John Erbey on the $650 billion kidney crisis and the problem no one seems to talking about: Signals KOLs

Summary

In this episode, Roivios founder and CEO John Erbey breaks down the massive and overlooked economic burden of kidney disease. He shares how his experience launching CardioMEMS led him to recognize the critical gap in fluid management for nephrology, and how that realization drove the creation of Roivios. Most importantly, he highlights the staggering $650 billion cost of kidney disease, why it’s growing at 16% per year, and why no one seems to be talking about it—even though it represents over 10% of the U.S. federal budget. John makes the case for shifting focus upstream, identifying and managing chronic kidney disease (CKD) early, instead of scrambling to contain the cost of end-stage renal disease (ESRD). He emphasizes that the 26 million CKD patients at risk are the real priority, not just the 800,000 ESRD patients already in dialysis. Simply put, if we don’t act now, the economic burden of kidney disease will cripple the U.S. healthcare system.

Signals KOLs is the series that highlights key opinion leaders whose work is shaping the future of kidney health across industry, academia, policy, research, advocacy, and beyond.

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Guest Bio

John Erbey is the founder and CEO of Roivios. He has spent the past 25 years bringing innovative therapeutics and medical devices to the market. Prior to founding Roivios, John held roles of increasing responsibility across the pharmaceutical and medical device industries. He holds a PhD in epidemiology from the University of Pittsburgh’s Graduate School of Public Health. His dissertation on the cardiovascular risk associated with insulin resistance in adults with type 1 diabetes earned him induction into Delta Omega, the National Honor Society for Public Health. He has published 17 peer reviewed articles and delivered dozens of conference presentations and invited lectures.

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Keywords

kidney health, chronic kidney disease, healthcare economics, nephrology, innovation, epidemiology, USRDS, fluid management, metabolic, sepsis, hospitalization

Chapters

• (00:20) – John’s Background & Path to Roivios

• (02:10) – From Epidemiology to Health Economics & MedTech

• (04:45) – The Hidden Role of the Kidneys in Systemic Health

• (06:15) – The $650B Problem No One Is Talking About

• (07:30) – Why the Cost of Kidney Care Is Growing 16% Annually

• (08:50) – The Emperor’s New Clothes Moment: Connecting the Data

• (09:30) – A Broken Approach: Why Early CKD Intervention Matters

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Takeaways

• The Hidden Cost of Kidney Disease: The U.S. spends $650 billion annually on kidney care, accounting for over 10% of the federal budget, yet this issue remains largely unaddressed in policy discussions.¹

• The Crisis Is Growing Rapidly: Kidney care costs are increasing at 16% per year, an unsustainable trajectory that could cripple the healthcare system if left unchecked.²

• Chronic Kidney Disease (CKD) Is the Real Battleground: While 800,000 patients are in dialysis, 26 million people with CKD are at high risk—and three times as many die before reaching ESRD.³

• A Simple Blood Test Can Drive Early Intervention: A creatinine test can easily identify at-risk CKD patients, yet widespread screening remains underutilized in preventive care.

• We Must Shift Focus Upstream: Instead of only improving dialysis care, the real opportunity lies in preventing kidney failure in the first place—saving lives and reducing costs.⁴

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Milestones

• Jan-2025: Roivios and Caresyntax Partner to Revolutionize Renal Care Through Data-Driven Insights (Press release)

• Dec-2024: FDA Grants IDE Approval for the Pivotal Trial of the JuxtaFlow® Renal Assist Device (RAD) (BioSpace)

• Nov-2024: Roivios Shares Promising Data on JuxtaFlow Renal Assist Device From BIPASS-AKI Feasibility Study (Press release, Study research poster)

• Apr-2024: Roivios Secures FDA Breakthrough Device Designation for JuxtaFlow® RAD, Showcases Pioneering Data at Society of Cardiovascular Anesthesiologists Annual Meeting (Press release)

Data presented at STS 2024 in Philadelphia, PA

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Discussion

• Do you think the $650 billion true cost of kidney disease will tip the balances in how we think about healthcare policy, priority, or strategy?

• What do you see as the biggest barriers to shifting the focus from ESRD management to CKD prevention in the United States?

• Which policies, providers, and partners will help us engage and prioritize early detection and intervention?

• How do you think about the opportunity in earlier detection and slowing progression of kidney disease?

• What questions do you have for John and the Roivios team?

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Brought to you by…

This issue is made possible by Guaranteed, the company optimizing end-of-life care experiences for CKD and ESRD patients at risk-bearing nephrology practices when conservative kidney management, dialysis and kidney transplants are no longer viable options. Email raihan@onguaranteed.com today to learn more. Thank you team!

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1. Using the adjusted CKD PPPY estimates, the calculated the Total Population Cost/BOI increases from $623.6B to $707.9B. Excluding ESRD the adjusted burden of illness (BOI) is $655.6B. (Roivios Analysis)

2. Kidney Disease Surveillance System: Trends in Prevalence of CKD Stages among U.S. Adults (nccd.cdc.gov)

3. Fact Sheet: Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023 (cdc.gov)

4. National Center for Health Statistics: Health Insurance Statistics (cdc.gov/nchs)