early 2010s, now exceeding 5,500 residents. Kidney cancer incidence rates are rising at 1.6% per year while the national trend moves in the opposite direction, and kidney disease death rates — though still below the national average — are climbing at 3.0% per year in Iowa while falling nationally. Left unaddressed, these trajectories point toward a significantly heavier burden on patients and the health care system in the years ahead.
Geographic and social disparities compound the overall picture. Rural counties consistently show some of the highest kidney cancer incidence and kidney disease death rates in the state — Appanoose County’s cancer incidence rate of 38.3 per 100,000 is more than twice the national average, and Wright County’s kidney disease death rate of 21.2 is nearly double the Iowa statewide figure. Minority populations bear a disproportionate share of the burden: more than 60% of patients receiving charitable assistance from the American Kidney Fund are minorities, and the financial reality for most kidney failure patients — average incomes below $25,000 against out-of-pocket costs exceeding $10,000 per year — underscores how deeply socioeconomic inequity shapes outcomes.
The gap between patients who need a kidney transplant and those who receive one remains one of the most critical challenges in the data. With 560 Iowans on the transplant waiting list and only 133 transplants performed in 2025 — a 22% decline from 2015 levels — the system is falling further behind. This is especially significant given that transplantation costs Medicare roughly $53,000 less per patient per year than dialysis after the first year, and offers far better long-term survival outcomes. Expanding transplant access, controlling the upstream risk factors of diabetes and high blood pressure that cause nearly three-quarters of all kidney failure cases, and addressing the geographic disparities visible in the county-level data all represent essential priorities for improving kidney health in Iowa.
Sources:
- Kidney Transplant Centers in Iowa
- Kidney Disease Mortality | Stats of the States | CDC
- Explore Chronic Kidney Disease in Iowa | AHR
- Kidney failure Iowa: 2026
- Kidney failure in Iowa: 2024
- Kidney failure (ESRD) in Iowa 2021
- Iowa — Chronic Kidney Disease (CKD) State Fact Sheet
- Iowa Mortality: Quick Profile | HDPulse Data Portal
- State Cancer Profiles > Death Rates Table
- Death Rate Report for Iowa by County Kidney & Renal Pelvis, 2019-2023
- Kidney Disease (Nephritis & Nephrosis) Death Rates Table for Iowa by County
- CANCER IN IOWA
- Incidence Rate Report for Iowa by County Kidney & Renal Pelvis (All Stages), 2018-2022