Virginia is facing a serious and largely silent kidney disease crisis. An estimated one million adults in the state live with chronic kidney disease (CKD), yet nine in ten remain undiagnosed. Kidney failure — the most severe stage — now affects over 21,000 Virginians, a number that has grown by nearly a third in the past decade, placing enormous strain on patients, families, and the health care system.
This article presents a comprehensive statistical portrait of kidney disease in Virginia. It covers the full spectrum of the disease — from early-stage CKD prevalence and risk factors, through dialysis and transplantation trends, to geographic variation, racial disparities, and the specific experience of veterans seeking kidney care.
The data spans multiple years and reporting periods. Where statistics from different years are available, they are presented together to allow for trend analysis. Unless otherwise noted, figures refer to Virginia residents.
Chronic Kidney Disease (CKD)
Prevalence and Awareness
Chronic kidney disease is one of Virginia’s most prevalent yet underdiagnosed health conditions. Estimates consistently show that the vast majority of Virginians living with CKD are unaware of their diagnosis — representing a critical public health gap in screening and early intervention.
- Estimated adults in Virginia with CKD: 1,000,000
- Estimated adults who remain undiagnosed: 900,000 (90%)
- Adults who reported a CKD diagnosis (Virginia rate): 4.3%
- Virginia’s rank among all U.S. states: 33rd
- Estimated share of all Virginians with CKD (2022): ~1 in 8
- Virginians aware of their CKD (2022): ~2 in 100
- Adults in Virginia and Metro DC estimated to have CKD: ~2,000,000
- Of those, estimated to be unaware: >1,750,000 (>87.5%)
- People with risk factors (diabetes/hypertension) who are tested appropriately: <20%
The data reveals a profound gap between the actual and diagnosed burden of CKD in Virginia. With an estimated 900,000 of 1,000,000 cases undiagnosed, approximately 90% of affected adults do not know they have the disease.
Risk Factors
The three primary risk factors for CKD — diabetes, high blood pressure, and obesity — affect a large and significant proportion of Virginia’s adult population. Their prevalence creates a substantial pipeline of future kidney disease if not effectively managed.
- Diagnosed with diabetes: 10.9%
- Have high blood pressure: 33.6%
- Self-report as obese: 31.9%
More than a third of Virginians have high blood pressure — the second leading cause of kidney failure — while nearly 11% have been diagnosed with diabetes, the leading cause. Obesity, affecting nearly 32% of the adult population, is a key driver of both conditions.
CKD in the Medicare Population
Among Medicare beneficiaries, CKD prevalence varies significantly by geographic area within Virginia. Portsmouth City stands out as having substantially elevated rates compared to both state and national benchmarks.
| Location | CKD Prevalence (Medicare Population) | Period | Comparison |
| Portsmouth City, VA | 24% | 2023 | Higher than VA (18%) and U.S. (18%) |
| Virginia (statewide) | 18.0% | 2023 | Equal to U.S. average |
| United States | 18.0% | 2023 | National benchmark |
Portsmouth City prior-period value: 22% — indicating a worsening upward trend.
Historical Virginia Medicare Population Snapshot
- Medicare patients diagnosed with CKD: 4,960
- Medicare patients on dialysis: 11,046
- Medicare patients with a kidney transplant: 9,313
- Patients on the kidney transplant waitlist: 2,271
- Transplants performed (2016): 430
- Patients who died while on the waitlist (2016): 131
Portsmouth City’s CKD rate among Medicare beneficiaries (24%) exceeds both state and national averages by a third, and has risen from a prior value of 22%, pointing to a worsening local trend.
Kidney Failure (End-Stage Renal Disease)
Overall Burden
End-stage renal disease (ESRD), or kidney failure, is the most severe form of kidney disease. Without treatment — either dialysis or a kidney transplant — it is fatal. Virginia has seen a sustained and significant increase in the number of residents living with kidney failure over the past decade.
| Indicator | 2021 (Reported) | 2024 (Reported) | 2025 (Reported) |
| Total Virginians living with kidney failure | 20,215 | 21,229 | 21,439 |
| On dialysis | 14,096 | 13,975 | 13,955 |
| Living with a kidney transplant | 6,119 | 7,254 | 7,484 |
The number of Virginians living with kidney failure has grown by 30–33% over approximately one decade. While dialysis patient counts have edged slightly downward from 2021 to 2025 (14,096 to 13,955), the number of transplant recipients has grown considerably (from 6,119 to 7,484), suggesting gradual but meaningful improvement in transplant access.
Leading Causes
Diabetes and high blood pressure are the two dominant causes of kidney failure in Virginia, collectively accounting for nearly three-quarters of all cases. Both conditions are largely preventable and manageable, making early detection and treatment essential.
- Diabetes (2024 data): 44% of all kidney failure cases
- Diabetes (2025 data): 43% of all kidney failure cases
- High blood pressure (2024 data): 29% of all kidney failure cases
- High blood pressure (2025 data): 30% of all kidney failure cases
- Other causes combined: 27% of all kidney failure cases
Diabetes alone drives roughly 43–44% of all kidney failure cases in Virginia, and high blood pressure contributes an additional 29–30%. Together, these two chronic conditions account for approximately 73% of ESRD cases — and both are tightly linked to the risk factors identified in the CKD section above.
New Diagnoses by Year
Each year, thousands of Virginians are newly diagnosed with kidney failure. The data below show how newly diagnosed patients are treated — the vast majority begin dialysis, while a very small proportion receive a kidney transplant.
| Year | New Cases Diagnosed | Received a Transplant | Began Dialysis |
| 2018 | 3,318 | 89 (2.7%) | 3,229 (97.3%) |
| 2021 | 3,552 | 90 (2.5%) | 3,462 (97.5%) |
| 2022 | 3,463 | 108 (3.1%) | 3,355 (96.9%) |
Virginia consistently records over 3,000 new kidney failure cases annually. The transplant rate for newly diagnosed patients has remained extremely low — hovering between 2.5% and 3.1% — meaning approximately 97 of every 100 newly diagnosed patients begin dialysis rather than receiving a transplant.
Racial and Ethnic Disparities
Kidney disease disproportionately burdens communities of color in Virginia. African Americans, Hispanics, Native Americans, and other minority populations experience higher rates of CKD and ESRD, as well as significant disparities in access to diagnosis, treatment, and transplantation.
- All minority patients combined: >60% of AKF-assisted patients
- Black / African American: 34.7% of AKF-assisted patients
- Hispanic / Latino: 20.9% of AKF-assisted patients
- Native American / Asian / Pacific Islander: 5.2% of AKF-assisted patients
Despite representing a minority of Virginia’s general population, communities of color account for more than 60% of patients receiving AKF financial assistance. The overrepresentation of Black and Hispanic patients reflects well-documented disparities in the prevalence and management of diabetes and hypertension — the leading drivers of kidney failure — as well as structural barriers to early diagnosis, specialist access, and transplant referral.
Kidney and Renal Pelvis Cancer
Statewide Incidence Trends
Kidney and renal pelvis cancer incidence in Virginia has increased substantially since the early 2000s, though the rate of increase slowed markedly after 2006. The data below cover all races, all ages, and both sexes.
Annual Percent Change
| Period | Annual Percent Change | 95% Confidence Interval | Trend |
| 2002–2006 | +5.2% | 1.5 to 15.1 | Rising |
| 2006–2022 | +0.7% | −1.2 to 1.3 | Stable |
Year-by-Year Observed and Estimated Rates (per 100,000, All Ages, Both Sexes)
| Year | Observed Rate | Estimated Rate |
| 2002 | 11.6 | 11.9 |
| 2003 | 12.6 | 12.5 |
| 2004 | 13.5 | 13.1 |
| 2005 | 13.7 | 13.8 |
| 2006 | 14.5 | 14.5 |
| 2007 | 15.5 | 14.7 |
| 2008 | 14.8 | 14.8 |
| 2009 | 15.7 | 14.9 |
| 2010 | 13.5 | 15.0 |
| 2011 | 14.9 | 15.1 |
| 2012 | 14.1 | 15.2 |
| 2013 | 14.7 | 15.3 |
| 2014 | 15.8 | 15.4 |
| 2015 | 15.6 | 15.5 |
| 2016 | 16.3 | 15.7 |
| 2017 | 16.1 | 15.8 |
| 2018 | 15.4 | 15.9 |
| 2019 | 17.5 | 16.0 |
| 2020 | 15.4 | 16.1 |
| 2021 | 15.7 | 16.3 |
| 2022 | 16.0 | 16.4 |
Virginia vs. United States Comparison (2018–2022, All Ages, Both Sexes)
| Cancer Site | Virginia Rate (per 100,000) | U.S. Rate (per 100,000) |
| Kidney & Renal Pelvis | 16.0 | 17.5 |
| Lung & Bronchus | 50.9 | 52.5 |
| Colon & Rectum | 33.8 | 36.7 |
| Bladder | 17.0 | 18.8 |
| All Cancer Sites | 414.6 | 448.6 |
Kidney and renal pelvis cancer incidence in Virginia more than doubled from 11.6 per 100,000 in 2002 to 16.0 in 2022 — a 38% increase — though the sharpest growth occurred in the early 2000s (+5.2%/year from 2002 to 2006) and has since stabilized. Virginia’s overall rate (16.0) remains below the national average (17.5), and the state compares favorably to the U.S. across most cancer types.
County-Level Incidence
The following table presents county- and city-level age-adjusted kidney and renal pelvis cancer incidence rates across Virginia for 2018–2022.
An asterisk (*) in the Recent Trend column indicates that trend data are not statistically reliable, typically due to small case counts.
| County / City | Urban/Rural | Age-Adj. Rate (per 100,000) | Avg. Annual Count | Recent Trend |
| Petersburg City | Urban | 59.6 | 10 | Rising (+6.8%/yr) |
| Hopewell City | Urban | 56.2 | 6 | * |
| Caroline County | Rural | 44.2 | 8 | Stable |
| Lancaster County | Rural | 43.6 | 5 | * |
| Greensville County | Rural | 40.6 | 3 | * |
| Brunswick County | Rural | 39.6 | 4 | * |
| Powhatan County | Urban | 37.4 | 8 | Stable |
| Portsmouth City | Urban | 35.9 | 17 | Rising (+3.4%/yr) |
| Suffolk City | Urban | 34.2 | 18 | Rising (+4.3%/yr) |
| Colonial Heights City | Urban | 33.8 | 3 | * |
| Nottoway County | Rural | 33.7 | 3 | * |
| Page County | Rural | 33.4 | 6 | * |
| Prince George County | Urban | 33.0 | 7 | Stable |
| Mecklenburg County | Rural | 32.5 | 7 | Stable |
| Amelia County | Urban | 32.1 | 3 | * |
| Dinwiddie County | Urban | 31.1 | 6 | Stable |
| Floyd County | Urban | 30.3 | 3 | * |
| Chesapeake City | Urban | 29.9 | 37 | Rising (+2.6%/yr) |
| Fairfax City | Urban | 29.9 | 3 | * |
| Orange County | Rural | 29.7 | 7 | Stable |
| Westmoreland County | Rural | 29.7 | 4 | * |
| Spotsylvania County | Urban | 29.0 | 23 | Stable |
| New Kent County | Urban | 28.7 | 4 | * |
| Fredericksburg City | Urban | 28.5 | 3 | Stable |
| Nelson County | Urban | 28.2 | 4 | * |
| Chesterfield County | Urban | 27.8 | 57 | Stable |
| Henrico County | Urban | 27.7 | 50 | Stable |
| Gloucester County | Urban | 27.1 | 8 | * |
| Richmond City | Urban | 26.8 | 28 | Stable |
| Isle of Wight County | Urban | 26.6 | 6 | Stable |
| Greene County | Urban | 26.0 | 3 | * |
| Amherst County | Urban | 25.9 | 5 | Stable |
| Virginia Beach City | Urban | 25.7 | 64 | Rising (+2.0%/yr) |
| Hampton City | Urban | 25.4 | 19 | Stable |
| Norfolk City | Urban | 25.4 | 27 | Stable |
| Louisa County | Rural | 25.4 | 7 | Stable |
| Augusta County | Urban | 25.0 | 14 | Stable |
| Goochland County | Urban | 24.5 | 6 | * |
| Botetourt County | Urban | 24.4 | 6 | Stable |
| Shenandoah County | Rural | 24.4 | 7 | Stable |
| Staunton City | Urban | 24.3 | 4 | * |
| Roanoke City | Urban | 24.3 | 12 | Rising (+3.0%/yr) |
| Newport News City | Urban | 24.1 | 21 | Rising (+2.7%/yr) |
| Rockingham County | Urban | 24.1 | 12 | Stable |
| Southampton County | Rural | 24.1 | 4 | * |
| Stafford County | Urban | 24.1 | 19 | Stable |
| Hanover County | Urban | 23.9 | 17 | Stable |
| Salem City | Urban | 23.5 | 4 | * |
| Wythe County | Rural | 23.1 | 5 | Stable |
| James City County | Urban | 22.1 | 13 | Stable |
| Fauquier County | Urban | 21.4 | 10 | Stable |
| Winchester City | Urban | 21.0 | 3 | * |
| Virginia (Statewide) | — | 21.9 | 1,083 | Rising (+1.1%/yr) |
| Roanoke County | Urban | 20.6 | 13 | Stable |
| Frederick County | Urban | 20.4 | 12 | Stable |
| Culpeper County | Urban | 20.3 | 7 | Stable |
| Carroll County | Rural | 19.9 | 4 | * |
| Loudoun County | Urban | 19.9 | 39 | Stable |
| Franklin County | Urban | 19.8 | 8 | Stable |
| Montgomery County | Urban | 18.6 | 9 | Stable |
| Russell County | Rural | 17.9 | 3 | * |
| Prince William County | Urban | 17.8 | 40 | Stable |
| Halifax County w/ South Boston City | Rural | 17.6 | 5 | Stable |
| Accomack County | Rural | 17.5 | 5 | * |
| Albemarle County | Urban | 17.3 | 11 | Stable |
| Fluvanna County | Urban | 17.3 | 3 | * |
| York County | Urban | 16.9 | 7 | Stable |
| Rockbridge County | Rural | 16.4 | 3 | Stable |
| Pittsylvania County | Rural | 16.3 | 7 | Stable |
| Henry County | Rural | 16.2 | 7 | Stable |
| Lynchburg City | Urban | 15.7 | 5 | Stable |
| Smyth County | Rural | 15.4 | 4 | * |
| Bedford City and County | Urban | 15.3 | 8 | Stable |
| Arlington County | Urban | 14.9 | 16 | Stable |
| Fairfax County | Urban | 14.9 | 92 | Stable |
| Tazewell County | Rural | 14.4 | 7 | Stable |
| Charlottesville City | Urban | 14.2 | 3 | Stable |
| Pulaski County | Urban | 13.7 | 4 | Stable |
| Manassas City | Urban | 13.6 | 3 | Stable |
| Alexandria City | Urban | 13.4 | 11 | Stable |
| Washington County | Urban | 11.8 | 4 | Stable |
| United States | — | 23.7 | 45,124 | Falling (−1.1%/yr) |
Petersburg City has the highest age-adjusted incidence rate in the state at 59.6 per 100,000 — nearly three times the statewide average — and is rising rapidly at +6.8% per year. Hopewell City (56.2) and Lancaster County (43.6) also show rates far above average.
Dialysis
Dialysis is the primary life-sustaining treatment for most Virginians with kidney failure. It is highly demanding — both physically and financially — and imposes severe constraints on patients’ ability to work, maintain income, and afford ongoing care.
- Virginians currently on dialysis (2025): 13,955
- Share of ESRD patients unable to work: >80%
- ESRD patients classified as disabled: 80%
- Average annual out-of-pocket costs for dialysis patients: >$10,000
- Average annual Medicare cost per dialysis patient: $85,979
- Average annual Medicare cost for transplant (after first year): $32,586
Dialysis functions as full-time medical life support, consuming more time and energy than a full-time job — more than 80% of patients cannot maintain employment, making ESRD effectively a disability for the overwhelming majority.
Kidney Transplants
Waiting List and Annual Procedures
Kidney transplantation is the preferred long-term treatment for kidney failure, offering better survival outcomes and lower ongoing costs than dialysis. Virginia has seen substantial growth in transplant volumes in recent years, though demand continues to far exceed supply.
| Indicator | ~2016 | 2020 | 2023 | 2024 |
| On the kidney transplant waiting list | 2,271 | 2,174 | 2,620 | 2,801 |
| Transplants performed (Virginia) | 430 | 685 | 815 | 953 |
| Patients who died while on waiting list | 131 | — | — | — |
| Share of waitlisted patients who received a transplant | — | ~1 in 3 | — | — |
2024 Transplant Breakdown (Reported 2025)
- Total transplants performed in Virginia: 953
- Living donor transplants: 135
- Deceased donor transplants: 818
- Change vs. 2014 total transplant volume: +148%
- Change vs. 2014 living donor volume: −2%
2023 Transplant Breakdown (Reported 2024)
- Total transplants performed in Virginia: 815
- Living donor transplants: 124
- Deceased donor transplants: 691
- Change vs. 2013 total transplant volume: +108%
- Change vs. 2013 living donor volume: −5%
Virginia has made significant strides in transplant volume — a 148% increase since 2014 — driven almost entirely by growth in deceased donor transplants. This progress is meaningful but incomplete: the waiting list has grown from 2,174 in 2020 to 2,801 in 2024, and in 2020 only approximately 1 in 3 patients on the list received a transplant.
Transplant Centers in Virginia
Virginia has five kidney transplant centers — four serving adult patients and one primarily pediatric. These centers differ considerably in transplant volume, program participation, and clinical outcomes.
Center Rankings and Volume
- Inova Fairfax Hospital (Northern Virginia): 26 NKR transplants (last 12 months)
- Henrico Doctor’s Hospital (Richmond area): 14 NKR transplants
- Sentara Norfolk General Hospital (Norfolk): 11 NKR transplants
- UVA Health West Complex (Charlottesville): 5 NKR transplants
- Children’s Hospital of the King’s Daughters (Norfolk): 0 NKR transplants
- Virginia total: 56 NKR transplants
Donor Program Participation
| Center | Deceased Donor Priority | Living Donor Priority | Donor Shield | Remote Donation | Voucher | NKR Member | Equal Access | Donor Referral Network | Kidney for Life | Donor Care Network |
| Inova Fairfax Hospital | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Henrico Doctor’s Hospital | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✗ | ✗ | ✗ |
| Sentara Norfolk General Hospital | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✗ | ✗ | ✗ |
| UVA Health West Complex | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✗ | ✗ | ✗ |
| Children’s Hospital of the King’s Daughters | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
Recipient Activity — Prior Year (April 2025 – March 2026)
| Center | Living Donor Tx | NKR Living Donor Tx | NKR % of LD Tx |
| Inova Fairfax Hospital | 46 | 26 | 57% |
| UVA Health West Complex | 29 | 6 | 21% |
| Sentara Norfolk General Hospital | 25 | 15 | 60% |
| Henrico Doctor’s Hospital | 16 | 11 | 69% |
| Children’s Hospital of the King’s Daughters | 3 | 0 | 0% |
| Total | 119 | 58 | 49% |
Adult Transplant Outcomes
Living Donor (LD)
| Center | 1-Yr Graft Survival | 3-Yr Graft Survival | 1-Yr Patient Survival | 3-Yr Patient Survival |
| Inova Fairfax Hospital | 100% | 93% | 100% | 94% |
| UVA Health West Complex | 97% | 93% | 98% | 94% |
| Henrico Doctor’s Hospital | 95% | 94% | 100% | 97% |
| Sentara Norfolk General Hospital | 95% | 85% | 97% | 92% |
Deceased Donor (DD)
| Center | 1-Yr Graft Survival | 3-Yr Graft Survival | 1-Yr Patient Survival | 3-Yr Patient Survival |
| UVA Health West Complex | 92% | 91% | 97% | 94% |
| Henrico Doctor’s Hospital | 92% | 87% | 95% | 91% |
| Inova Fairfax Hospital | 95% | 86% | 97% | 91% |
| Sentara Norfolk General Hospital | 92% | 77% | 94% | 84% |
Pediatric Transplant Outcomes
| Center | Donor Type | 1-Yr Graft Survival | 3-Yr Graft Survival | 1-Yr Patient Survival | 3-Yr Patient Survival |
| UVA Health West Complex | Living Donor | 100% | 86% | 100% | 100% |
| UVA Health West Complex | Deceased Donor | 94% | 84% | 100% | 100% |
| Children’s Hospital of the King’s Daughters | Living Donor | 100% | 100% | 100% | 100% |
| Children’s Hospital of the King’s Daughters | Deceased Donor | 100% | 100% | 100% | 100% |
LD = Living Donor | DD = Deceased Donor | NKR = National Kidney Registry
Inova Fairfax Hospital is Virginia’s dominant transplant center by volume, accounting for 26 of 56 NKR transplants (46%) in the past 12 months and 46 living donor procedures in the prior year. All four adult centers report strong 1-year outcomes (92–100% graft survival, 94–100% patient survival).
Veterans and Kidney Disease
Dialysis Outcomes
Veterans living with kidney failure may receive dialysis through the VA health system directly, through VA-purchased community care (VA-PC), through Medicare, or through a combination of settings. The following data cover 27,241 veterans and examine mortality outcomes by care setting.
Care Setting Distribution
- VA only: 4% of veterans (n = 1,100)
- VA-PC (community care, VA-funded): 11% of veterans (n = 3,079)
- Medicare only: 67% of veterans (n = 18,215)
- Dual settings (VA + Medicare or other): 18% of veterans (n = 4,847)
- Total sample: 27,241 veterans
2-Year Mortality by Setting
- Dual settings: 23%
- VA only: 25%
- VA-PC only: 30%
- Medicare only: 42%
Patient Demographics and Profile
| Characteristic | Overall | VA Only | VA-PC | Medicare | Dual |
| Male | 97.7% | 97.3% | 97.8% | 97.7% | 98.0% |
| Age <55 | 8.8% | 16.3% | 13.8% | 5.9% | 15.1% |
| Age 55–64 | 24.0% | 42.8% | 44.6% | 14.1% | 43.7% |
| Age 65–74 | 24.1% | 20.9% | 22.2% | 25.0% | 23.1% |
| Age 75–84 | 31.6% | 15.8% | 16.3% | 39.6% | 14.9% |
| Age ≥85 | 11.5% | 4.2% | 3.2% | 15.5% | 3.2% |
| White | 67.3% | 36.6% | 56.8% | 74.8% | 52.6% |
| Black | 25.0% | 50.5% | 32.8% | 19.0% | 36.8% |
| Hispanic | 4.9% | 10.1% | 6.8% | 3.6% | 7.3% |
| Full/Part-time employed | 5.1% | 9.7% | 5.8% | 4.1% | 7.3% |
| VA copayment required | 30.3% | 9.5% | 7.6% | 40.9% | 9.4% |
| Urban residence | 84.9% | 96.5% | 80.6% | 84.7% | 85.8% |
| Distance <30 mi from VA dialysis unit | 36.0% | 88.9% | 13.5% | 34.1% | 45.4% |
Primary Causes of ESRD and Comorbidities
| Cause | Overall | VA Only | VA-PC | Medicare | Dual |
| Diabetes (primary cause of ESRD) | 44.9% | 52.9% | 52.3% | 41.2% | 52.1% |
| Hypertension (primary cause of ESRD) | 33.3% | 23.6% | 28.6% | 36.4% | 26.5% |
| Glomerulonephritis | 5.6% | 6.7% | 5.2% | 5.3% | 6.7% |
| Other / Uncertain | 16.3% | 16.7% | 13.8% | 17.1% | 14.7% |
| Comorbidity | Overall | VA Only | VA-PC | Medicare | Dual |
| Diabetes | 59.9% | 67.5% | 70.0% | 55.2% | 69.4% |
| Hypertension | 74.3% | 92.1% | 91.5% | 66.0% | 90.6% |
| Mental illness | 37.5% | 56.3% | 53.8% | 29.6% | 52.4% |
| Anemia | 55.1% | 67.1% | 61.3% | 51.6% | 61.2% |
| Congestive heart failure | 52.1% | 45.4% | 48.5% | 54.0% | 48.5% |
| Ischemic heart disease | 50.0% | 39.8% | 43.7% | 53.3% | 44.0% |
| COPD | 29.4% | 26.5% | 29.9% | 30.0% | 27.3% |
| Cerebrovascular disease | 18.0% | 19.7% | 18.8% | 17.8% | 17.9% |
Dialysis Type, Access, and Expenditure Shifts
- In-center hemodialysis (overall): 94.1% of all veterans
- Home hemodialysis or peritoneal dialysis (overall): 5.9% of all veterans
- Catheter access (overall): 70.5% of all veterans
- Arteriovenous fistula or graft (overall): 23.5% of all veterans
- 1993: VA-PC (community-based dialysis) represented 17% of VA dialysis expenditures
- 2008: 56% of VA dialysis patients received treatment through VA-PC
- 2017: VA-PC represented 81% of VA dialysis expenditures; 77% of VA patients treated through VA-PC
Despite representing only 4% of veteran dialysis patients, those receiving care exclusively in the VA system had the second-lowest 2-year mortality (25%), with only dual-setting patients faring slightly better (23%). Medicare-only patients — by far the largest group at 67% — had the worst 2-year mortality at 42%, nearly double the VA-only rate. VA-only patients are markedly different in profile: younger (59% under age 65), disproportionately Black and Hispanic (61% combined), largely exempted from copayments (91%), and with very high rates of mental illness (56%).
Post-Transplant Outcomes
Veterans who receive kidney transplants may have their subsequent care managed through the VA, through Medicare, or through both systems. The setting of post-transplant care is strongly associated with long-term survival.
Care Setting Distribution
- VA only: 752 veterans (12%)
- Medicare only: 2,092 veterans (34%)
- Both VA and Medicare: 3,362 veterans (54%)
- Total: 6,206 veterans
Mortality and Clinical Outcomes
| Indicator | VA Only | Dual (VA + Medicare) | Medicare Only | Overall |
| 5-year mortality | 11% | 16% | 20% | 17% |
| 30-day post-transplant mortality | <1% | — | 1.3% | — |
| Need for dialysis at 1 year | 2% | 4% | 3% | — |
Veterans receiving post-transplant care exclusively within the VA system have substantially better outcomes across every measured metric. Their 5-year mortality (11%) is nearly half that of Medicare-only patients (20%) and significantly lower than dual-care patients (16%).
Economic Burden
Treatment Costs
Kidney disease imposes enormous costs on both patients and the public health system. The following figures illustrate the financial scale of treatment across different stages and modalities.
- Average annual cost of kidney disease treatment in Virginia: $77,400
- Average annual Medicare cost — dialysis patient: $85,979
- Average annual Medicare cost — transplant (after first year): $32,586
- Cost of a kidney disease test: $80–$143
The contrast between the cost of a kidney disease test ($80–$143) and the annual cost of treating kidney failure ($77,400–$85,979) powerfully illustrates the economic case for early detection and prevention. Catching CKD early — when it can potentially be slowed or halted — is orders of magnitude cheaper than managing kidney failure.
Financial Hardship and AKF Charitable Assistance
Most Virginians living with kidney failure face severe financial hardship. Low income, inability to work, and high out-of-pocket costs combine to create a situation where many patients cannot afford the insurance premiums required to maintain access to life-sustaining treatment. The American Kidney Fund (AKF) provides critical grants to bridge this gap.
Patient Financial Profile
- Average annual income of AKF-assisted patients: <$25,000
- Average annual out-of-pocket dialysis costs: >$10,000
- Estimated out-of-pocket costs as share of average income: ~40%+
AKF Charitable Assistance to Virginia Patients — Year by Year
| Year | Virginians Assisted | Total Assistance Provided |
| 2020 | 2,184 | $6,100,000 |
| 2023 | 1,534 | $4,667,717 |
| 2024 | 1,599 | $4,181,901 |
The ratio of out-of-pocket costs to income is striking — dialysis patients spending over $10,000 per year on health care while earning less than $25,000 are devoting more than 40% of their income to medical expenses, before housing, food, or transportation. AKF assistance ensures these patients can maintain insurance coverage for their life-sustaining treatment.
Insurance Coverage Among AKF-Assisted Patients
The majority of patients receiving AKF charitable assistance rely on Medicare-related coverage programs. The table below shows the insurance breakdown for AKF recipients across the two most recent reported years.
| Insurance Type | 2023 | 2024 |
| Medicare Part B | 44.6% | 25.0% |
| Medigap (Medicare Supplement) | 23.4% | 27.3% |
| Employer Group Health Plans (incl. COBRA) | 17.2% | 20.1% |
| Medicare Advantage | 1.4% | 0.6% |
Medicare-related coverage dominates among AKF-assisted patients — consistent with ESRD patients’ automatic Medicare eligibility regardless of age. The most notable year-over-year shift is a sharp drop in Medicare Part B recipients (from 44.6% to 25.0%) and a corresponding increase in Medigap (23.4% to 27.3%) and employer-based coverage (17.2% to 20.1%).
Conclusion
The data assembled in this report paint a clear and sobering picture: kidney disease in Virginia is widespread, underdiagnosed, and growing. Over 21,000 residents now live with kidney failure, more than 13,900 depend on dialysis to survive, and the waiting list for a kidney transplant continues to grow faster than transplant capacity. Each year, approximately 3,400 to 3,500 new cases of kidney failure are diagnosed — yet fewer than one in twenty newly diagnosed patients receives a transplant rather than beginning dialysis. The total cost burden — $77,400 on average annually per patient — falls hardest on those least able to bear it, with the typical AKF-assisted patient earning under $25,000 while facing over $10,000 in out-of-pocket medical expenses per year.
Disparities run throughout the data. Communities of color bear a disproportionate burden of both CKD and ESRD, accounting for more than 60% of patients assisted by the American Kidney Fund despite representing a minority of the general population. Geographic concentration of transplant centers — all four major adult facilities situated in Northern Virginia, Richmond, Norfolk, and Charlottesville — limits equitable access for patients in rural and southwestern regions. At the county level, localities such as Petersburg City, Hopewell City, and Portsmouth City show incidence and prevalence rates far above state and national averages, with upward trends that signal deepening local crises.
The path forward is clear in its broad outlines: earlier and more systematic screening, particularly among the more than 44% of Virginians who have diabetes or high blood pressure; expanded transplant infrastructure, especially in underserved regions; and continued investment in integrated care models — such as the VA’s — which consistently outperform fragmented care on dialysis and post-transplant mortality outcomes. At an individual level, the cost of a kidney disease test ($80–$143) is a fraction of the $77,400 average annual treatment cost, making prevention and early detection not just a clinical priority, but a compelling economic imperative.
Sources:
- State of CKD in Virginia
- Explore Chronic Kidney Disease in Virginia | AHR
- in Virginia
- Greater Hampton Roads :: Indicators :: Chronic Kidney Disease: Medicare Population :: County : Portsmouth City, VA
- Kidney failure in Virginia: 2025
- Virginia and Metro D.C. Ending Disparities in CKD Leadership Summit | National Kidney Foundationt
- Chronic Kidney Disease Treatment Cost in Virginia vs Turkey
- Kidney failure in Virginia: 2024
- Renal Disease Council – 2022 Report
- Survival among Veterans Obtaining Dialysis in VA and Non-VA Settings – PMC
- The life-changing impact Carilion’s Kidney transplant center could have for local patients
- Veterans Receiving VA-Only Post-Kidney Transplant Care Had Lower Five-Year Mortality Compared to Non-VA Transplant Care
- KIDNEY DISEASE IN VIRGINIA
- Incidence Rate Report for Virginia by County: Kidney & Renal Pelvis (All Stages^), 2018-2022
- Virginia Cancer Incidence: Quick Profile | HDPulse Data Portal
- State Cancer Profiles > Historical Trends Data Table
- Kidney Transplant Centers in Virginia