Kidney disease — ranging from early chronic kidney disease (CKD) to full kidney failure (end-stage renal disease, or ESRD) and kidney cancer — affects hundreds of thousands of Missourians. It is a largely silent condition in its early stages, yet it can progress to a point where dialysis or a transplant become the only options for survival, placing enormous strain on patients, families, and the healthcare system.
This article compiles all of the statistical data provided on Missouri’s kidney disease burden, transplant activity, transplant center performance, chronic kidney disease prevalence, mortality, and kidney/renal pelvis cancer. It covers everything from statewide prevalence trends and financial assistance figures to detailed, center-by-center transplant outcomes and county-level mortality and cancer data.
Chronic Kidney Disease (CKD) in Missouri
Chronic kidney disease is the gradual, often symptom-free decline of kidney function that can progress to kidney failure if undetected. The data below combines several different surveillance efforts covering CKD awareness, prevalence, disparities, and testing rates in Missouri.
Prevalence and Awareness
| Estimated MO Adults with CKD | Aware/Diagnosed | Undiagnosed Share |
| 635,000 | ~83,000 aware | 540,000 undiagnosed (90%) |
- Fewer than 17% of Missourians at risk (those with diabetes and/or hypertension) are tested for CKD each year.
- In the Missouri 2016 County-Level Study, only 2.72% of Missouri residents reported being diagnosed with kidney disease — lower than national estimates, likely reflecting low general awareness of the disease rather than a lower true prevalence.
- A separate claims-based analysis by MHVC found that only 1% of Missourians had a CKD diagnosis in claims data, compared with the National Institutes of Health’s (NIH) estimate that 9% of U.S. adults under 65 have CKD.
- Of Missourians who were diagnosed with CKD, 55% were already at Stage 3 (a point at which patients need increased treatment and face high risk of irreversible progression), and 11% had an unspecified stage recorded in their medical claims, complicating disease management.
Every measure of CKD awareness in this dataset points the same direction: true CKD prevalence in Missouri is almost certainly far higher than what shows up in diagnoses or claims data.
Racial and Demographic Disparities in CKD Risk
Compared to the general population, CKD risk in Missouri is:
- 4x higher in Black or African American residents
- 1.3x higher in Hispanic or Latino residents
- 1.2x higher in American Indian or Alaska Native residents
- Higher in women than men
- Higher in adults over age 65
Black Missourians face by far the largest disparity in this dataset, at four times the general population’s CKD risk — a larger gap than for any other group listed.
CKD Among Missouri’s Top Chronic Diseases (2018 BRFSS Data)
- Arthritis: 31.1%
- Diabetes: 11.5%
- CVD (coronary heart disease, heart attack, stroke): 10.1%
- Asthma: 9.4%
- Chronic Obstructive Pulmonary Disease (COPD): 9.1%
While kidney disease itself isn’t in this particular top-5 chronic disease list, both major upstream drivers of kidney disease — diabetes (11.5%) and cardiovascular disease (10.1%) — rank among Missouri’s most common chronic conditions.
CKD Testing Trend in Missouri (2013–2018)
| State | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | Mean | Trend | p-value |
| Missouri | 14.8 | 14.8 | 15.1 | 16.0 | 16.3 | 16.1 | 15.5 | No trend | 0.086 |
Annual testing among people with known CKD is less than 30% each year in Missouri.
CKD testing rates crept up slightly from 14.8 in 2013 to a peak of 16.3 in 2017 before dipping slightly in 2018, but the change was not statistically significant (“No trend,” p = 0.086) — and even among Missourians already diagnosed with CKD, fewer than 3 in 10 are tested annually.
CKD Screening Among Missouri Medicaid Beneficiaries with Hypertension/Diabetes
| Population | Year | Total Group Population | Receiving eGFR | Receiving Albumin/Creatinine Ratio | Receiving Both | % eGFR | % Albumin/Creatinine Ratio | % Both |
| Hypertension | 2019 | 189,848 | 53,100 | 8,225 | 3,795 | 28% | 4% | 2% |
| Hypertension | 2020 | 183,772 | 48,948 | 8,214 | 3,474 | 27% | 4% | 2% |
| Diabetes | 2019 | 101,204 | 30,308 | 8,754 | 3,821 | 30% | 9% | 4% |
| Diabetes | 2020 | 97,671 | 28,107 | 8,961 | 3,620 | 29% | 9% | 4% |
| Hypertension and Diabetes | 2019 | 77,421 | 25,928 | 6,866 | 3,277 | 33% | 9% | 4% |
Even among Medicaid beneficiaries with diabetes and/or hypertension — two of the leading causes of kidney failure — complete CKD screening (both eGFR and albumin/creatinine ratio testing) reached only 2–4% of any group in either year, despite eGFR alone being ordered for 27–33% of beneficiaries.
Kidney Failure (ESRD) in Missouri
Prevalence Trends Over Time
| Reported Year | Living with Kidney Failure | On Dialysis | Living with a Transplant |
| 2021 | 13,660 | 9,318 | 4,342 |
| 2023 | 13,868 | 9,215 (66.4%) | 4,653 (33.6%) |
| 2025 | 13,866 | 9,033 | 4,833 |
| 2026 | 13,967 | 8,977 | 4,990 |
The overall number of Missourians living with kidney failure has stayed roughly stable, in the 13,700–14,000 range. Within that stable total, however, the mix has shifted: the number on dialysis has declined somewhat (9,318 → 8,977) while the number living with a functioning transplant has risen steadily (4,342 → 4,990), suggesting a gradual shift toward transplantation over dialysis as the more common state for long-term kidney failure patients.
New Diagnoses and Initial Treatment Path
| Diagnosis Year | New Cases Diagnosed | Received a Transplant | Began Dialysis |
| 2018 | 2,307 | 51 | 2,256 |
| 2020 | 2,417 | 80 | 2,337 |
| 2022 | 2,349 | 63 | 2,286 |
| 2023 | 2,307 | 84 | 2,223 |
In every year shown, well over 95% of newly diagnosed kidney failure patients began dialysis rather than receiving an immediate transplant — only 51 to 84 people per year (roughly 2–3.5% of new cases) received a transplant right away, underscoring how limited organ availability shapes most patients’ initial experience with kidney failure.
Leading Causes of Kidney Failure
- 2023: Diabetes 47%, High blood pressure 30%
- 2025: Diabetes 43%, High blood pressure 30%
Diabetes and high blood pressure together account for roughly three-quarters of all kidney failure cases, with diabetes consistently the single largest driver even as its reported share edged down slightly (47% → 43%).
Population Risk Factors for Kidney Failure (2021)
- Diagnosed with diabetes: 10.3%
- Have high blood pressure: 30.9%
- Self-report obese: 34.8%
These are general population risk-factor rates. More than a third of Missourians self-report as obese, and roughly 3 in 10 have high blood pressure — both established risk factors for eventual kidney failure.
Kidney and Renal Pelvis Cancer in Missouri
Overall Burden and Survival (2018–2022)
- Total cases found: 7,840
- Kidney and Renal Pelvis Cancer survivors: 13,709
- 5-year relative survival rate: 74.70%
- Missouri’s national rank for kidney/renal pelvis cancer death rate: 12th
- Overall incidence rate: 20.50 per 100,000
- Overall death rate: 4.0 per 100,000
With a 5-year relative survival rate of nearly 75%, kidney and renal pelvis cancer in Missouri has a considerably better prognosis than many other cancers, and survivors (13,709) outnumber new cases found in the same five-year window (7,840), reflecting long-term survivorship.
Incidence and Death Rates by Race and Gender
- By race — incidence rate: Black 23.5, White 20.3 (per 100,000)
- By race — death rate: Black 3.9, White 4.2 (per 100,000)
- By gender — incidence rate: Male 26.9, Female 14.8 (per 100,000)
Black Missourians have a higher incidence rate than White Missourians (23.5 vs. 20.3), yet a slightly lower death rate (3.9 vs. 4.2) — an inversion worth noting given that survival gaps often run the opposite direction for other cancers.
Stage at Diagnosis
- Localized: 67.5%
- Regional: 15.4%
- Distant: 13.4%
- Unknown: 3.6%
Two-thirds of Missouri kidney and renal pelvis cancer cases are caught while still localized, which likely helps explain the relatively strong overall 5-year survival rate.
Kidney Transplants in Missouri
Transplant Waiting List and Transplants Performed
| Report Year | Waiting List Size | Transplants Performed (Year) | Increase vs. Comparison Year |
| 2021 | 1,432 | 593 (2020) | — |
| 2023 | 1,583 (as of Feb. 17, 2023) | 573 (2022) | +39.8% vs. 2012 |
| 2025 | 1,777 | 632 (2024) | +55% vs. 2014 |
| 2026 | 1,967 | 599 (2025) | +43% vs. 2015 |
The waiting list has grown by more than a third across the reported period (1,432 → 1,967), while the number of transplants actually performed each year has moved up and down without a clear sustained increase (593 → 573 → 632 → 599).
Living Donor vs. Deceased Donor Transplants
- 2022 transplants: 111 living donor, 462 deceased donor (+33.7% living donor vs. 2012)
- 2024 transplants: 128 living donor, 504 deceased donor (+38% living donor vs. 2014)
- 2025 transplants: 104 living donor, 495 deceased donor (+7% living donor vs. 2015)
Deceased donor transplants consistently outnumber living donor transplants by a factor of roughly 4-to-1 or more. Living donor transplants dropped noticeably from 128 (2024) to 104 (2025).
Missouri Kidney Transplant Centers
Missouri has eight kidney transplant centers. The tables below cover donor-side program participation, recipient-side outcomes and program participation, and one-year/three-year graft and patient survival outcomes for adult and pediatric programs.
Donor-Side Data and Program Participation
| Rank | Center | NKR Transplants (Last 12 Mo.) | Prioritization for Deceased Donor | NKR Prioritization for Living Donor | Donor Shield (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 |
| 1 | SSM Health Saint Louis University Hospital | 11 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✗ | ✗ | ✗ |
| 2 | Barnes-Jewish Hospital | 0 | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
| 3 | Cardinal Glennon Children’s Hospital | 0 | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
| 4 | Children’s Mercy Hospital | 0 | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
| 5 | St Louis Children’s Hospital | 0 | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
| 6 | St. Luke’s Hospital | 0 | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
| 7 | The Transplant Institute at Research Medical | 0 | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
| 8 | University of Missouri Hospital and Clinic | 0 | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
| Total | 11 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 |
Of the eight Missouri transplant centers, only SSM Health Saint Louis University Hospital reported any National Kidney Registry (NKR) transplants in the last 12 months (11) and is the only center enrolled in any of the eleven listed donor-support/donor-registry programs.
Recipient-Side Data and Program Participation
| Rank | Center | Kidney for Life Participant | Low Eplet Transplants (Last 12 Mo.) | NKR Transplants (Last 12 Mo.) | NKR Living Donor Transplants (Prior Yr.)* | Living Donor Transplants (Prior Yr.)* | NKR % of Living Donor Transplants* | Patient Microsites | Microsite Center of Excellence | Non-Steroidal Protocol | Voucher Program | NKR Member Center | Equal Access Commitment Center |
| 1 | SSM Health Saint Louis University Hospital | N | 3 | 11 | 15 | 29 | 52% | N | N | N | Y | Y | Y |
| 2 | Barnes-Jewish Hospital | N | 0 | 0 | 0 | 52 | 0% | N | N | ? | N | N | N |
| 3 | Cardinal Glennon Children’s Hospital | N | 0 | 0 | 0 | 2 | 0% | N | N | ? | N | N | N |
| 4 | Children’s Mercy Hospital | N | 0 | 0 | 0 | 3 | 0% | N | N | ? | N | N | N |
| 5 | St Louis Children’s Hospital | N | 0 | 0 | 0 | 2 | 0% | N | N | ? | N | N | N |
| 6 | St. Luke’s Hospital | N | 0 | 0 | 0 | 9 | 0% | N | N | ? | N | N | N |
| 7 | The Transplant Institute at Research Medical | N | 0 | 0 | 0 | 12 | 0% | N | N | ? | N | N | N |
| 8 | University of Missouri Hospital and Clinic | N | 0 | 0 | 0 | 4 | 0% | N | N | ? | N | N | N |
| Total | 0 | 3 | 11 | 15 | 113 | 14% | 0 | 0 | 0 | 1 | 1 | 1 |
Statewide, 113 living donor transplants occurred in the prior year (04/01/2025–03/31/2026), of which only 15 (about 14%) were facilitated through the National Kidney Registry, and all of those NKR-facilitated transplants took place at a single center (SSM Health Saint Louis University Hospital).
Adult Transplant Outcomes
| Rank | Center | NKR Transplants (Last 12 Mo.) | Living Donor Transplants (Prior Yr.) | LD 1-Yr Graft Survival | LD 3-Yr Graft Survival | LD 1-Yr Patient Survival | LD 3-Yr Patient Survival | DD 1-Yr Graft Survival | DD 3-Yr Graft Survival | DD 1-Yr Patient Survival | DD 3-Yr Patient Survival |
| 1 | SSM Health Saint Louis University Hospital | 11 | 29 | 94% | 100% | 97% | 100% | 99% | 93% | 99% | 94% |
| 2 | Barnes-Jewish Hospital | 0 | 52 | 98% | 91% | 100% | 94% | 95% | 86% | 97% | 89% |
| 3 | St. Luke’s Hospital | 0 | 9 | 100% | 100% | 100% | 100% | 96% | 78% | 99% | 82% |
| 4 | The Transplant Institute at Research Medical | 0 | 12 | 100% | 100% | 100% | 100% | 92% | 83% | 94% | 86% |
| 5 | University of Missouri Hospital and Clinic | 0 | 4 | 100% | 100% | 100% | 100% | 83% | 81% | 94% | 79% |
(LD = Living Donor, DD = Deceased Donor)
Living donor graft and patient survival rates are uniformly high (94–100% at one year) across all five adult centers. Deceased donor outcomes show more variation, particularly at 3 years, ranging from a 93% 3-year graft survival at SSM Health down to 78% at St. Luke’s Hospital — a 15-point spread among Missouri’s adult centers.
Pediatric Transplant Outcomes
| Rank | Center | NKR Transplants (Last 12 Mo.) | Living Donor Transplants (Prior Yr.) | LD 1-Yr Graft Survival | LD 3-Yr Graft Survival | LD 1-Yr Patient Survival | LD 3-Yr Patient Survival | DD 1-Yr Graft Survival | DD 3-Yr Graft Survival | DD 1-Yr Patient Survival | DD 3-Yr Patient Survival |
| 1 | Cardinal Glennon Children’s Hospital | 0 | 2 | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| 2 | Children’s Mercy Hospital | 0 | 3 | 100% | 100% | 100% | 100% | 96% | 100% | 95% | 100% |
| 3 | St Louis Children’s Hospital | 0 | 2 | 100% | 100% | 100% | 100% | 94% | 83% | 100% | 91% |
All three of Missouri’s pediatric transplant centers report perfect (100%) living donor graft and patient survival at both one and three years. Deceased donor outcomes are also very strong overall, with Cardinal Glennon reporting perfect outcomes across every measured category.
Kidney Disease Mortality in Missouri
Statewide Mortality Snapshot
- Kidney disease death rate: 20 (per 100,000)
- Kidney disease deaths: 1,659
This statewide figure confirms kidney disease mortality in Missouri as a persistent, sizable burden of roughly 1,600-plus deaths per year.
County-Level Kidney Disease (Nephritis & Nephrosis) Death Rates, 2019–2023
All races (including Hispanic/Latino), both sexes, all ages, sorted by age-adjusted death rate (deaths per 100,000).
| County | Age-Adjusted Death Rate (95% CI) | Avg. Annual Count | Recent 5-Yr Trend | 5-Yr Trend Change (95% CI) |
| Missouri | 20.7 (20.3, 21.2) | 1,620 | stable | 0.9 (-0.4, 1.3) |
| United States | 13.4 (13.3, 13.4) | 54,332 | stable | 0.0 (-0.3, 0.5) |
| Bollinger | 52.7 (37.3, 73.0) | 8 | NA | NA |
| New Madrid | 46.0 (33.8, 61.5) | 10 | NA | NA |
| Clark | 40.0 (24.7, 63.1) | 4 | NA | NA |
| Lewis | 39.3 (25.5, 58.6) | 5 | NA | NA |
| Ripley | 38.9 (26.3, 56.3) | 6 | NA | NA |
| Mississippi | 37.2 (24.7, 54.3) | 6 | NA | NA |
| Dunklin | 35.9 (27.7, 45.9) | 14 | NA | NA |
| Wayne | 35.4 (24.1, 51.4) | 7 | NA | NA |
| Cape Girardeau | 34.8 (29.9, 40.3) | 38 | rising | 3.7 (1.7, 6.3) |
| Stoddard | 33.4 (26.0, 42.5) | 15 | stable | 2.2 (-0.1, 5.1) |
| Madison | 32.6 (21.9, 47.4) | 6 | NA | NA |
| Butler | 31.7 (25.3, 39.3) | 18 | stable | 2.3 (-0.3, 5.6) |
| Bates | 31.3 (21.7, 44.1) | 7 | NA | NA |
| Johnson | 31.1 (24.5, 38.8) | 16 | NA | NA |
| Pemiscot | 30.5 (20.4, 44.3) | 6 | NA | NA |
| Vernon | 30.5 (21.8, 41.8) | 9 | NA | NA |
| Scott | 30.0 (23.5, 37.9) | 15 | rising | 2.9 (1.0, 5.4) |
| Perry | 29.8 (21.7, 40.5) | 9 | NA | NA |
| Osage | 29.6 (18.8, 44.7) | 5 | NA | NA |
| McDonald | 28.8 (20.3, 39.8) | 8 | NA | NA |
| St. Francois | 28.7 (23.7, 34.5) | 23 | rising | 3.1 (0.2, 6.9) |
| Dent | 27.8 (19.0, 40.1) | 7 | NA | NA |
| Pike | 27.7 (19.2, 39.2) | 7 | NA | NA |
| Linn | 27.4 (17.8, 41.2) | 5 | NA | NA |
| Audrain | 27.3 (19.5, 37.2) | 9 | NA | NA |
| Caldwell | 26.8 (15.9, 43.7) | 4 | NA | NA |
| Laclede | 26.5 (20.1, 34.3) | 12 | NA | NA |
| Macon | 26.4 (17.8, 38.3) | 6 | NA | NA |
| Adair | 26.3 (18.5, 36.6) | 8 | NA | NA |
| Oregon | 26.3 (15.9, 42.7) | 4 | NA | NA |
| Jasper | 26.0 (22.3, 30.1) | 37 | rising | 3.4 (2.1, 5.1) |
| Randolph | 25.9 (18.5, 35.6) | 8 | NA | NA |
| Washington | 25.6 (17.6, 36.1) | 7 | NA | NA |
| Marion | 25.4 (18.7, 33.9) | 10 | NA | NA |
| Iron | 25.3 (15.1, 41.0) | 4 | NA | NA |
| Newton | 25.3 (20.4, 31.0) | 20 | rising | 3.3 (1.3, 6.0) |
| Lawrence | 24.4 (18.6, 31.6) | 12 | NA | NA |
| Barry | 24.1 (18.1, 31.6) | 12 | NA | NA |
| Jefferson | 24.0 (21.3, 27.1) | 60 | rising | 16.1 (4.7, 23.5) |
| Chariton | 23.8 (13.7, 40.8) | 3 | NA | NA |
| St. Louis City | 23.4 (21.0, 26.0) | 74 | stable | 0.6 (-0.4, 1.7) |
| Pettis | 23.3 (17.8, 30.0) | 13 | stable | 2.0 (-0.3, 4.8) |
| Polk | 22.4 (16.5, 29.9) | 10 | NA | NA |
| Lafayette | 22.0 (16.2, 29.3) | 10 | NA | NA |
| Barton | 21.8 (13.4, 34.5) | 4 | NA | NA |
| Webster | 21.8 (15.9, 29.3) | 9 | NA | NA |
| Texas | 21.4 (15.1, 29.6) | 8 | NA | NA |
| Saline | 21.1 (14.0, 30.7) | 6 | NA | NA |
| Jackson | 20.9 (19.5, 22.4) | 174 | falling | -3.0 (-8.0, -0.3) |
| Ray | 20.8 (14.0, 29.9) | 6 | NA | NA |
| Phelps | 20.6 (15.5, 26.9) | 12 | NA | NA |
| Cedar | 20.4 (13.1, 31.1) | 5 | NA | NA |
| Morgan | 20.4 (13.9, 29.3) | 7 | NA | NA |
| St. Louis County | 20.4 (19.3, 21.5) | 280 | rising | 2.3 (1.7, 2.9) |
| Pulaski | 20.2 (14.2, 27.8) | 8 | NA | NA |
| Hickory | 19.9 (11.1, 35.8) | 3 | NA | NA |
| Cole | 19.7 (15.9, 24.1) | 19 | rising | 2.6 (0.6, 5.0) |
| Callaway | 19.5 (14.5, 25.8) | 11 | NA | NA |
| Miller | 19.0 (13.0, 27.1) | 7 | NA | NA |
| Gasconade | 18.7 (11.9, 28.9) | 5 | NA | NA |
| Cass | 18.6 (15.5, 22.2) | 26 | falling | -2.2 (-4.3, -0.1) |
| Buchanan | 18.5 (15.0, 22.7) | 20 | stable | 0.2 (-1.5, 2.0) |
| Douglas | 18.4 (10.9, 30.4) | 4 | NA | NA |
| Henry | 18.4 (12.3, 26.9) | 6 | NA | NA |
| Howell | 18.0 (13.4, 23.7) | 11 | NA | NA |
| Benton | 17.7 (11.8, 26.4) | 7 | NA | NA |
| Clay | 17.3 (15.1, 19.7) | 47 | stable | 1.0 (-0.3, 2.6) |
| Lincoln | 17.1 (12.7, 22.6) | 10 | falling | -3.9 (-7.3, -1.8) |
| Camden | 16.8 (12.7, 22.2) | 12 | NA | NA |
| Clinton | 16.8 (10.8, 25.3) | 5 | NA | NA |
| Wright | 16.8 (10.2, 26.3) | 4 | NA | NA |
| Greene | 16.7 (14.8, 18.7) | 62 | stable | 0.5 (-0.4, 1.4) |
| Moniteau | 16.6 (9.4, 27.6) | 3 | NA | NA |
| St. Charles | 16.5 (14.9, 18.3) | 79 | stable | 1.0 (-0.1, 2.3) |
| Platte | 16.1 (13.0, 19.7) | 19 | stable | 0.7 (-1.1, 3.0) |
| Andrew | 15.5 (9.4, 24.5) | 4 | NA | NA |
| Ste. Genevieve | 15.5 (9.6, 24.3) | 4 | NA | NA |
| Dallas | 15.0 (9.0, 24.1) | 4 | NA | NA |
| Warren | 14.8 (10.2, 21.0) | 7 | NA | NA |
| Boone | 14.3 (11.9, 17.0) | 26 | stable | 0.5 (-1.0, 2.4) |
| Christian | 14.3 (11.2, 18.0) | 15 | NA | NA |
| Livingston | 14.3 (7.9, 24.4) | 3 | NA | NA |
| Crawford | 14.1 (9.0, 21.6) | 5 | NA | NA |
| Taney | 14.1 (10.7, 18.4) | 12 | NA | NA |
| Stone | 13.9 (9.5, 20.2) | 8 | NA | NA |
| Franklin | 13.5 (10.9, 16.7) | 19 | stable | -1.2 (-2.9, 0.6) |
| Nodaway | 13.5 (8.2, 21.6) | 4 | NA | NA |
| Cooper | 13.3 (7.7, 22.0) | 3 | NA | NA |
Missouri’s statewide age-adjusted kidney disease death rate (20.7 per 100,000) is more than 50% higher than the national rate (13.4). Rural southeastern Missouri counties dominate the highest-rate list — Bollinger (52.7), New Madrid (46.0), Clark (40.0), and several Bootheel counties all report rates well above both the state and national averages, while suburban St. Louis and central Missouri counties (St. Charles, Boone, Franklin) tend to sit at or below the national rate.
Financial Assistance for Missouri Kidney Patients (American Kidney Fund)
Missourians on dialysis or living with a transplant frequently rely on charitable assistance from the American Kidney Fund (AKF) to cover insurance premiums and other health-care costs not covered by insurance.
| Grant Year | Recipients | Total Charitable Assistance |
| 2020 | 1,577 | $4.9 million |
| 2022 | 1,371 | $4,499,086 |
| 2024 | 1,226 | $3,857,951 |
| 2025 | 1,424 | Not specified in source |
Both the number of recipients and the dollar amount of assistance fluctuate from year to year rather than following one consistent direction. 2024 recorded the lowest recipient count and lowest dollar total in the reported span, with a rebound in recipient numbers reported for 2025.
Insurance Coverage of AKF Grant Recipients
| Grant Year | Medicare Part B | Medicare Advantage | Medigap | Commercial Employer Group Plans (incl. COBRA) |
| 2022 | 40.9% | 1.3% | 27.2% | 17.7% |
| 2024 | 25% | 0.6% | 27.3% | 20.1% |
The share of AKF recipients covered primarily by Medicare Part B dropped sharply, from 40.9% of recipients in 2022 to 25% in 2024, while the share with commercial employer coverage rose somewhat (17.7% → 20.1%). Medigap coverage stayed roughly constant near 27% across both years.
Disability, Minority Impact, and Financial Hardship
- Disability status: More than 80% of dialysis patients cannot work, as dialysis functions as life support and managing kidney failure and its related conditions is more time-consuming than a full-time job.
- Racial disparity among AKF-assisted patients: More than 60% of the Missourians AKF helps are minorities — 34.7% Black, 20.9% Hispanic/Latino, and 5.2% Native American/Asian/Pacific Islander.
- Financial hardship: The average income of AKF-assisted patients is under $25,000 per year, yet the average out-of-pocket cost for dialysis patients exceeds $10,000 per year.
Kidney failure disproportionately affects minority Missourians and imposes an outsized financial burden relative to income — out-of-pocket costs can exceed 40% of a typical AKF-assisted patient’s annual income, on top of an inability to work for most dialysis patients.
Conclusion
Taken together, this data paints a picture of a substantial and fairly steady kidney disease burden in Missouri: roughly 14,000 Missourians are living with kidney failure at any given time, the mix continues to shift toward more people living with transplants and fewer relying solely on dialysis. At the same time, the transplant waiting list has grown faster than the supply of transplants performed each year, meaning the gap between need and available kidneys — living or deceased donor — continues to widen rather than close.
The chronic kidney disease picture is, if anything, more concerning: estimates of true CKD prevalence run into the hundreds of thousands of Missouri adults, yet only a small fraction are ever diagnosed or regularly screened, even among high-risk Medicaid beneficiaries with diabetes or hypertension. Layered on top of this underdiagnosis are significant racial and geographic disparities — CKD risk is four times higher among Black Missourians, and kidney disease death rates are markedly elevated in rural southeastern counties. Kidney and renal pelvis cancer follows a similar geographic pattern, with an incidence rate that is both higher than, and rising faster than, the national average.
Financial assistance from the American Kidney Fund continues to play an important role for low-income dialysis and transplant patients, even as the size of that assistance has fluctuated from year to year rather than growing steadily alongside the patient population. Read as a whole, the data underscores the value of earlier CKD detection and more consistent screening, along with continued attention to the transplant centers, counties, and demographic groups facing the greatest burden.
Sources:
- Kidney Transplant Centers in Missouri
- Kidney failure
- Kidney failure MISSOURI: 2026
- Kidney failure MISSOURI: 2023
- Explore Chronic Kidney Disease in Missouri | AHR
- Missouri Ending Disparities in CKD Leadership Summit (Show Me CKDintercept Initiative) | National Kidney Foundation
- CKD | Missouri Health Value Collaborative
- Kidney failure (ESRD) in Missouri 2021
- Kidney Disease Mortality | Stats of the States | CDC
- Missouri 2016 County-Level Study Health Factors
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- Data Portal | HDPulse (NIMHD)
- Missouri – Dialysis Patient Citizens Education Center
- Chronic Kidney Disease in MO
- Incidence Rate Report for Missouri by County Kidney & Renal Pelvis (All Stages), 2018-2022
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