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US Kidney Statistics

Kidney Disease Statistics in Texas, USA

Kidney disease is one of the most urgent and costly public health challenges in Texas, where rates of End-Stage Renal Disease (ESRD) consistently exceed national averages. Although the state represents a fraction of the U.S. population, it accounts for more than one in ten ESRD patients nationwide, and the number of Texans living with kidney failure has risen sharply over the past decade—largely driven by preventable conditions like diabetes and high blood pressure.

Because early Chronic Kidney Disease (CKD) rarely causes symptoms, most people do not know they are affected until kidney failure occurs, leaving dialysis or transplantation as the only options. This late detection carries steep human and financial costs, with dialysis alone exceeding $93,000 per patient annually, while prevention can save hundreds of thousands per case.

The burden falls unevenly. Black, Hispanic, Native American, rural, low-income, and uninsured Texans face higher risks, longer travel distances for care, and greater financial strain. These disparities make kidney disease not only a medical issue but also a social and economic one.

This report brings together the latest data on CKD and ESRD in Texas—covering prevalence, causes, disparities, geography, costs, and outcomes—to provide a clear, comprehensive reference for action.

Prevalence and Scale of Kidney Disease in Texas

Kidney disease in Texas spans a spectrum from early Chronic Kidney Disease (CKD) — often undetected — to End-Stage Renal Disease (ESRD), which requires dialysis or transplantation to sustain life. The numbers below capture the scale of the crisis across multiple reporting years.

Texans Living with Kidney Failure (ESRD)

Metric	2021 Report	2024 Report	2025 Report
Total living with kidney failure	72,012	76,126	78,184
On dialysis	54,454	55,954	56,985
Living with a kidney transplant	17,558	20,172	21,199
On the transplant waiting list	8,542	8,478	9,036

Additional scale benchmarks:

ESRD Network 14 (which serves Texas) reported 80,915 total ESRD patients in 2023 — up from 71,996 in 2019
Texas represents approximately 10.3% of the entire U.S. ESRD patient population
ESRD Network 14 is the largest ESRD network in the United States
Texas’s ESRD incidence rate consistently exceeds the national rate

The steady climb from 72,012 (2021) to 78,184 (2025) — a 43% increase since 2012 — shows that growth in kidney failure has not been arrested despite improvements in medical care. Texas’s outsized share of the national ESRD population (10.3% vs. ~8.8% of U.S. population) confirms that state-specific risk factors are driving above-average rates.

New Cases Diagnosed Annually

Data Year	Report Year	New Cases	Began Dialysis	Received Transplant
2018	2021 report	12,493	12,205	288
2021	2024 report	13,615	13,309	306
2022	2025 report	13,408	13,095	313

Over 97% of newly diagnosed kidney failure patients begin dialysis rather than receiving a transplant — a ratio that reflects the profound scarcity of donor organs relative to demand. Although transplant numbers are slowly rising, the structural gap between dialysis starts and transplants remains enormous.

Long-Term Growth Trajectory

ESRD prevalence rates tripled from 1990 to 2008
Total ESRD patients on dialysis increased six-fold from 1985 to 2009
New ESRD cases per year (incidence) doubled since 1990
In 2008, approximately 44,000 Texans were receiving dialysis or living with a transplant; by 2025 that figure reached 78,184
In 2008, the ESRD incidence rate in Texas was 377 per million population — above the U.S. rate of 351 per million

National Scale for Context

More than 37 million Americans have kidney disease; millions more are at risk
Over 785,000 Americans live with kidney failure — a 100%+ increase since 2000
Approximately 555,000 Americans are on dialysis; nearly 230,000 live with transplants
Each month, almost 11,000 new cases of kidney failure are diagnosed nationally
9 out of 10 people with early kidney disease do not know they have it
Kidney disease is the 9th leading cause of death in the United States

Texas’s share of national ESRD burden exceeds its share of population, indicating that preventable risk factors — especially unmanaged diabetes and hypertension — are more prevalent or less well-controlled here than in most states.

Causes and Risk Factors

Diabetes and hypertension dominate as causes of kidney failure in Texas, together accounting for roughly 73–79% of all new ESRD cases depending on the year and data source. Both are largely preventable and manageable — making kidney failure, at its core, a disease of under-treated chronic conditions.

Leading Causes of Kidney Failure in Texas

Cause	2011 Task Force Data	2024 Report	2025 Report
Diabetes	53% of new cases	44%	43%
High blood pressure	26% of new cases	29%	30%
Combined total	79% of new cases	73%	73%

Nationally, diabetes and hypertension together account for 72% of all new ESRD cases.

Risk Factors for CKD and ESRD

Diabetes (the single largest modifiable cause)
High blood pressure / hypertension
Cardiovascular disease
Obesity
Family history of kidney disease
Age over 60
Race/ethnicity: Black, Hispanic, Asian American, Native American populations all face elevated risk
Limited access to preventive healthcare
Low socioeconomic status and lack of insurance

Texas Population Risk Profile

12.2% of Texans have been diagnosed with diabetes
31.7% have high blood pressure
34% self-report as obese
In the Rio Grande Valley, nearly 1 in 3 adults has diabetes — and nearly half are unaware of it
One third of people diagnosed with kidney failure in 2018 nationally received little or no pre-ESRD care

The convergence of high diabetes, hypertension, and obesity rates in Texas — combined with a large uninsured population and limited primary care access in rural and border regions — creates the conditions for above-national kidney failure rates. The Rio Grande Valley situation, where diabetes is near-universal and frequently undiagnosed, represents the extreme end of this spectrum.

Racial and Ethnic Disparities

Kidney failure has a profoundly disproportionate impact on communities of color. Higher rates of underlying risk factors (diabetes, hypertension, obesity), reduced access to healthcare, and socioeconomic barriers all contribute to the gap — but racial disparities in kidney disease outcomes persist even within groups with similar insurance coverage, pointing to deeper systemic inequities.

Relative Risk of Developing Kidney Failure vs. White Americans

Group	Relative Risk
Black Americans	4.3× greater
American Indians	2.3× greater
Hispanic/Latino (vs. non-Hispanic/Latino)	2.2–2.3× greater
Asian Americans	1.6× greater

CKD Prevalence in Texas Medicare Population by Race (2023)

Race/Ethnicity	CKD Prevalence (%)
Black/African American	28%
American Indian/Alaska Native	24%
White	18%
Hispanic	18%
Asian/Pacific Islander	16%

The 12-percentage-point gap between Black (28%) and Asian/Pacific Islander (16%) Medicare beneficiaries in Texas shows that racial disparities persist even within a fully-insured population — ruling out insurance status alone as the explanation. Upstream social determinants, differential exposure to risk factors, and systemic barriers to care all play roles.

CKD Self-Report Rates by Race/Ethnicity (Texas Adults)

Non-Hispanic Black adults: 4.5% — Texas ranks 8th highest out of 29 reporting states
Hispanic adults (all races): 4.5% — Texas ranks 22nd out of 24 reporting states (near the highest burden)
Non-Hispanic White adults: 4.0% — Texas ranks 25th out of 49 states

AKF Financial Assistance by Race

The American Kidney Fund provides assistance to a disproportionately high share of minority patients — reflecting compounded financial need:

Group	AKF Assists (2025 data)	AKF Assists (2024 data)
White Americans with kidney failure	1 in 20	1 in 21
Black Americans with kidney failure	1 in 13	1 in 12
Hispanic/Latino Americans with kidney failure	1 in 10	1 in 10

Of all patients the AKF helps nationally:

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

Hispanic/Latino and Black patients are 2–3× more likely to need AKF financial assistance than White patients. This disparity reflects not just higher disease rates, but lower average incomes and greater out-of-pocket costs relative to earnings — a compounding burden of illness and poverty.

Geographic Disparities Within Texas

Location within Texas profoundly shapes kidney disease outcomes. The Rio Grande Valley has the highest ESRD incidence in the United States. Northeast Texas has persistently above-average kidney disease mortality. Rural areas statewide face dramatically lower dialysis facility access than urban centers. Socioeconomic status at the county level strongly predicts CKD hospitalization rates.

Rio Grande Valley and South Texas

South Texas and the Rio Grande Valley (RGV — Hidalgo, Cameron, Starr, and Willacy counties) have the highest ESRD incidence in the entire nation
Texas had the highest ESRD rates nationally from 2016 to 2020, with border regions leading the state
Texas averaged 12,562 new ESRD cases annually between 2016 and 2020 — the highest of any ESRD network nationally
The RGV is predominantly Hispanic (over 94% of population) and is one of the most medically underserved regions in the country
By 2032, vascular surgery and nephrology are projected to have the 1st and 4th worst physician shortages in Texas respectively
Only 42.3%–58.4% of the needed specialist FTEs are projected to be available in the RGV by 2032

The RGV represents an extreme case: the highest ESRD rates in the country paired with a physician workforce projected to cover fewer than half the region’s specialist needs. Without urgent recruitment and retention strategies, the care gap will continue to widen as prevalence increases.

Urban vs. Rural Dialysis Access

751 dialysis facilities are distributed across Texas; most are concentrated in the three major metro areas and along the Texas-Mexico border
Urban patients typically travel an average of 6.8 miles to reach a dialysis facility; rural patients average 28.83 miles — four times farther
Urban areas (Dallas–Fort Worth, Houston, Austin–San Antonio) have the highest dialysis accessibility scores; western and northern rural counties have the lowest
Counties with a high percentage of urban residents consistently show significantly higher dialysis accessibility scores
A significant inverse relationship exists between elderly population rate and accessibility — older adults in rural areas face the greatest barriers

Metro area dialysis infrastructure:

Metro Area	ZIP Codes	Dialysis Facilities	Share of TX ESRD Patients
Dallas–Fort Worth	344	208	24.91%
Houston	264	248	25.09%
Austin–San Antonio	205	124	16.03%
Three metros combined	—	580	66.03%

The three major metros contain 66% of Texas’s ESRD patients and the bulk of its dialysis infrastructure. However, even within urban areas, neighborhoods on the outskirts have lower accessibility — the urban-rural divide exists at both the state and sub-metro level. Rural counties in western and northern Texas face the most severe gaps, with patients needing to travel nearly 30 miles on average for treatments required three times per week.

Northeast Texas Mortality

Year	Northeast Texas (per 100,000)	Texas (per 100,000)	U.S. (per 100,000)
2005	14.6	14.9	14.7
2010	18.8	18.4	15.3
2015	20.7	16.1	13.4
2018	18.3	16.4	12.9
2019	15.9	14.7	12.7

In 2019 in Northeast Texas:

Kidney disease mortality rate was 8% higher than the Texas average and 25% higher than the U.S. rate
Non-Hispanic Black residents had a mortality rate of approximately 29–30 per 100,000 — double the ~14 per 100,000 rate for Non-Hispanic White residents
Male mortality (18 per 100,000) was 29% higher than female mortality (14 per 100,000)

Northeast Texas peaked at 20.7 per 100,000 in 2015 — 55% above the national rate that year. Although it has declined, it remains persistently elevated. The 2:1 Black-to-White mortality ratio mirrors national patterns but is especially acute in this region, pointing to the compounded effect of systemic barriers and disease burden.

Socioeconomic Disparities in CKD Hospitalizations

In 2021, there were 2,455,233 hospitalizations among Texas residents aged 18 and above
441,466 (18.0%) included a CKD diagnosis
Average CKD hospitalization rate across all 254 Texas counties: 1,687 ± 604 per 100,000 people
Counties in the top 25% by socioeconomic status had on average 422 fewer CKD hospitalizations per 100,000 people than the bottom 25% of counties (p<0.001)
Disparities in income, property values, poverty, unemployment, and education were each statistically significantly associated with CKD hospitalization rates

The 422-per-100,000 difference in CKD hospitalizations between the highest and lowest socioeconomic status counties is vast — and it implicates social determinants of health as primary drivers. This finding supports the case for addressing poverty, housing, education, and employment as kidney disease prevention strategies, not merely clinical interventions.

CKD Prevalence: Metro vs. Non-Metro

Geography	CKD Self-Report Rate (%)
Metropolitan areas	4.0%
Non-metropolitan areas	5.1%

Non-metro Texans have a CKD prevalence 27.5% higher than metro Texans (5.1% vs. 4.0%). Combined with lower dialysis access and fewer specialists, rural residents face a worse disease burden with fewer resources to manage it.

Kidney Transplantation in Texas

Transplantation is the preferred treatment for ESRD — associated with better survival and lower long-term costs than dialysis. Despite significant growth in transplant volume over the past decade, supply remains far below demand, with fewer than 1 in 4 patients on the waiting list receiving a transplant in a given year.

Transplant Activity and Waiting List

Metric	2020	2023	2024
Transplants performed	2,242	2,544	2,489
Living donor transplants	—	782	695
Deceased donor transplants	—	1,762	1,794
Patients on waiting list	8,542	—	9,036
As of Nov 1, 2024 (waiting)	—	—	8,860
Approx. share receiving transplant	~1 in 4	~1 in 3	~1 in 4

Growth in Transplant Volume

2,489 transplants performed in 2024 — a 75% increase from 2014
2,544 transplants performed in 2023 — an 86% increase from 2013
Living donor transplants in 2024 were up 56% from 2014; in 2023 they were up 69% from 2013

Despite impressive volume growth, the fundamental equation remains unchanged: far more patients need transplants than receive them. The growing waiting list (9,036 in 2025) combined with the static ~1-in-4 transplant rate indicates that demand is rising at least as fast as supply. Growth in living donor transplants is the most promising trend, as living donor kidneys generally yield better outcomes than deceased donor organs.

Recent Policy Developments

The Comprehensive Immunosuppressive Drug Coverage Act is now in effect, funding long-term medication needs for kidney transplant recipients — expected to reduce late transplant failure from medication non-adherence due to cost
Kidney allocation has shifted from Organ Procurement Organization geographic boundaries to a continuous distance-based system — improving equality of wait times but increasing transport costs
The U.S. Organ Procurement and Transplant Network Modernization Act of 2023 is being implemented, introducing a new Board structure, upgraded technology, and improved patient communication
The Scientific Registry of Transplant Recipients is adding new tracking of patient survival while waiting and evaluation times at transplant centers

These policy changes meaningfully improve system equity and transparency. However, none directly increases the supply of donor kidneys — the fundamental bottleneck. The shift to distance-based allocation may benefit rural and border patients who were previously disadvantaged by arbitrary OPO geographic boundaries.

Financial Burden of Kidney Disease

Kidney disease is one of the most expensive chronic conditions in the American healthcare system. Costs escalate dramatically as disease progresses, and the financial burden on patients — especially low-income and uninsured patients — is often catastrophic.

Cost by CKD Stage and Treatment Type

Stage / Treatment	Mean Annual Cost Per Patient
CKD Stage G3a	$3,060
CKD Stage G3b	$3,544
CKD Stage G4	$5,332
CKD Stage G5	$8,736
Peritoneal dialysis	$49,490
In-center hemodialysis	$57,334
Kidney transplant (year 1)	$75,326

Medicare Spending on ESRD and CKD

In 2018, Medicare spending on ESRD was $49.2 billion — 7.2% of total Medicare paid claims, despite ESRD patients comprising less than 1% of the Medicare population
A hemodialysis patient costs Medicare more than $93,000 per year
Preventing one patient from reaching kidney failure saves Medicare an estimated $250,000
Total Medicare FFS spending for all CKD beneficiaries was $86.1 billion in 2021 — 22.6% of total Medicare FFS expenditures
CKD patients (13.5% of Medicare FFS beneficiaries aged 66+) accounted for 24.1% of total Medicare FFS spending ($76.8 billion) in 2021

The cost leverage of early intervention is extraordinary: preventing kidney failure saves roughly 16× the annual cost of managing early-stage CKD. Yet prevention and early detection are chronically underfunded compared to dialysis and transplantation, which are Medicare entitlements. The asymmetry — less than 1% of Medicare patients generating 7.2% of spending — underscores the systemic case for upstream investment.

Emergency vs. Scheduled Dialysis

Setting	Cost Per Treatment	Relative Cost
Scheduled outpatient dialysis	~$250	1×
Emergency department dialysis	~$2,000	8×

More than 10,000 uninsured patients sought dialysis at Texas emergency departments in 2017, incurring over $21.8 million in hospital costs
Uninsured patients often go weeks without dialysis, arriving at the ER in critical condition
Dialysis patients have the highest morbidity rate of any patient group in emergency departments
Harris Health System’s Riverside Dialysis Center reduced emergency dialysis treatments from 300/month to 150/month by connecting uninsured patients with scheduled outpatient slots

The 8× cost differential between emergency and scheduled dialysis quantifies the price of the uninsured access gap. Systematic outreach — as demonstrated by Riverside’s 50% reduction in emergency visits — can shift care to less costly, more effective settings. The obstacle is not medical but structural: uninsured patients have no mechanism to access scheduled care without deliberate program support.

Patient Financial Hardship

Average income of patients the AKF helps: less than $25,000 per year
Average out-of-pocket dialysis costs: more than $10,000 per year — over 40% of annual income for the typical AKF-assisted patient
More than 80% of people on dialysis cannot work, making kidney failure an effective disability

A patient earning under $25,000 who faces $10,000+ in annual out-of-pocket costs while being medically unable to work is in an untenable financial position without external support. This reality drives the scale of AKF and state KHC program assistance described in the following sections.

American Kidney Fund (AKF) Assistance to Texas Patients

The American Kidney Fund provides charitable financial assistance to low-income kidney failure patients to help cover insurance premiums, co-pays, and other costs not covered by insurance. In Texas, AKF assistance is substantial and has grown significantly over recent years.

Annual AKF Assistance in Texas

Year	Texans Assisted	Total Charitable Assistance
2020	18,667	$73,400,000
2023	16,381	$67,404,352
2024	18,818	$77,282,911

Insurance Type of AKF Recipients (National)

Medicare Part B: 44.6% (2023) → 25.0% (2024)
Medigap: 23.4% (2023) → 27.3% (2024)
Employer Group Health Plans (including COBRA): 17.2% (2023) → 20.1% (2024)
Medicare Advantage: 1.4% (2023) → 0.6% (2024)

The AKF provided over $77 million in charitable assistance to nearly 19,000 Texans in 2024 — averaging over $4,100 per recipient. This reflects the large gap remaining even after Medicare and other primary insurance coverage. The notable shift from Medicare Part B (44.6% in 2023 to 25.0% in 2024) toward Medigap and employer plans suggests changes in program design or recipient mix rather than reduced need.

Texas Kidney Health Care (KHC) Program

The Kidney Health Care (KHC) program is a state-funded program established to fill gaps left by the federal Medicare ESRD program. It provides limited benefits — prescription drugs, transportation, Medicare premium assistance, and dialysis coverage — to low-income Texans with ESRD. Required by law, the Texas Health and Human Services Commission submits an annual report to the Governor and Legislature each February.

Eligibility Requirements

ESRD diagnosis from a licensed physician meeting Medicare’s definition
Requires regular dialysis or has received a kidney transplant
Ineligible for Medicaid medical, drug, or travel benefits
Household gross income of less than $60,000 per year
Texas resident

Client Demographics (Fiscal Year 2024)

Total enrolled clients: 19,310
Clients receiving one or more benefits: 13,891
New clients approved in FY 2024: 2,039 (up from 1,811 in FY 2023)

Age Distribution

Age Group	Number	Percent
0–19	7	0.04%
20–34	638	3.30%
35–44	1,909	9.88%
45–54	4,043	20.94%
55–64	5,771	29.89%
65–74	4,982	25.80%
75 and up	1,960	10.15%
Total	19,310	100%

Gross Annual Income Distribution

Gross Annual Income	Number	Percent
Under $20,000	10,185	52.74%
$20,000–$29,999	4,097	21.22%
$30,000–$39,999	2,349	12.16%
$40,000–$49,999	1,627	8.43%
$50,000–$59,999	1,048	5.43%
$60,000+	4	0.02%
Total	19,310	100%

Over 73% of KHC clients earn under $30,000/year and more than half earn under $20,000 — confirming the program serves the most financially vulnerable ESRD patients. The 55–74 age group accounts for 55.7% of enrolled clients, reflecting the age distribution of kidney failure, which rises sharply with age.

Benefit Expenditures (FY 2024)

Benefit Category	Clients Served	Avg Cost/Client (Pre-Rebate)	Avg Cost/Client (Post-Rebate)	Total Cost (Pre-Rebate)
Prescription Drugs	3,944	$838.48	$0.03	$3,306,971.87
Transportation	10,391	$483.70	$483.70	$5,026,159.87
Medicare Part D Premium Asst	3,816	$187.47	$187.47	$715,381.60
Medical Services	60	$3,142.34	$3,142.34	$188,540.18

Program financial summary (FY 2024):

Total expenditures (pre-rebate): approximately $9.237 million — a decrease of $413,461 from FY 2023
Drug manufacturer rebates earned: approximately $3.306 million
Total expenditures post-rebate: approximately $5.930 million
Average annual cost per client (pre-rebate): ~$665; post-rebate: ~$427 (a 7% decrease from FY 2023)
Medical services cost per client rose 13% from FY 2023 to FY 2024, indicating rising patient acuity
Program has open-enrollment contracts with 700 dialysis facilities statewide
In FY 2024, 5,256 clients were enrolled in a Medicare Part D stand-alone plan; 8,837 in a Medicare Advantage plan

Transportation is by far the most widely used KHC benefit (10,391 clients), confirming that the logistics of thrice-weekly dialysis travel represent the single greatest practical barrier for most patients. The near-zero post-rebate cost for prescription drugs ($0.03/client) reflects HHSC’s strategic decision to prioritize drug rebates — an effective cost management approach that preserves program capacity.

Program Challenges

The current income eligibility threshold ($60,000/year) was established nearly three decades ago with no cost-of-living adjustments — effectively shrinking program reach in real terms as living costs have risen
Current policy does not require enrolled clients to renew eligibility, resulting in outdated records and reduced benefit utilization
The program has seen declining enrollment and benefit utilization in recent years due to these limitations
HHSC has identified eligibility reform, enrollment expansion, and benefit redesign as priorities for upcoming fiscal years

A 30-year-old income cap with no inflation adjustment is a structural flaw that quietly excludes an expanding pool of financially vulnerable patients in real-dollar terms. Simultaneously, the lack of a renewal requirement means program data may substantially overstate actual active enrollment. Both issues require legislative action to resolve.

CKD Prevalence by Demographic Group (Texas Self-Report Data)

The following figures represent the percentage of Texas adults who reported being told by a health professional they had kidney disease (excluding kidney stones, bladder infections, and incontinence). The overall Texas rate is 4.1%, ranking the state 28th nationally.

By Gender and Age

Group	Texas CKD Rate (%)	Texas Rank
Female	4.1%	19 / 49
Male	4.1%	35 / 49
Ages 18–44	1.3%	19 / 44
Ages 45–64	5.1%	40 / 49
Ages 65+	9.8%	34 / 49

CKD rates rise sharply with age — from 1.3% in young adults to 9.8% in those 65 and older. Texas’s poor ranking in the 45–64 age group (40th out of 49 states) suggests that middle-aged Texans carry an above-average CKD burden, likely driven by high rates of diabetes and hypertension in this cohort.

By Educational Attainment

Less than high school: 8.1% — Texas ranks 34th out of 35 reporting states (near highest burden)
High school grad / GED: 5.4% — Texas ranks 32nd out of 49
Some post-high school education: 4.2% — Texas ranks 11th out of 49
College graduate: 2.9% — Texas ranks 7th out of 49 (near lowest burden)

CKD prevalence among Texans without a high school diploma (8.1%) is nearly three times that of college graduates (2.9%). Texas ranks near the bottom nationally for CKD burden in its least-educated adults — reflecting the compound effect of reduced health literacy, fewer economic resources, and limited access to preventive care.

By Household Income

Income Level	Texas CKD Rate (%)	Texas Rank
Under $25,000	7.7%	25 / 48
$25,000–$49,999	6.1%	31 / 49
$50,000–$74,999	4.6%	31 / 45
$75,000–$99,999	2.7%	9 / 43
$100,000–$149,999	3.3%	27 / 40
$150,000 or more	2.0%	13 / 31

Texans earning under $25,000/year have a CKD rate (7.7%) nearly four times that of those earning $150,000+ (2.0%). The income gradient is steep and consistent, reflecting differential access to healthcare, healthy food, and the financial means to manage chronic conditions before they progress to kidney disease.

By Disability Status

Difficulty with self-care: 15.5% have CKD
Difficulty with mobility: 12.9%
Independent living difficulty: 12.4%
Difficulty hearing: 10.8%
Difficulty seeing: 10.1%
Difficulty with cognition: 6.9%
No disability: 2.1%

Texans with disabilities have CKD rates 3–7× those of non-disabled Texans. This reflects both shared comorbidity burden (the conditions that cause disability often also cause CKD) and reduced ability to access preventive care. Self-care difficulty (15.5%) is the highest CKD rate of any subgroup in this dataset.

CKD in the Texas Medicare Population: Trends Over Time

CKD prevalence among Texas Medicare beneficiaries is tracked separately from general population surveys. Texas’s 2023 rate of 19% places it in the second-worst quartile of states (national range for this quartile: 18.0%–20.0%) and above the U.S. average of 18%.

Annual CKD Prevalence — Texas Medicare vs. U.S.

Year	Texas (%)	U.S. (%)
2012	16.6	15.5
2013	17.4	16.1
2014	18.1	16.6
2015	19.9	18.1
2016	24.8	22.3
2017	26.4	24.0
2018	26.7	24.5
2019	25.0	24.0
2020	26.0	24.0
2021*	18.0	17.0
2022	18.0	18.0
2023	19.0	18.0

*In 2021, CMS refined CKD detection algorithms following the ICD-9 to ICD-10-CM transition. This caused a significant apparent drop in prevalence; data before and after 2021 are not directly comparable.

Kidney Disease Mortality in Texas

Kidney disease mortality reflects both the overall disease burden and the effectiveness of access to treatment. Texas statewide mortality exceeds the national rate, and specific regions — particularly Northeast Texas — show even higher rates. Racial disparities in mortality are stark and persistent.

Texas Statewide Kidney Disease Deaths

Year	Texas Death Rate (per 100,000)	Texas Deaths
2019	14.7	4,165
2020	15.1	4,400
2021	16.0	4,513
2022	16.0	4,766

Key Mortality Benchmarks

In 2008, 6,058 dialysis patients in Texas died
Patients who progress to Stage 3 CKD are ten times more likely to die from any cause than to progress to dialysis
The ten-year mortality of a patient with diabetes, albuminuria, and impaired GFR is 47%
In states that expanded Medicaid, first-year dialysis mortality decreased compared to non-expansion states; Texas has not expanded Medicaid

Texas kidney disease deaths rose 14% in just three years (2019–2022), tracking the rise in ESRD prevalence. The finding that Stage 3 CKD carries a 10:1 risk of death vs. dialysis progression underscores that kidney disease is life-threatening well before end-stage — yet it receives far less public awareness than cancers with comparable mortality rates.

National CKD Trends

Understanding Texas’s kidney disease crisis within the national context reveals where trends have improved nationally — and why Texas has not benefited as much as other states.

U.S. CKD Prevalence Trends

CKD prevalence rose from 4.8% (1988–1994) to 6.9% (2003–2004), then stabilized nationally
After 2003–2004, CKD rates decreased or stabilized in most demographic groups nationally
CKD has continued to increase among Mexican Americans and African Americans
Researchers attribute the broader national stabilization to improved blood pressure control, better blood sugar management in diabetics, and increased use of RAS inhibitors
The prevalence of diabetes in the U.S. has increased dramatically since the late 1980s; among most diabetics, CKD prevalence has not changed significantly nationally — but rates have increased among African Americans and Mexican Americans, possibly because these groups are less likely to receive renoprotective medications

Global Context

Country / Region	CKD Trend
England / Norway	Slight decrease despite rising obesity and diabetes
South Korea	Slight decrease
China	Expected major upsurge similar to 1980s–2000s U.S. trend
Central America (coastal Pacific)	Rapid increase among young male agricultural workers — possible heat stress, dehydration, chemical exposure

The national stabilization of CKD — driven by better chronic disease management — has not been equally distributed. Black and Mexican American populations continue to see rising rates, mirroring Texas’s pattern. The Central American agricultural worker epidemic is particularly relevant given Texas’s large agricultural workforce with similar demographic characteristics; this pattern warrants monitoring in Texas border and farming regions.

Conclusion

The data tell a clear and urgent story: kidney disease in Texas is a crisis of scale, inequity, and preventable progression. More than 78,000 Texans live with kidney failure, over 13,000 new cases are diagnosed each year, and the burden has risen 43% in just over a decade. Yet the impact is not evenly shared. Black Texans face more than four times the risk of kidney failure, residents of the Rio Grande Valley experience some of the highest ESRD rates in the nation alongside severe physician shortages, rural patients travel much farther for dialysis, and low-income and less-educated communities bear disproportionately high rates of chronic kidney disease.

The financial case for prevention is just as compelling. Avoiding kidney failure saves hundreds of thousands of dollars per patient, and shifting care from emergency dialysis to planned outpatient treatment dramatically lowers costs. Still, the highest-value interventions—early detection, routine screening, and accessible primary care—remain underfunded compared with the late-stage systems that treat disease after it becomes irreversible.

Although transplant volumes are rising and policy reforms are improving access and outcomes, progress is not keeping pace with the growth of the crisis, particularly in border, rural, and low-income communities. Closing the gap will require coordinated investment in primary care, early CKD management, specialist recruitment in underserved regions, expanded transplant pathways, and sustained action on the social and economic conditions that drive kidney disease.