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US Kidney Statistics

Kidney Disease Statistics in North Carolina, USA

North Carolina is confronting a major and growing kidney disease crisis. An estimated 1.7 million North Carolinians live with kidney disease in some form, and the state’s adult CKD prevalence of 3.5% places it 12th in the nation. As of 2025, more than 27,400 North Carolinians are living with kidney failure — a 31% increase since 2012, more than twice Ohio’s growth rate over a comparable period. Diabetes and high blood pressure together cause 73% of all kidney failure cases, and both are highly prevalent in the adult population.

The disease falls hardest on racial and ethnic minorities: Black Americans face more than four times the risk of kidney failure compared to White Americans, and Hispanic and American Indian populations face more than double the risk. Financially, kidney failure is devastating — more than 80% of dialysis patients cannot work, yet average out-of-pocket costs exceed $10,000 per year for patients whose typical income is under $25,000. North Carolina’s kidney and renal pelvis cancer incidence rate (18.9 per 100,000) exceeds both Ohio’s (18.2) and the national average (17.3).

Chronic Kidney Disease (CKD)

Chronic kidney disease is a progressive condition in which the kidneys gradually lose the ability to filter waste and excess fluid from the blood. North Carolina’s adult CKD prevalence of 3.5% places the state 12th nationally.

Statewide Prevalence

NC CKD adult prevalence: 3.5%
National rank: 12th
Estimated NC residents with kidney disease: more than 1.7 million
Medicare patients diagnosed with CKD: 13.79%

North Carolina’s 3.5% CKD prevalence ranks 12th nationally, still representing 1.7 million residents with kidney disease. The high concentration of CKD among Medicare patients (13.79%) reflects the disease’s heavier burden on older, lower-income adults who rely on public insurance.

Leading Risk Factors

Diabetes and high blood pressure are responsible for 73% of all kidney failure cases in North Carolina, closely mirroring the national pattern.

Risk Factor	NC Adult Prevalence	Share of Kidney Failure Cases
Diabetes (diagnosed)	11.8%	43%
High blood pressure	35.1%	30%
Obesity (self-reported)	34.0%	Major contributing factor

More than a third of North Carolina adults have high blood pressure and nearly 12% have diagnosed diabetes — together sustaining a large pipeline of patients progressing toward kidney failure. Obesity at 34% compounds both cardiovascular and renal risk.

End-Stage Renal Disease (ESRD / Kidney Failure)

End-stage renal disease is the final, permanent stage of CKD. Without dialysis or a kidney transplant, ESRD is fatal. North Carolina’s ESRD population has grown substantially, and significantly faster than the national trend.

Current ESRD Population (2025)

Total North Carolinians living with kidney failure: 27,405
On dialysis: 19,612
Living with a functioning kidney transplant: 7,793
Increase since 2012: +31%

At 31%, North Carolina’s growth in kidney failure cases since 2012 is more than twice Ohio’s rate (13%) over a similar period. The ratio of dialysis patients (19,612) to transplant recipients (7,793) — roughly 2.5 to 1 — reflects the persistent national shortage of donor kidneys.

New Kidney Failure Cases by Year

New ESRD diagnoses show that the overwhelming majority of newly diagnosed patients begin dialysis rather than receive a transplant, consistently across all measured years.

Diagnosis Year	New Cases	Received Transplant	Began Dialysis
2018	4,332	104 (2.4%)	4,228 (97.6%)
2021	4,405	124 (2.8%)	4,281 (97.2%)
2022	4,354	120 (2.8%)	4,234 (97.2%)

Across all measured years, fewer than 3% of newly diagnosed ESRD patients in North Carolina received a kidney transplant at or near the time of diagnosis. The consistency of this pattern across multiple years underscores how far transplant supply falls short of clinical need.

Racial and Ethnic Disparities

Kidney disease falls far more heavily on racial and ethnic minorities in North Carolina, driven by higher rates of the underlying risk factors, reduced access to preventive care, and structural determinants of health.

Relative Risk of Kidney Failure

Black Americans: 4.3× greater
American Indians: 2.3× greater
People of Hispanic/Latino ethnicity: 2.3× greater
Asian Americans: 1.6× greater

The 4.3× greater risk for Black Americans is the starkest single disparity in the dataset. In North Carolina, counties like Robeson and Scotland — with large American Indian and Black populations — show among the state’s highest kidney mortality rates, demonstrating how racial disparities translate directly into geographic concentrations of premature death.

Racial/Ethnic Composition of AKF-Assisted Patients

Of the patients the American Kidney Fund helps in North Carolina, the majority are minorities, reflecting both greater disease burden and greater financial need.

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

Share of Kidney Failure Patients Reached by Race

1 in 20 White Americans with kidney failure receives AKF assistance
1 in 13 Black Americans with kidney failure receives AKF assistance
1 in 10 Hispanic/Latino Americans with kidney failure receives AKF assistance

The AKF reaches a disproportionately higher share of minority patients, consistent with their greater disease burden and financial fragility. The 1-in-10 reach among Hispanic/Latino patients versus 1-in-20 for White patients reflects both higher disease prevalence and lower incomes among Hispanic patients.

Pediatric Kidney Disease

Kidney disease in children and young adults represents a distinct and especially costly dimension of North Carolina’s kidney disease burden, with higher per-patient costs, specialized workforce needs, and unique transplant considerations.

Pediatric ESRD

NC children, adolescents, and young adults (<24) with ESRD (2005): 407
Pediatric kidney transplants performed in NC (1988–2007): 365
NC share of all U.S. pediatric kidney transplants (1988–2007): 2.6%
Pediatric patients on NC transplant waiting list (March 2008): 38
Estimated cost of pediatric ESRD through public insurance (NC, SFY 2006): more than $8 million
Pediatric ESRD as share of all ESRD in NC: ~1%

Pediatric ESRD accounts for an estimated 1% of all ESRD in North Carolina.

Pediatric Nephrology Workforce

North Carolina’s pediatric nephrology workforce is small and concentrated in a small number of cities.

Full-time pediatric nephrologist equivalents in NC: 9
Ratio: approximately 1 per 1 million population
Locations: Chapel Hill, Charlotte, Durham, and Winston-Salem

Analysis: With only 9 full-time pediatric nephrologists concentrated in four cities, access is limited for children in rural and underserved areas of North Carolina.

Kidney and Renal Pelvis Cancer

North Carolina’s age-adjusted kidney and renal pelvis cancer incidence rate (18.9 per 100,000) exceeds both Ohio (18.2) and the U.S. national average (17.3). County-level cancer incidence data is presented in Section 9.

Statewide Incidence and Mortality (2018–2022)

Indicator	NC (2018–2022)	U.S. Comparison
Age-adjusted incidence rate — all (per 100,000)	18.9	17.3
Age-adjusted incidence rate — male (per 100,000)	25.8	23.7
Age-adjusted mortality rate (per 100,000)	3.7	3.4

Kidney cancer ranked 8th most frequently occurring cancer in NC (2010–2014)
Kidney cancer ranked 13th as a cause of cancer death in NC (2010–2014)
All-cancer age-adjusted incidence: 464.4 per 100,000 (NC); 442.3 (U.S.)

North Carolina’s kidney cancer incidence (18.9 per 100,000) exceeds the national average (17.3). The state’s male incidence rate (25.8) also exceeds the U.S. male rate (23.7). Mortality (3.7 per 100,000) modestly exceeds the national rate (3.4).

By Sex

Males are diagnosed with kidney and renal pelvis cancer at nearly twice the rate of females, and their mortality rate is more than twice as high.

Sex	Incidence Rate (per 100,000)	Mortality Rate (per 100,000)
Male	22.4	6.0
Female	12.0	2.3

All rates from 2010–2014 data.

The male-to-female disparity in kidney cancer is pronounced and consistent across all racial and ethnic groups in North Carolina.

By Race/Ethnicity (2010–2014)

All rates are per 100,000 population.

Group	Male Incidence	Female Incidence	Male Mortality	Female Mortality
Non-Hispanic White	22.4	11.6	6.1	2.3
Non-Hispanic Black	25.4	14.6	6.3	2.6
Hispanic	16.3	11.1	3.1	2.0

Non-Hispanic Black North Carolinians have the highest kidney cancer incidence and mortality across both sexes, mirroring the pattern seen for kidney failure. Hispanic residents have notably lower mortality rates despite not having markedly lower incidence, which may reflect differences in cancer subtype, stage at diagnosis, or treatment response.

By Age Group (2010–2014)

Kidney and renal pelvis cancer is predominantly a disease of middle age and older adults.

0–19: 1.1%
20–44: 8.5%
45–64: 43.0%
65–84: 42.5%
85+: 4.9%

More than 85% of cases are diagnosed in adults age 45 to 84. The near-equal split between the 45–64 and 65–84 groups underscores that this is not exclusively a disease of older adults. Over half of deaths occur in the 65–84 age range.

Historical Baseline (2010–2014)

Age-adjusted incidence rate (per 100,000): 16.7
Age-adjusted mortality rate (per 100,000): 3.9
Projected new cases for 2017: 2,054 (1,266 males; 788 females)
Projected deaths for 2017: 474 (320 males; 154 females)

Comparing the 2010–2014 incidence baseline (16.7 per 100,000) to the 2018–2022 rate (18.9) shows approximately a 13% increase in kidney cancer incidence, consistent with the rising national trend driven in part by expanded CT imaging.

Stage at Diagnosis (2010–2014)

Localized: 67.6%
Regional: 14.9%
Distant: 13.4%
Unknown: 4.2%

The majority of cases (67.6%) are diagnosed at the localized stage, when survival is highest. However, 13.4% are diagnosed with distant-stage disease. Increasing early-stage detection remains a critical goal.

County-Level Cancer Incidence — Males (2018–2022)

The following table presents age-adjusted kidney and renal pelvis cancer incidence rates among males by county, ranked from highest to lowest. North Carolina’s statewide male rate is 25.8 per 100,000; the U.S. male rate is 23.7.

County	Rate per 100,000 (95% CI)	Avg. Annual Count	Recent Trend
McDowell	39.5 (29.6–52.0)	12	Stable
Pender	37.6 (29.0–48.1)	14	Stable
Granville	37.5 (28.8–48.0)	14	Stable
Chowan	37.5 (21.0–62.9)	4	Stable
Scotland	37.1 (25.9–51.8)	8	Rising
Davie	34.9 (25.5–47.0)	10	Stable
Robeson	34.4 (27.9–42.0)	21	Rising
Duplin	34.4 (25.6–45.4)	11	Stable
Yancey	34.0 (20.3–54.1)	4	*
Randolph	33.6 (28.2–39.8)	30	Rising
Wayne	33.5 (27.3–40.7)	22	Rising
Anson	33.2 (20.5–51.2)	5	*
Caldwell	33.0 (26.3–41.0)	18	Stable
Polk	32.7 (18.4–54.3)	4	*
Stanly	32.6 (24.7–42.5)	13	Stable
Haywood	32.6 (25.1–42.0)	15	Rising
Bladen	32.2 (21.5–46.8)	7	Rising
Hoke	31.3 (21.6–44.0)	8	*
Madison	31.1 (18.8–48.9)	4	*
Rutherford	31.0 (23.9–39.7)	15	Rising
Burke	30.7 (24.4–38.3)	18	Stable
Alamance	30.6 (25.8–36.1)	30	Rising
Cleveland	30.3 (24.0–37.8)	18	Stable
Davidson	30.2 (25.6–35.6)	32	Stable
Onslow	30.1 (24.6–36.3)	23	Stable
Orange	30.0 (24.6–36.3)	23	Stable
Montgomery	29.6 (18.9–44.7)	5	Stable
Franklin	29.2 (21.9–38.2)	12	*
Macon	29.0 (19.6–41.8)	8	Stable
Columbus	28.7 (20.8–38.8)	10	Stable
Lenoir	28.7 (20.6–39.0)	10	Stable
Gaston	28.7 (24.6–33.3)	37	Stable
Sampson	28.6 (21.1–38.1)	10	Stable
Richmond	28.2 (19.6–39.5)	8	Stable
Rowan	28.0 (23.2–33.6)	26	Stable
Brunswick	28.0 (23.0–33.9)	33	Rising
Forsyth	27.9 (24.7–31.4)	59	Stable
Stokes	27.8 (19.9–38.3)	9	Stable
Edgecombe	27.8 (19.6–38.5)	8	Stable
Catawba	27.7 (23.1–33.0)	28	Stable
Surry	27.7 (21.3–35.5)	14	Stable
Yadkin	27.6 (18.7–39.7)	7	Stable
Beaufort	27.6 (19.5–38.1)	9	Stable
Martin	27.4 (16.5–43.7)	4	Stable
Vance	27.3 (18.6–38.8)	7	Stable
Avery	27.2 (15.9–44.9)	4	*
Durham	26.6 (23.0–30.6)	42	Stable
Johnston	26.5 (22.3–31.4)	31	Stable
Rockingham	26.4 (20.8–33.2)	17	Stable
Union	26.1 (22.1–30.7)	33	Stable
Wilson	26.1 (19.9–33.7)	13	Stable
Lincoln	26.0 (20.1–33.2)	15	Stable
Nash	25.7 (19.7–32.9)	14	Stable
Wilkes	25.6 (18.8–34.2)	11	Stable
Halifax	25.5 (18.0–35.4)	8	Stable
Cumberland	25.4 (21.8–29.4)	38	Rising
Watauga	24.9 (17.2–35.3)	7	*
Guilford	24.6 (22.1–27.5)	70	Stable
Iredell	24.6 (20.5–29.3)	27	Stable
Carteret	24.3 (18.3–31.9)	13	Stable
Alexander	24.1 (15.9–35.5)	6	Falling
Pitt	24.0 (19.3–29.6)	19	Stable
Cabarrus	24.0 (20.1–28.5)	28	Stable
Craven	23.8 (18.6–30.0)	16	Stable
Harnett	23.6 (18.5–29.8)	15	Rising
Jackson	23.5 (15.0–35.2)	6	Rising
Moore	23.5 (18.5–29.6)	17	Stable
Lee	22.9 (16.3–31.4)	8	*
New Hanover	22.9 (19.4–27.0)	32	Rising
Buncombe	22.9 (19.7–26.5)	39	Stable
Wake	22.8 (20.9–24.7)	122	Stable
Mecklenburg	22.6 (20.7–24.6)	114	Stable
Dare	22.2 (14.3–33.4)	6	Stable
Chatham	22.1 (16.8–28.9)	13	Stable
Caswell	22.1 (12.9–36.2)	4	Falling
Henderson	21.9 (17.4–27.3)	18	Stable
Warren	21.3 (12.0–36.5)	3	*
Person	20.6 (13.8–30.3)	6	Stable
Cherokee	19.9 (11.8–32.2)	5	*
Transylvania	17.5 (10.6–28.0)	5	Stable
Ashe	17.0 (10.0–28.3)	4	Stable

Male kidney cancer incidence ranges from 17.0 (Ashe) to 39.5 (McDowell) per 100,000 — more than a twofold difference. Counties with rising trends — including Scotland, Robeson, Randolph, Wayne, Haywood, Bladen, Rutherford, Alamance, Brunswick, Cumberland, Harnett, Jackson, and New Hanover — are priority areas for early detection interventions. High-burden counties are distributed across rural, coastal plain, and mountain regions.

Dialysis

Dialysis is life-sustaining treatment that the majority of North Carolina’s kidney failure patients depend on. Kidney failure is formally classified as a disability, and dialysis is considered life support.

Dialysis Dependency and Treatment

Most outpatient hemodialysis patients attend clinic three times per week — a schedule equivalent to a part-time job in time alone, but far more physically demanding
Dialysis is described as “more consuming than a full-time job” when factoring in treatment, recovery, and comorbidity management

Insurance Coverage

North Carolina offers Medigap insurance to dialysis patients under age 65 — a state-level protection not available in all states. Medicare, a federal program, pays for dialysis for more than 80% of all dialysis treatments nationally.

The following breakdown reflects insurance types among North Carolinians receiving AKF charitable premium assistance:

2024 Insurance Breakdown

Medigap: 27.3%
Medicare Part B: 25.0%
Commercial / Employer Group Plans (including COBRA): 20.1%
Medicare Advantage: 0.6%

2023 Insurance Breakdown

Medicare Part B: 44.6%
Medigap: 23.4%
Employer Group Health Plans (including COBRA): 17.2%
Medicare Advantage: 1.4%

The availability of Medigap for dialysis patients under 65 is a meaningful state-level protection that reduces gaps in Medicare coverage. The year-to-year variation in insurance breakdowns (Medicare Part B: 44.6% in 2023 vs. 25% in 2024) likely reflects shifts in plan enrollment patterns among AKF-assisted patients.

Kidney Transplantation

A kidney transplant is the preferred long-term treatment for kidney failure, offering better quality of life, longer survival, and significantly lower cost than dialysis. In North Carolina, transplant volumes have grown substantially but demand still far outstrips supply.

Supply, Demand, and Trends (2024)

North Carolinians on the kidney transplant waiting list: 3,784
Kidney transplants performed in NC (2024): 857
Living donor transplants (2024): 140
Deceased donor transplants (2024): 717
Increase in total transplants from 2014 to 2024: +42%
Change in living donor transplants vs. 2014: −7%
Share of wait-list patients receiving a transplant in 2024: About 1 in 4

With 3,784 on the waiting list and only 857 transplants performed in 2024, approximately 2,927 North Carolinians did not receive a transplant that year. While total transplant volume has grown 42% since 2014, the 7% decline in living donor transplants is concerning — living donor kidneys typically yield better outcomes. Only about 1 in 4 wait-list patients received a transplant in 2024.

Transplant Center Wait Times (2025)

Wait times for a kidney transplant vary significantly across North Carolina’s five transplant centers.

Transplant Center	Estimated Wait Time	Patients on Waiting List	2025 Deceased-Donor Transplants
Vidant Medical Center	51 months	552	81
Wake Forest Baptist Medical Center	53 months	827	144
UNC Hospitals	56 months	828	167
Duke University Hospital	59 months	945	152
Carolinas Medical Center	66 months	843	121

Wait times range from 51 to 66 months (4.25 to 5.5 years). Even at the fastest center, patients wait more than four years. Duke has the largest waiting list (945 patients) and longest projected wait, yet leads in NKR transplant activity. Carolinas Medical Center has the longest wait (66 months) with 843 patients on its list, suggesting lower transplant throughput relative to demand.

Adult Transplant Center Outcomes

North Carolina has five transplant centers performing adult kidney transplants. Duke University Hospital leads in NKR transplant volume.

Center	NKR Txp. (12 mo.)	LD 1-yr Graft	LD 3-yr Graft	LD 1-yr Patient	LD 3-yr Patient	DD 1-yr Graft	DD 3-yr Graft	DD 1-yr Patient	DD 3-yr Patient
Duke University Hospital	43	99%	94%	100%	99%	93%	87%	99%	92%
Atrium Health Wake Forest Baptist	16	100%	98%	100%	97%	93%	85%	98%	89%
ECU Health Medical Center	14	95%	93%	97%	96%	96%	83%	96%	87%
UNC Hospitals	7	100%	91%	100%	91%	96%	87%	98%	90%
Carolinas Medical Center	0	97%	87%	97%	95%	93%	86%	94%	89%

LD = Living Donor | DD = Deceased Donor | NKR = National Kidney Registry

Living Donor Transplant Volume (Prior Year)

Center	Total Living Donor Txp.	NKR % of Living Donor Txp.
Duke University Hospital	94	52%
UNC Hospitals	34	18%
Atrium Health Wake Forest Baptist	33	52%
ECU Health Medical Center	21	72%
Carolinas Medical Center	14	0%

Duke leads in both NKR volume (43 in 12 months) and living donor transplants (94 in the prior year). One-year patient survival rates are strong across all centers, most exceeding 96% for living donor transplants. Carolinas Medical Center recorded zero NKR transplants in the last 12 months and zero NKR living donor transplants, reflecting limited integration with the National Kidney Registry’s paired donation programs.

Pediatric Transplant Center Outcomes

Four North Carolina centers perform pediatric kidney transplants. Duke University Hospital reports 100% survival across all measured metrics.

Center	NKR Txp. (12 mo.)	LD 1-yr Graft	LD 3-yr Graft	LD 1-yr Patient	LD 3-yr Patient	DD 1-yr Graft	DD 3-yr Graft	DD 1-yr Patient	DD 3-yr Patient
Duke University Hospital	43	100%	100%	100%	100%	100%	100%	100%	100%
Atrium Health Wake Forest Baptist	16	100%	100%	100%	100%	100%	75%	100%	100%
UNC Hospitals	7	83%	80%	100%	75%	91%	100%	100%	100%
Carolinas Medical Center	0	100%	67%	100%	100%	91%	79%	90%	100%

Duke University Hospital achieves 100% survival across every measured metric for pediatric transplants. Three-year graft survival shows more variability: Carolinas Medical Center reports 67% three-year living donor graft survival in pediatric patients, and UNC reports 80%, reflecting the clinical challenges of long-term pediatric transplant management.

County-Level Kidney Disease Mortality — Nephritis and Nephrosis (2016–2020)

County mortality rates for kidney disease (nephritis and nephrosis) range from 6.69 to 29.21 per 100,000 across North Carolina counties.

Highest Burden Counties (rate 20.91–29.21 per 100,000): Robeson, Scotland, Anson, Edgecombe, Halifax, Northampton, Hertford, Bertie, Warren, Tyrrell, and some southwestern mountain counties
Medium-High Burden Counties (rate 16.56–20.91 per 100,000): Rockingham, Caswell, Nash, Wilson, Wayne, Cumberland, Hoke, Columbus, Bladen, Sampson, Rutherford, Cleveland, Burke, Gaston, Richmond, Montgomery
Medium-Low Burden Counties (rate 12.54–16.56 per 100,000): Forsyth, Guilford, Alamance, Iredell, Cabarrus, Rowan, Johnston, Harnett, Moore, New Hanover, Onslow, Pender, and most Piedmont counties
Lowest Burden Counties (rate 6.69–12.54 per 100,000): Wake (Raleigh), Durham, Orange (Chapel Hill), Mecklenburg (Charlotte), most urban Triangle counties, and several western mountain counties

The highest kidney disease mortality is concentrated in rural eastern NC counties — Robeson, Scotland, Anson, Edgecombe, Halifax, Northampton, and neighbors — many of which have large Black and American Indian populations. This geographic concentration reinforces the racial disparity data: the same populations facing the highest risk of kidney failure live in areas with the highest kidney disease death rates. The lowest burden is in the major urban Triangle counties and Mecklenburg, which have more robust health care infrastructure and specialist access.

Financial Impact

Patient Out-of-Pocket Costs

Kidney failure imposes a devastating financial burden. More than 80% of dialysis patients cannot work due to the physical demands of treatment, yet out-of-pocket costs far exceed the typical income of affected patients.

Dialysis patients who cannot work: more than 80%
Average income of AKF-assisted patients: less than $25,000 per year
Average out-of-pocket costs for dialysis patients: more than $10,000 per year
Cost of a kidney disease test: $80–$143
Annual cost of pediatric dialysis per patient: ~$100,000

Cost to Medicare

Two data sets are available reflecting different collection periods.

Indicator	Older Data	More Recent Data
Pre-kidney failure patient	—	$25,920 per year
Dialysis patient	$85,979 per year	$79,439 per year
Transplant patient — first year after transplant	—	$23,308 per year
Transplant patient — after first year	$32,586 per year	—

Even using the more recent (lower) estimates, dialysis costs Medicare nearly $79,439 per year per patient — more than three times the cost of a transplant patient’s first year ($23,308). The cost of a kidney disease test ($80–$143) is trivially low compared to the downstream cost of undetected CKD progressing to dialysis. For patients, earning under $25,000 while spending over $10,000 out of pocket — while unable to work — creates a financial crisis on top of a medical one.

Pediatric Dialysis Costs

Dialysis (per patient): ~$100,000
Erythropoietin (anemia treatment): $5,000–$7,000
Anti-rejection medication: $7,000–$20,000

Pediatric dialysis runs approximately $100,000 per year per patient — significantly more than for adults — due to higher staff-to-patient ratios, pediatric specialist fees, and higher medication costs.

AKF Assistance in North Carolina

The American Kidney Fund provides grants to low-income kidney patients to cover insurance premiums and other health care costs not covered by insurance.

Grant Totals by Year

Year	NC Grant Recipients	Total AKF Assistance
2020	4,562	$16,500,000
2023	2,641	$11,302,722
2024	2,632	$10,089,339

AKF assistance in North Carolina has declined from $16.5 million (2020) to just over $10 million (2024) — a 39% reduction — while recipient counts fell from 4,562 to 2,632. This may reflect changes in AKF grant program structure rather than reduced patient need, given that the ESRD population grew 31% since 2012. The 2020 figure included pandemic-related emergency assistance, which inflated that year’s totals.

Conclusion

Kidney disease in North Carolina is a growing, inequitably distributed, and financially devastating public health emergency. The 31% growth in kidney failure cases since 2012 signals that North Carolina’s trajectory is worsening faster than most states. With fewer than 3% of newly diagnosed ESRD patients receiving a kidney transplant at diagnosis, dialysis dependency is the near-universal outcome for new patients.

The racial and geographic disparities are stark and overlapping: Black, Hispanic, and American Indian North Carolinians face multiples of the kidney failure risk faced by White residents, and these same populations are concentrated in rural eastern counties — Robeson, Scotland, Edgecombe, Halifax, Northampton — that show the highest kidney disease mortality rates in the state. Major urban counties (Wake, Durham, Orange, Mecklenburg) show the lowest mortality, reflecting better access to specialist care and earlier diagnosis.

Meaningful progress is visible in transplant volume, which has grown 42% since 2014, and in the excellent outcomes reported by leading transplant centers. Sustained investment in CKD screening among high-risk populations, expanded transplant access, reversal of the living donor decline, and targeted community outreach in high-burden eastern NC counties represent the clearest pathways to reducing North Carolina’s kidney disease burden.