Kidney disease is one of the most persistent and costly chronic health problems facing Tennessee today. Tens of thousands of residents are living with kidney failure, thousands depend on dialysis just to stay alive, and thousands more are waiting for a transplant that, for many, may not come in time. Year after year, the data shows the same underlying pressures: a steadily growing patient population, a transplant system that cannot fully keep pace with demand, and a financial and human toll that falls hardest on the state’s most vulnerable residents.
Much of this burden traces back to two common, manageable conditions — diabetes and high blood pressure — which together account for the large majority of kidney failure cases in the state. Once kidney failure sets in, patients face a difficult choice between long-term dialysis and the hope of a transplant, while also confronting disability, lost income, and out-of-pocket costs that often exceed what they can afford. These pressures are not distributed evenly: certain rural counties, racial and ethnic groups, and lower-income patients consistently bear a disproportionate share of the disease’s impact.
This article brings together statistics on kidney failure prevalence, causes, transplant activity, transplant center performance, charitable financial assistance, mortality, and kidney-related cancer across Tennessee. The data is grouped into five major topics — prevalence and causes, financial and social burden, transplants, mortality, and kidney-related cancer — each broken into subtopics, so the full picture can be reviewed section by section.
Kidney Disease Prevalence in Tennessee
Kidney disease has been described as a growing concern in the state, with thousands of new cases diagnosed every year and only a fraction of people on the transplant waiting list receiving a transplant in any given year.
- More than 2,600 Tennesseans are waiting for a kidney transplant, but only about one in three will receive one this year.
- More than 11,000 Tennesseans rely on dialysis.
- Nearly 3,000 Tennesseans were diagnosed with kidney disease in a single recent year.
- Adults who report ever being told they have kidney disease (Tennessee): 4.9%
- Tennessee’s national rank for this measure: 45
Chronic Kidney Disease Tennessee Ranking
| Metric | 2024 Rank | 2022 Rank | Status |
| Chronic Kidney Disease | 45 | 47 | Minor improvement |
Tennessee consistently ranks among the worst states in the country for chronic kidney disease prevalence, though the move from 47th to 45th between 2022 and 2024 suggests a slight, modest improvement rather than a reversal of the underlying trend.
Kidney Failure (ESRD) Prevalence
The American Kidney Fund (AKF) publishes an annual snapshot of how many Tennesseans are living with kidney failure, on dialysis, or living with a transplant. Tracking these figures across report years shows a long-term upward trend in the overall kidney-failure population.
| Report Year | Tennesseans Living with Kidney Failure | Tennesseans on Dialysis | Tennesseans Living with a Kidney Transplant |
| 2021 | 15,662 | 11,495 | 4,167 |
| 2022 | 16,120 | 11,808 | 4,312 |
| 2023 | 16,055 | 11,587 (72.2%) | 4,468 (27.8%) |
| 2024 | 15,871 | 11,241 | 4,630 |
| 2025 | 15,854 | 11,055 | 4,799 |
The total number of Tennesseans living with kidney failure rose noticeably from 2021 to 2023 before edging down slightly through 2025.
Leading Causes of Kidney Failure and At-Risk Populations
Diabetes and high blood pressure are consistently identified as the two leading causes of kidney failure in Tennessee.
| Report Year | Diabetes | High Blood Pressure |
| 2021 | 47% | 28% |
| 2022 | 47% | 30% |
| 2023 | 44% | 29% |
| 2024 (per 2025 report) | 43% | 30% |
Diabetes has consistently caused close to half of all kidney failure cases in Tennessee, with high blood pressure responsible for roughly another third — together accounting for the large majority of kidney failure diagnoses in the state across every year reported.
New Kidney Failure Diagnoses
Each AKF report also tracks how many new cases of kidney failure were diagnosed in Tennessee in the prior data year, and how those new patients were treated.
| Data Year for New Cases | New Cases Diagnosed | Received a Transplant | Began Dialysis |
| 2018 | 2,969 | 69 | 2,900 |
| 2019 | 2,946 | 70 | 2,876 |
| 2020 | 2,958 | 70 | 2,888 |
| 2021 | 2,990 | 55 | 2,935 |
| 2022 | 2,812 | 66 | 2,746 |
Roughly 2,800–3,000 Tennesseans are newly diagnosed with kidney failure each year, and the overwhelming majority — typically 97% or more — begin dialysis immediately rather than receiving a transplant, underscoring the scarcity of timely transplants relative to need.
Kidney & Renal Pelvis Cancer in Tennessee
Beyond kidney failure, Tennessee tracks incidence of kidney and renal pelvis cancer by county, sorted from lowest to highest age-adjusted rate.
Statewide Comparison
- Tennessee: 19.9 (95% CI: 19.4–20.3) per 100,000; 1,688 average annual cases; trend falling at -2.9 (95% CI: -5.1– -0.6)
- United States (SEER+NPCR): 17.5 (95% CI: 17.5–17.6) per 100,000; 70,592 average annual cases; trend falling at -1.0 (95% CI: -1.5– -0.6)
New Cancer Cases in Context
Kidney and renal pelvis cancer also ranks among the top 10 most common cancers diagnosed in Tennessee for both men and women.
New Cancer Cases — Female
- Female breast — 122.9 (29.0%)
- Lung & bronchus — 59.8 (15.5%)
- Colorectal — 33.9 (8.1%)
- Corpus uteri — 24.3 (6.0%)
- Urinary system — 23.4 (5.7%)
- Thyroid — 16.0 (3.2%)
- Melanoma — 15.6 (3.5%)
- Non-Hodgkin lymphoma — 14.2 (3.5%)
- Kidney & renal pelvis — 14.2 (3.4%)
- Pancreas — 11.2 (2.8%)
New Cancer Cases — Male
- Prostate — 116.9 (24.3%)
- Lung & bronchus — 82.9 (16.2%)
- Urinary system — 63.4 (11.9%)
- Colorectal — 45.6 (8.5%)
- Kidney & renal pelvis — 27.3 (5.2%)
- Melanoma — 26.4 (4.9%)
- Non-Hodgkin lymphoma — 21.6 (4.0%)
- Oral cavity & pharynx — 20.6 (4.1%)
- Leukemia — 16.7 (3.0%)
- Pancreas — 14.5 (2.8%)
Kidney and renal pelvis cancer ranks 5th among new cancer diagnoses in Tennessee men (5.2% of all male cancers) but only 9th among women (3.4% of all female cancers), indicating men are diagnosed with this cancer at meaningfully higher rates than women in the state.
Kidney Transplants in Tennessee
Transplant Activity and the Waiting List
Tennessee has seen a long-term increase in the total number of kidney transplants performed, driven mostly by deceased-donor transplants.
| Report Year | Data Year | Total Transplants in TN | Living Donor Transplants | Deceased Donor Transplants | Tennesseans on Waiting List |
| 2021 | 2020 | 655 | — | — | 2,783 |
| 2022 | 2021 | 716 | 113 | 603 | 2,694 |
| 2023 | 2022 | 688 | 128 | 560 | 2,681 (as of Feb. 17, 2023) |
| 2024 | 2023 | 861 | 106 | 755 | 2,610 |
| 2025 | 2024 | 964 | 116 | 848 | 2,560 |
Note: Living/deceased donor breakdowns were not reported separately for 2020 data. In 2020, only about 1 in 4 Tennessee patients on the waiting list received a kidney transplant; in 2022, about 1 in 4 received one as well.
Growth in Transplants Compared to a Decade Earlier
- 2022 report (2021 vs. 2011): total transplants +55.7%; living donor transplants −17.5%
- 2023 report (2022 vs. 2012): total transplants +56.4%; living donor transplants +2.4%
- 2024 report (2023 vs. 2013): total transplants +86%; living donor transplants −2%
- 2025 report (2024 vs. 2014): total transplants +108%; living donor transplants +25%
Total kidney transplants in Tennessee have more than doubled over the past decade, and the most recent report shows living-donor transplants also growing substantially (+25% vs. 2014) after a period of decline in earlier years.
Transplant Centers
Donor Programs
Nine hospitals in Tennessee perform kidney transplants and are tracked for donor-side participation in National Kidney Registry (NKR) programs over the most recent 12 months.
| Rank | Transplant Center | NKR Transplants (12 mo.) |
| 1 | Vanderbilt University Medical Center | 18 |
| 2 | Ascension Saint Thomas Hospital West | 3 |
| 3 | Baptist Memorial Hospital | 0 |
| 4 | Centennial Medical Center | 0 |
| 5 | Erlanger Medical Center | 0 |
| 6 | Le Bonheur Children’s Medical Center | 0 |
| 7 | Methodist University Hospital Transplant Institute | 0 |
| 8 | Tennessee Valley Healthcare System | 0 |
| 9 | University of Tennessee Medical Center for Transplant Services | 0 |
| Total | 21 |
Of these nine centers, only Vanderbilt and Ascension Saint Thomas Hospital West participate in any NKR donor-side programs:
| Donor Program / Certification | Vanderbilt | Ascension Saint Thomas | Other 7 Centers |
| Prioritization – Deceased Donor | ✓ | ✓ | ✗ |
| Prioritization – Living Donor | ✓ | ✓ | ✗ |
| Donor Shield | ✓ | ✓ | ✗ |
| NKR Remote Donation | ✓ | ✓ | ✗ |
| Voucher Program | ✓ | ✓ | ✗ |
| NKR Member Center | ✓ | ✓ | ✗ |
| Equal Access Commitment | ✓ | ✓ | ✗ |
| Donor Referral Network | ✗ | ✗ | ✗ |
| Kidney for Life Participant | ✗ | ✗ | ✗ |
| Donor Care Network | ✗ | ✗ | ✗ |
| Nutcracker Care Network | Not reported | Not reported | Not reported |
Analysis: Almost all (18 of 21) NKR-tracked living/deceased donor transplant activity in Tennessee over the past 12 months is concentrated at Vanderbilt, with Ascension Saint Thomas the only other participating center.
Recipient Programs
The same nine centers are also tracked on the recipient side, including transplant volume, living-donor activity, and the share of living-donor transplants facilitated through the NKR.
| Rank | Transplant Center | Low Eplet Transplants (12 mo.) | NKR Transplants (12 mo.) | NKR Living Donor Transplants (Prior Yr) | Living Donor Transplants (Prior Yr) | NKR % of Living Donor Transplants |
| 1 | Vanderbilt University Medical Center | 6 | 18 | 22 | 69 | 32% |
| 2 | Ascension Saint Thomas Hospital West | 1 | 3 | 4 | 14 | 29% |
| 3 | Baptist Memorial Hospital | 0 | 0 | 0 | 0 | 0% |
| 4 | Centennial Medical Center | 0 | 0 | 0 | 0 | 0% |
| 5 | Erlanger Medical Center | 0 | 0 | 0 | 4 | 0% |
| 6 | Le Bonheur Children’s Medical Center | 0 | 0 | 0 | 2 | 0% |
| 7 | Methodist University Hospital Transplant Institute | 0 | 0 | 0 | 15 | 0% |
| 8 | Tennessee Valley Healthcare System | 0 | 0 | 0 | 0 | 0% |
| 9 | University of Tennessee Medical Center for Transplant Services | 0 | 0 | 0 | 18 | 0% |
| Total | 7 | 21 | 26 | 122 | 22% |
Recipient Program Participation
| Indicator | Vanderbilt | Ascension St. Thomas | Other 7 Centers |
| Kidney for Life Participant | No | No | No |
| Patient Microsites | No | Yes | No |
| Microsite Center of Excellence | No | No | No |
| Non-Steroidal Protocol | Yes | Yes | Not reported |
| Voucher Program | Yes | Yes | No |
| NKR Member Center | Yes | Yes | No |
| Equal Access Commitment | Yes | Yes | No |
Across all nine centers, 122 living-donor transplants were performed in the prior year, but only 22% of those went through the NKR — and almost all of the NKR-facilitated activity again came from Vanderbilt and Ascension Saint Thomas.
Transplant Outcomes
Adult Patients
Outcome data tracks 1-year and 3-year graft and patient survival for both living-donor (LD) and deceased-donor (DD) transplants at each center.
| Rank | Transplant Center | NKR Transplants (12 mo.) | LD Transplants (Prior Yr) | 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 |
| 1 | Vanderbilt University Medical Center | 18 | 69 | 98% | 93% | 98% | 96% | 95% | 85% | 96% | 91% |
| 2 | Ascension Saint Thomas Hospital West | 3 | 14 | 100% | 96% | 100% | 96% | 89% | 76% | 92% | 86% |
| 3 | Centennial Medical Center | 0 | 0 | 63% | 100% | 100% | 100% | 86% | 91% | 95% | 90% |
| 4 | Erlanger Medical Center | 0 | 4 | 100% | 77% | 100% | 92% | 90% | 80% | 94% | 93% |
| 5 | Methodist University Hospital Transplant Institute | 0 | 15 | 95% | 100% | 98% | 100% | 94% | 88% | 96% | 92% |
| 6 | Tennessee Valley Healthcare System | 0 | 0 | 100% | 100% | 100% | 100% | 91% | 100% | 89% | 100% |
| 7 | University of Tennessee Medical Center for Transplant Services | 0 | 18 | 97% | 100% | 100% | 100% | 97% | 88% | 98% | 90% |
Adult living-donor transplant outcomes are strong across nearly every Tennessee center, with most 1-year graft and patient survival rates at or near 100%. Deceased-donor outcomes are somewhat more variable, with 3-year graft survival ranging from 76% (Ascension Saint Thomas) to 100% (Tennessee Valley Healthcare System).
Pediatric Patients
Only two Tennessee centers report pediatric kidney transplant outcomes.
| Rank | Transplant Center | NKR Transplants (12 mo.) | LD Transplants (Prior Yr) | 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 |
| 1 | Vanderbilt University Medical Center | 18 | 69 | 83% | 91% | 100% | 100% | 100% | 83% | 100% | 94% |
| 2 | Le Bonheur Children’s Medical Center | 0 | 2 | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Pediatric patient survival rates are 100% across nearly every measure at both centers, though Vanderbilt’s pediatric living-donor 1-year graft survival rate (83%) is notably lower than Le Bonheur’s reported 100%, despite Vanderbilt’s much larger transplant volume.
Transplant Wait Times by Center
Wait time forecasts vary substantially by transplant center, largely reflecting differences in waiting-list size relative to deceased-donor transplant volume.
| Transplant Center | Wait Time Forecast (months) | Patients on Waiting List | 2025 Deceased-Donor Transplants |
| St. Thomas Hospital | 21 | 271 | 148 |
| Methodist University Hospital | 35 | 641 | 153 |
| Vanderbilt University Medical Center | 46 | 1,369 | 319 |
| University of Tennessee Medical Center | 56 | 339 | 54 |
| Erlanger Medical Center | 92 | 318 | 26 |
Wait times range from under two years at St. Thomas Hospital to nearly eight years at Erlanger Medical Center. The shortest wait time (St. Thomas) is associated with the highest ratio of annual deceased-donor transplants to waiting-list size, while the longest wait time (Erlanger) has the lowest such ratio.
Kidney Disease Mortality in Tennessee
Statewide Mortality Snapshot
Tennessee’s overall kidney disease (nephritis and nephrosis) mortality rate exceeds the national average.
- Age-adjusted death rate (per 100,000): 13.3
- Total deaths: 1,193
National/State Comparison (Age-Adjusted Death Rate per 100,000)
- United States: 13.55
- Tennessee: 14.94
Tennessee’s kidney disease mortality rate runs notably higher than the national rate in this comparison, consistent with the state’s relatively poor national ranking for chronic kidney disease prevalence.
Kidney Disease Death Rates by County (2019–2023)
This dataset shows age-adjusted nephritis/nephrosis death rates with confidence intervals and five-year trends for Tennessee counties with sufficient data, sorted from highest to lowest rate.
| County | Age-Adjusted Death Rate (95% CI) | Avg. Annual Deaths | 5-Yr Trend | 5-Yr Trend Change (95% CI) |
| Tennessee | 14.2 (13.8–14.6) | 1,167 | Stable | 0.1 (-1.2–0.8) |
| United States | 13.4 (13.3–13.4) | 54,332 | Stable | 0.0 (-0.3–0.5) |
| Claiborne | 28.7 (21.5–37.7) | 12 | NA | NA |
| Decatur | 24.2 (15.0–38.0) | 4 | NA | NA |
| Overton | 23.4 (16.0–33.3) | 7 | NA | NA |
| Benton | 23.2 (15.4–34.4) | 6 | NA | NA |
| Smith | 22.5 (14.5–33.5) | 5 | NA | NA |
| Morgan | 22.3 (14.8–32.6) | 6 | NA | NA |
| Hamblen | 21.9 (17.5–27.1) | 18 | Rising | 4.3 (2.5–6.9) |
| Rhea | 20.0 (14.2–27.5) | 8 | NA | NA |
| Macon | 19.9 (13.0–29.1) | 5 | NA | NA |
| Jackson | 19.8 (11.0–33.6) | 3 | NA | NA |
| Greene | 19.7 (15.8–24.4) | 19 | Rising | 2.8 (0.8–5.2) |
| Marion | 19.5 (13.7–27.1) | 8 | NA | NA |
| Cocke | 18.8 (13.3–26.0) | 8 | NA | NA |
| Coffee | 18.4 (14.2–23.5) | 14 | NA | NA |
| Shelby | 18.4 (17.2–19.7) | 175 | Rising | 1.8 (0.9–2.8) |
| Carter | 18.2 (14.3–23.0) | 16 | Stable | 2.3 (0.0–5.1) |
| Gibson | 18.1 (13.8–23.6) | 12 | NA | NA |
| Lawrence | 18.1 (13.4–24.1) | 10 | NA | NA |
| McMinn | 17.8 (13.8–22.7) | 14 | Rising | 2.3 (0.5–4.6) |
| Unicoi | 17.7 (11.5–26.8) | 5 | NA | NA |
| Scott | 16.9 (10.3–26.2) | 4 | NA | NA |
| Haywood | 16.8 (10.3–26.3) | 4 | NA | NA |
| Madison | 16.7 (13.5–20.4) | 20 | Rising | 1.6 (0.4–3.2) |
| McNairy | 16.5 (11.1–23.9) | 6 | NA | NA |
| Obion | 16.4 (11.4–23.1) | 7 | NA | NA |
| Warren | 16.4 (11.8–22.4) | 9 | NA | NA |
| White | 16.3 (10.8–23.7) | 6 | NA | NA |
| Hawkins | 16.2 (12.5–20.8) | 14 | NA | NA |
| Henry | 16.2 (11.6–22.4) | 9 | NA | NA |
| Wayne | 16.2 (9.7–26.2) | 4 | NA | NA |
| Grundy | 16.0 (9.1–27.0) | 3 | NA | NA |
| Roane | 16.0 (12.2–20.6) | 13 | NA | NA |
| Johnson | 15.8 (9.9–24.7) | 5 | NA | NA |
| Washington | 15.8 (13.2–18.7) | 27 | Rising | 2.7 (1.0–4.9) |
| Jefferson | 15.7 (11.8–20.5) | 12 | Stable | 2.4 (-0.1–6.0) |
| Monroe | 15.6 (11.4–21.0) | 10 | NA | NA |
| Grainger | 15.5 (9.7–23.7) | 5 | NA | NA |
| Carroll | 14.8 (9.8–21.6) | 6 | NA | NA |
| Bradley | 14.6 (11.8–17.9) | 20 | Stable | 1.9 (-0.2–4.8) |
| Campbell | 14.6 (10.4–20.1) | 8 | NA | NA |
| Hamilton | 14.5 (13.0–16.1) | 70 | Rising | 2.6 (1.4–4.1) |
| Knox | 14.5 (13.1–16.0) | 80 | Stable | 1.0 (-0.1–2.5) |
| Hardeman | 14.4 (9.1–22.1) | 5 | NA | NA |
| Marshall | 14.1 (9.2–20.6) | 6 | NA | NA |
| Anderson | 14.0 (11.0–17.6) | 16 | Stable | 2.8 (-0.2–6.5) |
| Tipton | 14.0 (10.2–18.8) | 9 | NA | NA |
| Cumberland | 13.9 (10.5–18.1) | 15 | NA | NA |
| Sullivan | 13.8 (11.7–16.2) | 33 | Stable | -0.6 (-9.9–1.3) |
| Rutherford | 13.6 (11.6–15.8) | 36 | Rising | 2.2 (0.6–4.4) |
| Loudon | 13.4 (10.2–17.6) | 13 | NA | NA |
| Maury | 13.4 (10.6–16.8) | 17 | NA | NA |
| Fentress | 13.1 (7.7–21.4) | 4 | NA | NA |
| Fayette | 12.8 (8.9–18.1) | 8 | NA | NA |
| Hardin | 12.8 (8.2–19.4) | 5 | NA | NA |
| Bedford | 12.5 (8.4–17.8) | 6 | NA | NA |
| Franklin | 12.3 (8.7–17.2) | 8 | NA | NA |
| Putnam | 12.3 (9.3–16.1) | 11 | NA | NA |
| Hickman | 12.2 (7.2–19.5) | 4 | NA | NA |
| Lauderdale | 12.2 (7.0–19.9) | 3 | NA | NA |
| Weakley | 12.1 (7.9–18.1) | 5 | NA | NA |
| Davidson | 11.8 (10.7–13.1) | 78 | Stable | -0.4 (-1.4–0.6) |
| Henderson | 11.7 (7.4–17.9) | 5 | NA | NA |
| Robertson | 11.5 (8.3–15.6) | 9 | NA | NA |
| Sevier | 11.1 (8.6–14.2) | 14 | NA | NA |
| Sumner | 11.0 (9.2–13.1) | 26 | Falling | -18.0 (-30.0– -4.1) |
| Blount | 10.6 (8.6–12.9) | 21 | Falling | -8.3 (-28.1– -0.3) |
| Wilson | 10.2 (8.1–12.7) | 16 | Stable | -1.2 (-3.7–1.8) |
| Montgomery | 10.1 (8.0–12.6) | 17 | Stable | -0.7 (-2.3–1.1) |
| Giles | 9.4 (5.6–15.0) | 4 | NA | NA |
| Cheatham | 8.3 (4.8–13.3) | 4 | NA | NA |
| Dickson | 8.3 (5.4–12.3) | 5 | NA | NA |
| Dyer | 8.3 (5.1–13.1) | 4 | NA | NA |
| Lincoln | 7.5 (4.4–12.1) | 4 | NA | NA |
| Williamson | 7.1 (5.7–8.8) | 18 | Stable | -0.8 (-2.5–1.3) |
Tennessee’s statewide kidney-disease death rate (14.2) is above the U.S. rate (13.4), and that gap is driven largely by a cluster of mostly rural East and Middle Tennessee counties — led by Claiborne (28.7), Decatur (24.2), and Overton (23.4) — with rates double the national average.
Kidney/Renal Pelvis Cancer Death Rate Comparison by County (2019–2023)
This dataset ranks Tennessee counties by a priority index reflecting how their kidney/renal pelvis cancer death rate compares to the national rate.
| Location | Priority Index (1=highest concern) | Recent Trend | Rate vs. U.S. | Avg. Annual Deaths | Age-Adjusted Death Rate (95% CI) | Rate Ratio (County:U.S.) | 5-Yr Trend Change (95% CI) |
| United States | — | Falling | — | 14,378 | 3.4 (3.4–3.5) | — | -1.4 (-2.3– -1.1) |
| Tennessee | — | Falling | — | 348 | 4.0 (3.8–4.2) | — | -0.5 (-0.8– -0.2) |
| Carroll | 4 | Stable | Higher | 3 | 8.2 (4.7–13.7) | 2.4 | -0.4 (-4.4–3.9) |
| Lawrence | 4 | Stable | Higher | 4 | 6.4 (3.8–10.3) | 1.9 | 1.0 (-2.7–5.2) |
| Sullivan | 4 | Stable | Higher | 14 | 5.5 (4.2–7.0) | 1.6 | 0.9 (-1.2–3.4) |
| Blount | 6 | Stable | Similar | 6 | 3.0 (2.0–4.3) | 0.9 | -2.6 (-5.6–0.4) |
| Davidson | 6 | Stable | Similar | 23 | 3.3 (2.7–4.0) | 1.0 | -0.7 (-2.4–1.1) |
| Greene | 6 | Stable | Similar | 5 | 4.5 (2.8–7.0) | 1.3 | 1.7 (-0.8–4.8) |
| Hamblen | 6 | Stable | Similar | 4 | 4.4 (2.6–7.1) | 1.3 | -1.3 (-4.3–1.8) |
| Knox | 6 | Stable | Similar | 22 | 3.8 (3.1–4.6) | 1.1 | -1.3 (-2.7–0.1) |
| Madison | 6 | Stable | Similar | 5 | 4.2 (2.7–6.3) | 1.2 | -1.4 (-3.9–1.0) |
| Maury | 6 | Stable | Similar | 5 | 3.5 (2.2–5.3) | 1.0 | -1.5 (-4.3–1.6) |
| Montgomery | 6 | Stable | Similar | 7 | 3.8 (2.6–5.4) | 1.1 | -1.7 (-4.6–1.5) |
| Putnam | 6 | Stable | Similar | 4 | 3.4 (2.1–5.5) | 1.0 | -3.0 (-6.4–0.3) |
| Roane | 6 | Stable | Similar | 4 | 4.9 (2.9–7.8) | 1.4 | 0.1 (-2.2–2.5) |
| Rutherford | 6 | Stable | Similar | 12 | 4.0 (3.0–5.1) | 1.1 | 0.1 (-1.7–2.5) |
| Sevier | 6 | Stable | Similar | 4 | 3.1 (1.9–4.8) | 0.9 | -1.8 (-4.3–0.9) |
| Shelby | 6 | Stable | Similar | 38 | 3.9 (3.3–4.5) | 1.1 | -0.8 (-2.0–0.4) |
| Sumner | 6 | Stable | Similar | 10 | 4.3 (3.2–5.7) | 1.3 | -1.2 (-3.0–0.8) |
| Tipton | 6 | Stable | Similar | 4 | 5.7 (3.5–8.9) | 1.7 | -0.7 (-3.4–2.6) |
| Washington | 6 | Stable | Similar | 8 | 4.1 (2.9–5.8) | 1.2 | -0.4 (-3.7–3.1) |
| Williamson | 6 | Stable | Similar | 9 | 3.0 (2.2–4.1) | 0.9 | -1.4 (-3.6–1.5) |
| Wilson | 6 | Stable | Similar | 7 | 4.0 (2.7–5.7) | 1.2 | -1.5 (-4.2–1.7) |
| Hamilton | 8 | Falling | Similar | 15 | 3.0 (2.4–3.8) | 0.9 | -2.3 (-4.6–0.0) |
Carroll, Lawrence, and Sullivan counties stand out as having kidney/renal pelvis cancer death rates significantly higher than the national rate (rate ratios of 1.6–2.4), while most other tracked counties have rates statistically similar to the national average
Financial and Social Burden of Kidney Disease in Tennessee
Financial Assistance from the American Kidney Fund (AKF)
The American Kidney Fund provides grants to help low-income Tennessee dialysis and transplant patients pay insurance premiums and other health care costs not covered by insurance.
| Report Year | Data Year | Tennesseans Who Received AKF Grants | Total Charitable Assistance |
| 2021 | 2020 | 2,512 | $6.2 million |
| 2022 | 2021 | 1,883 | $5,775,521 |
| 2023 | 2022 | 1,638 | $5,282,567 |
| 2024 | 2023 | 1,445 | $4,427,976 |
| 2025 | 2024 | 1,346 | $4,026,896 |
Both the number of Tennesseans receiving AKF charitable assistance and the total dollar amount of that assistance have declined steadily and substantially since 2020 — falling by roughly half over five years — even though the underlying number of Tennesseans living with kidney failure has not dropped nearly as much.
Insurance Coverage of AKF-Assisted Patients
| Insurance Type | 2021 Data | 2022 Data | 2023 Data | 2024 Data |
| Medicare Part B | 36.8% | 40.9% | 44.6% | 25% |
| Medicare Advantage | 1.2% | 1.3% | 1.4% | 0.6% |
| Medigap | 31.1% | 27.2% | 23.4% | 27.3% |
| Commercial/Employer Group Plans (incl. COBRA) | 18.9% | 17.7% | 17.2% | 20.1% |
| Commercial plans (separate category) | 10.5% | — | — | — |
| Exchange plans | 3.4% | — | — | — |
| Annuity | 1.5% | — | — | — |
| Medicaid (states that charge premiums) | 0.1% | — | — | — |
Across all years, traditional Medicare (Part B) and Medigap supplemental coverage together account for the largest share of AKF-assisted patients’ insurance, reflecting how dialysis and transplant patients — many of whom qualify for Medicare due to ESRD regardless of age — rely heavily on Medicare-related coverage rather than employer or marketplace plans.
Disease Burden: Disability, Demographics, and Financial Hardship
Kidney failure carries burdens well beyond the medical diagnosis itself, affecting patients’ ability to work, disproportionately impacting minority communities, and creating significant financial strain.
- Share of dialysis patients who cannot work: more than 80%
- Average annual income of AKF-assisted patients: less than $25,000
- Average annual out-of-pocket dialysis costs: more than $10,000
- Financial hardship indicator: 28%
Demographics of AKF-Assisted Patients
- Black: 34.7%
- Hispanic/Latino: 20.9%
- Native American/Asian/Pacific Islander: 5.2%
Dialysis functions as life support and is described as more demanding than a full-time job, with over 80% of patients unable to work — a major driver of the financial hardship seen among patients whose average income (under $25,000) falls far short of their average out-of-pocket dialysis costs (over $10,000/year).
Kidney Disease, Medicare Patients, and Treatment Costs
Medicare plays a central role in covering kidney disease treatment in Tennessee, both in terms of patient volume and cost.
- Patients on Medicare diagnosed with CKD: 4,267
- Patients on dialysis: 8,929
- Patients with a kidney transplant: 10,182
- Patients on the transplant waitlist: 2,572
- Transplants performed in 2016: 476
- Patients who died while on the waitlist in 2016: 102
Average Cost to Medicare
- Dialysis patient (annual): $85,979
- Transplant, after first year: $32,586
- Kidney disease test: $80–$143
Dialysis is far more expensive to Medicare on an ongoing basis than a transplant after its first year — at roughly 2.6 times the cost — reinforcing why expanding access to transplantation, rather than long-term dialysis, is both a clinical and a financial priority. The 102 patients who died while on the waitlist in 2016 also illustrates the real-world stakes of waiting-list delays.
Conclusion
Kidney disease remains a significant and, in several respects, worsening public health issue in Tennessee. The number of Tennesseans living with kidney failure has grown substantially over the past decade, driven mainly by diabetes and high blood pressure, even as the share of patients living with a transplant — rather than remaining on dialysis — has gradually improved. Roughly 2,800 to 3,000 Tennesseans are newly diagnosed with kidney failure each year, and the overwhelming majority begin dialysis immediately, underscoring how scarce timely transplants remain relative to need.
On the treatment side, transplant activity has more than doubled since the early 2010s, and outcomes at Tennessee’s transplant centers are generally strong, with most living-donor survival rates near 100%. Access, however, is uneven: most NKR-affiliated donor and recipient program participation is concentrated at just two centers, Vanderbilt and Ascension Saint Thomas, and wait times across the state’s centers range from under two years to nearly eight years depending on where a patient is listed. This unevenness in access compounds the disease’s existing burden, since not every patient has equal opportunity to reach a center with shorter wait times or fuller program participation.
Finally, the financial and demographic data make clear that kidney failure disproportionately burdens low-income and minority Tennesseans, even as charitable assistance from the American Kidney Fund has declined in recent years. Geographically, rural counties in East and Middle Tennessee consistently show the highest kidney disease death and cancer incidence rates, while Williamson County and other Nashville-area suburbs consistently rank among the lowest — a pattern that holds across nearly every dataset in this report. Taken together, these statistics point to a disease that is not just a medical challenge but a structural one, shaped by geography, income, and access to care as much as by biology.
Sources:
- Kidney Transplant Centers in Tennessee
- Kidney failure
- Kidney failure in Tennessee: 2024
- Kidney failure in Tennessee: 2023
- Kidney failure in Tennessee: 2022
- Kidney failure (ESRD) in Tennessee 2021
- Explore Chronic Kidney Disease in Tennessee | AHR
- Kidney disease on the rise in TN, affecting thousands
- The State of Health in Tennessee 2025
- KIDNEY DISEASE IN TENNESSEE
- Kidney Disease Mortality | Stats of the States | CDC
- Kidney Disease (Nephritis & Nephrosis) Death Rates Table for Tennessee by County
- Tennessee Nephritis/Kidney Disease
- Kidney Transplant Centers in Tennessee: Wait Times by Center
- Incidence Rate Report for Tennessee by County Kidney & Renal Pelvis (All Stages^), 2018-2022
- Death Rate/Trend Comparison by Cancer, 2019-2023 Tennessee Counties versus United States
- Cancer in Tennessee 2016-2020 Annual Report | TN.gov