Guest Blog: Lives on the Line: Dialysis Patients Fight for Innovative Medicine
By Katie Riley, Vice President of Communications, Alliance for Aging Research
For many older Americans with kidney failure, life isn’t just about surviving the next dialysis session, it is about protecting their hearts, keeping their transplant hope alive, and preserving dignity and independence.
When kidneys stop working and patients rely on dialysis, phosphorus levels build up. That small-but-dangerous imbalance massively raises the risk of cardiovascular events and can threaten someone’s eligibility for a transplant.
Enter a lifesaving tool: oral Phosphate Lowering Therapies (PLTs). These medications help keep phosphorus under control and are especially important for older adults, including those on fixed incomes or using nursing-home care. But a federal policy change at the start of 2025 cut off easy access. Under the new rule, oral-only PLTs were moved into the ESRD payment bundle meaning many patients outside dialysis centers or in nursing homes have to jump through hoops to get access to them.
That policy shift is more than inconvenient…it’s harmful. Reports reveal that aging dialysis patients in nursing homes are being denied coverage altogether, resulting in higher phosphorus levels, greater risk of heart problems, and shrinking transplant chances.
Patients across the country have been impacted by the bundle and are sharing their concerns with policymakers and the public. Here are a few of their stories:
CKD care is not always straightforward, and encompassing every patient into a single fixed-payment bundle system takes away the key patient and provider relationship, where decisions are made to save lives, not time.
Ensuring that older adults can get the treatments they need to manage chronic conditions like kidney failure demands action.
The solution to this problem is simple. Medicare must reverse the decision to include oral-only Phosphate Lowering Therapies into the ESRD Bundle and restore coverage access to Medicare Part D. This change would immediately expand treatment options, reduce avoidable harm, and help keep thousands of older Americans eligible for transplant.
But the call for action is not just coming from advocates or clinicians, it is coming directly from patients. Their experiences are clear, consistent, and urgent. They are telling us what is at stake: their health, their independence, and their chance at a better life. Policymakers must listen.
Seniors and kidney patients deserve policies shaped by the realities they live every day not by technical payment decisions that ignore those realities. We urge the administration to return to a patient-centered Medicare approach that respects individual needs and ensures that older adults can age with health, dignity, and hope.
