HHS Funding Cuts and Layoffs Raise Concern in the Kidney Community

Kidney disease impact

Roach noted in his statement that some of the HHS cuts have affected critical kidney health programs. He said that many employees, who were working to modernize the transplant system, were cut from the Health Resources and Services Administration's Division of Transplantation. “Mass layoffs stand in direct opposition to the goals of transplant system reform to improve efficiency, transparency, and the ability of government to respond to the needs of people who rely on the system,” Roach said. “Chaotic terminations of the employees charged with implementing reforms will ensure the status quo persists.”

Other staff cuts that Roach described as alarming were:

• The Centers for Medicare & Medicaid Services staff who are responsible for organ procurement, transplant, and dialysis safety, as well as for improving patient care and transplant access

• The National Institutes of Health (NIH) researchers who are developing new kidney disease therapies that may help prevent progression to kidney failure

• The Centers for Disease Control and Prevention staff who are working to prevent dialysis-related infections, track and prevent infectious diseases that may harm patients who are immunocompromised, and monitor overall US health

• The US Food and Drug Administration staff who ensure access to safe food, medications, and devices that are vital to people with kidney diseases

“It is unclear if any prior thought was given to the effects [that] these mass terminations will have on the ability of these agencies to function or the effects [that] these cuts will have on everyday Americans,” Roach said. He continued, “Right now, the journey to recovery just became harder for those waiting on a transplant, for patients who rely on dialysis to be safe, and for those hoping for a cure or treatment for their chronic illnesses. There will also be an incalculable loss of talent, expertise, and experience that will be difficult, if not impossible, to ever replace.”

HHS also plans to cut contracts with outside organizations by 35% (4). One outside contract researcher for HHS, who was fired abruptly in January under the anti-DEI initiative, was studying racial and ethnic disparities in kidney care using federal data. The investigator, who wished to remain anonymous, said that they were given just 15 minutes’ notice before the contracting organization shut off their access to their work or ability to inform collaborators and community-based partners. The researcher worries that the kidney community will lose progress on inequities and rebuilding trust with underserved communities. “We know the health inequities in kidney care have persisted for decades,” the contract investigator said. “In the past decade, we saw some progress in [the] closing of these gaps. By terminating these health equity-related projects, we are reversing that progress and could go back and widen inequities.”

Mohottige and the former HHS contractor expressed concern about the impact of the department-wide cuts at NIH. The former HHS contract researcher noted that cuts to infectious disease outbreak prevention and surveillance, vaccine access and development, and defunding of state health departments will all have impacts on vulnerable populations like people living with kidney diseases.

Patients have also expressed concern: “As someone living with the consequences of kidney disease, I’ve learned that hope is often our greatest medicine,“ said Robert Pito Sanchez, MPS, senior clinical interviewer nephrology at the Albert Einstein College of Medicine in New York. “We look to the future because that's where the healing is supposed to come from—where scientists, we believe, are working day and night to better understand what's happening in our bodies, and how to stop it. The termination of the APOL1 gene study didn't just cut funding—it cut into that hope. It sent a message that the pursuit of answers for people like me, for communities like mine, isn't worth the cost or the time.” Pito Sanchez is on the community-based advisory board for the APOL1 study.

ASN President Prabir Roy-Chaudhury, MD, PhD, FASN, wrote a letter to the new director of NIH, Jayanta Bhattacharya, MA, MD, PhD, congratulating him on his position and emphasizing the importance of working together to improve kidney disease diagnosis, prevention, and care to meet the administration's goals of curbing chronic disease and its devastating impact on Americans. Roy-Chaudhury emphasized that President Trump recognized the importance of improving kidney care during his first term in his Executive Order on Advancing American Kidney Health (5). The Executive Order supports kidney disease research, and Roy-Chaudhury noted that it helped lead to significant steps by legislators and the Executive Branch to improve kidney care. Preventing and slowing kidney diseases also have the potential to substantially reduce Medicare's $150 billion in annual costs for kidney disease care, he noted in the letter. Yet, the recent cuts may jeopardize these efforts, he said.

Roy-Chaudhury stated that “…recent NIH funding cuts threaten to undermine these efforts and contradict the goals articulated by HHS Secretary Kennedy and yourself to address chronic diseases and improve health outcomes.” He noted the disproportionate impact of the termination of the coordinating centers for critical networks on nephrology and geriatric nephrology researchers working to improve outcomes for people with kidney diseases. “These programs provide vital research infrastructure and support training and career development for early-stage investigators committed to strengthening the medical workforce,” Roy-Chaudhury said. “Reducing investments in kidney research jeopardizes progress in tackling chronic diseases and runs counter to the administration's stated mission of improving kidney health for all Americans.”

Uncertainty and delays

The cuts are already causing disruption in ongoing kidney disease research, impacting patients, and threatening to derail the next generation of researchers. Mariya Sweetwyne, PhD, an assistant professor at University of Washington Medicine in Seattle, was in the process of applying for her first NIH grant to fund her research on how mitochondria affect cellular aging and injury response in the kidney when NIH abruptly canceled the request for proposal. “We are trying to understand how aging overlaps with kidney diseases, making older kidneys more susceptible to disease,” Sweetwyne said. “Understanding that and the cell types involved [are] key for developing targeted therapies and therapies with fewer side effects.”

The grant for which she was applying was designed to fund researchers who also mentor and support students from under-represented backgrounds as part of NIH's efforts to increase diversity in science. NIH also canceled funding for numerous ongoing studies in the anti-DEI push, including a study on how long-term arsenic and uranium in drinking water contribute to cardiovascular and kidney diseases and a study on the role of mitochondria in sex differences in acute kidney injury (6).

Sweetwyne, who launched her laboratory 4 years ago, can reapply for other grants. She is optimistic about her prospects because reviewers scored her application well. She is also an NIH reviewer. However, having to restart the process will delay much-needed funding for her nascent laboratory until at least spring 2026. Sweetwyne is unsure what will happen next. She has start-up funds from her university to help support her salary for now. However, she will be unable to hire graduate students, and she will need to fully support her salary, her laboratory's operating and equipment expenses, and the wages of the people working in her laboratory with grants once her start-up funds run out.

But she is more concerned about the impact on kidney research and people living with kidney diseases. “Are people going to feel like they can talk about what problems they see in kidney research practices and how that affects our ability to come up with solutions for kidney diseases?” she asked.

Freezing prospects

The seemingly arbitrary cancellations also make it harder for researchers, especially those just starting, to pursue or sustain a research career. Sweetwyne noted that some top-ranked graduate programs have rescinded all of their offers to prospective trainees because the programs are uncertain about whether they can support the trainees for 5 years. Many universities have also frozen hiring, she said.

“We are rapidly losing pathways for people to start new projects,” Sweetwyne said. That is particularly frustrating for kidney disease research, she shared, since the field has enjoyed recent “game-changing” breakthroughs with sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, as well as promising approaches using big data, gene editing, and RNA therapies. “We are right on the cusp of being able to do something incredible, and we are shutting it down,” she said.

Mohottige shared that concern, especially given the limited number of nephrologists and nephrology researchers. She noted that many young investigators are being advised to avoid equity-related work. She also worried about the impact on scientific innovation and global competition. “I am concerned about the impact on a whole generation and maybe multiple generations of investigators,” she expressed.

Mohottige has been working with her community advisory board, colleagues, and institution to appeal the grant cancellation. In April, she and advisory board members met with the Senate Health, Education, Labor and Pensions Committee members’ staff to discuss the importance of the study in helping prevent kidney diseases and kidney disease progression to kidney failure, which is costly to both taxpayers and people with kidney diseases who often experience a reduced quality of life and financial instability. Mohottige noted that the study may help patients with other chronic diseases by identifying environmental contributors and how to mitigate them to preserve health.

“We urge the administration and Congress to reconsider and roll back these actions immediately so potential cuts can be made in a thoughtful and safer manner,” Roach concurred. “To do otherwise may result in absolute tragedy for the American people” (3).