ANNA provides written testimony to the House, Labor Health, and Human Services Subcommittee regarding funding for nursing and nephrology related programs in FY 2008

Written Testimony to the House Labor, Health, and Human Services Appropriations Subcommittee

American Nephrology Nurses’ Association

ANNA President, JoAnne E. Gilmore, BSN RN CNN

March 30, 2007


On behalf of the American Nephrology Nurses’ Association (ANNA), I appreciate having the opportunity to submit written testimony to the House House, Labor Health, and Human Services (LHHS) Subcommittee regarding funding for nursing and nephrology related programs in fiscal year (FY) 2008. ANNA is a professional nursing organization of more than 12,000 registered nurses practicing in nephrology, transplantation, and related therapies. Nephrology nurses use the nursing process to care for patients of all ages who are experiencing, or are at risk for, kidney disease. 

ANNA understands that Congress has many concerns and limited resources, but believes kidney disease is a heavy burden on our society that must be addressed. The United States has the highest incidence rate of late stage kidney disease in the world[1]. The direct economic cost for treating kidney failure is $20 billion a year in the United States and the number of people diagnosed with kidney failure has doubled each decade for the last 20 years. Because kidney disease imposes such a heavy burden in the United States, we must provide adequate funding for research and prevention programs.

Kidney Disease and Nephrology Nursing 

Chronic kidney disease (CKD) is the slow, progressive loss of kidney function as a result of abnormalities of the kidney. The National Kidney Foundation estimates that around 20 million Americans have CKD, and another 20 million are at risk. When CKD patients lose 85 percent of kidney function, it is known as end stage renal disease (ESRD). When patients reach ESRD, they must receive replacement therapy either in the form of dialysis or kidney transplant in order to survive. While kidney transplant is a treatment option for many ESRD patients, unfortunately the need for donor organs exceeds the supply, resulting in long waiting times for those who do not have a living donor.

Chronic kidney disease is often undiagnosed until the signs and symptoms related to the loss of kidney function materialize. Risk factors for developing CKD include increasing age, family history and diabetes. The disease is more prevalent in men and people of African American, American Indian, Hispanic, Asian, or Pacific Islander descent.

Since treatment of kidney patients often spans the duration of their lifetime, nephrology nurses must be skilled in offering care for all stages of life and disease progression. Nephrology nurses work in dialysis clinics, hospitals, physician practices, transplant programs, and many other settings.

To ensure that patients receive the best quality care possible, ANNA supports federal programs and research institutions that address the national nursing shortage and conduct biomedical research into kidney disease and related health problems. Therefore, ANNA respectfully requests that the Subcommittee provide increased funding for the following programs.

Nursing Workforce and Development Programs at the Health Resources and Services Administration (HRSA)

ANNA supports efforts to resolve the national nursing shortage, including appropriate funding to address the shortage of qualified nursing teaching faculty. Nephrology nursing requires a high level of education and technical expertise, and ANNA is committed to assuring and protecting access to professional nursing care delivered by highly educated, well-trained, and experienced registered nurses for individuals with kidney disease or other disease processes that require replacement therapies.

According to the Department of Health and Human Services, the Nursing Workforce Development programs at HRSA have supported the recruitment, education, and retention of an estimated 36,750 nurses. A report issued by HRSA, Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020, predicts that the nursing shortage is expected to grow by 29 percent by 2020. The HRSA Nursing Workforce Development Programs provide the largest source of federal funding to address the national nursing shortage, therefore:

ANNA strongly supports the national nursing community’s request of $200 million in fiscal year (FY) 2008 funding for Nursing Workforce Development programs at HRSA.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

As the primary professional caretakers of patients with CKD and ESRD, ANNA members support legislative, regulatory, and programmatic efforts that promote prevention and management of chronic kidney disease, including early diagnosis, education and proactive creation of native fistulae for dialysis.

NIDDK supports and conducts research on many serious diseases, including chronic kidney disease and ESRD. Specifically, the National Kidney Disease Education Program (NKDEP) at NIDDK is focused on reducing the overall mortality and morbidity from kidney disease. The programs at NKDEP were created to increase awareness about the seriousness of kidney disease, and the importance of prevention, early diagnosis, and appropriate management of kidney disease.

ANNA encourages Congress to authorize funding for research into and prevention of kidney disease by providing the maximum possible funding level for NIDDK in FY 2008. 

National Institute of Nursing Research (NINR)

ANNA understands that research is essential for the advancement of nursing science, and believes new concepts must be developed and tested to sustain the continued growth and maturation of the nephrology nursing specialty. NINR works to create cost-effective and high-quality health care by testing new nursing science concepts, and investigating how to best integrate them into daily practice. NINR has a broad mandate that includes seeking to prevent and delay disease and to ease the symptoms associated with both chronic and acute illnesses. NINR’s recent areas of research focus include the following:

  • End of life and palliative care in rural areas;
  • Research in multi-cultural societies;
  • Bio-behavioral methods to improve outcomes research; and
  • Increasing health promotion through comprehensive studies.

ANNA respectfully requests $150 million in funding for NINR in FY 2008 to continue their efforts to address issues related to chronic and acute illnesses.


I appreciate the opportunity to share the priorities of ANNA for FY 2008 funding levels for programs designed to chronic kidney disease and provide a sustainable nursing workforce. Providing $200 million in FY 2008 funding to the HRSA Nursing Workforce Development programs, $150 million to NINR and the largest allocation possible for NIDDK will ensure we are providing adequate resources for this fight. ANNA thanks the Subcommittee for their consideration and is happy to serve as a resource regarding these programs or other kidney disease or nursing issues.

[1]Sources: National Kidney Disease Education Program, American Nephrology Nurses’ Association