SlowItDownCKD

Daniel Holmes
May 12
4 min read

It’s Not Veteran’s Day, But…

Enlisted Kidney Foundation’s Dan Holmes posted an update that caught my eye. Remember, in addition to being a chronic kidney disease patient, I’m married to a veteran with CKD. I asked Dan for permission to reprint that post. As gracious as ever, he agreed. And so, that’s this week’s blog. Thank you, Dan.

“Veterans and Kidney Disease: Closing the Gap Between Risk and Real Care

By Dan Holmes, Enlisted Kidney Foundation

Kidney disease is one of the most under-recognized health threats facing veterans today. More than 1.4 million veterans are living with it, and many don’t know until their kidney function is already severely compromised. For some, the first real conversation happens when dialysis or transplant is already on the table.

As a veteran, a kidney patient, and the founder of The Enlisted Kidney Foundation (EKF), I’ve seen the same pattern again and again: the science is improving, the systems are evolving but the individual veteran is still left to figure it out alone.

That’s the gap we need to close.

Why Veterans Are at Higher Risk

Veterans carry a unique combination of risk factors for kidney disease. Conditions like hypertension, diabetes, and cardiovascular disease are more common and all of them directly impact kidney health. Layer in years of physical strain, chronic stress, irregular sleep cycles, and potential toxic exposures, and you have a population sitting squarely in a high-risk category.

The real problem? Chronic kidney disease (CKD) is often silent.

Many veterans feel completely fine while their kidneys are steadily losing function. Without routine monitoring, especially eGFR and urine protein testing, CKD often isn’t discovered until symptoms like fatigue, swelling, or shortness of breath show up. By then, the disease may already be advanced.

That creates a critical opportunity: we have to start the conversation earlier. Screening, awareness, and education need to happen before the crisis.

What’s Changing Inside the VA

There has been progress.

The VA [Gail here: that’s the United States Department of Veterans Affairs] and Department of Defense have been shifting toward earlier detection and better tracking of kidney health. There’s more emphasis on lab monitoring, improved use of data to identify high-risk patients, and a growing focus on slowing disease progression instead of reacting late.

These are meaningful steps forward.

But here’s the disconnect, system improvements don’t automatically translate to patient awareness. Many veterans still don’t know what labs to ask for, what their numbers mean, or how often they should be checked.

Policy doesn’t improve outcomes unless the person at risk understands how to engage with it.

Access Is Expanding But Awareness Isn’t

Resources inside the VA are improving:

Home dialysis options that reduce travel and improve quality of life
Tele-nephrology visits that expand access to specialists
Integrated care teams that coordinate treatment across disciplines

On paper, these are major wins.

In reality, many veterans never hear about these options unless they know exactly what to ask for or have someone guiding them through the system.

Access without awareness is still a barrier.

This is where navigation becomes just as important as treatment. A program can exist, but if a veteran doesn’t know about it or is overwhelmed trying to navigate the system, it might as well not exist at all.

Toxic Exposure and Kidney Disease

Any real conversation about veteran kidney health has to include toxic exposure.

PFAS, often referred to as “forever chemicals”, have been widely used in military settings, particularly in firefighting foam (AFFF). These chemicals have been linked to serious health conditions, including kidney cancer.

[Gail here again. I’m inserting some explanatory information about PFAS and AFFF. The United States Environmental Protection Agency tells us:

“PFAS are widely used, long lasting chemicals, components of which break down very slowly over time.
Because of their widespread use and their persistence in the environment, many PFAS are found in the blood of people and animals all over the world and are present at low levels in a variety of food products and in the environment.
PFAS are found in water, air, fish, and soil at locations across the nation and the globe.
Scientific studies have shown that exposure to some PFAS in the environment may be linked to harmful health effects in humans and animals.
There are thousands of PFAS chemicals, and they are found in many different consumer, commercial, and industrial products. This makes it challenging to study and assess the potential human health and environmental risks.”

As for AFFF, I turned to Interstate Technology Regulatory Council:

“Class B firefighting foams are commercial surfactant solutions that are designed and used to combat Class B flammable fuel fires. PFAS (fluorinated surfactants) are the active ingredient in Class B fluorinated foams.” ]

Right now, many veterans are still forced to prove that their illness is connected to their service. That burden is heavy and often overwhelming.

There are ongoing efforts to change that. Scientific reviews and proposed legislation aim to recognize these exposures and make it easier for veterans to access care and benefits without fighting uphill battles for proof.

But until those systems fully catch up, many veterans are still navigating this on their own.

Where The Enlisted Kidney Foundation Comes In

The system is evolving but evolution doesn’t automatically equal access.

There’s still a gap between what exists on paper and what a veteran actually experiences in real life.

That’s where EKF steps in….

Because information alone isn’t enough.

Most people don’t just need data, they need someone to walk alongside them. Someone who understands the system, speaks their language, and can say, “You’re not alone in this.”

A Call to Action

If you’re a veteran, caregiver, or healthcare professional, don’t wait for symptoms to start the conversation.

Start now.