By: Michael Wayne Holliday, Jr., M.D., Ph.D., FASN Assistant Professor of Medicine/Nephrology, Baylor College of Medicine
Disclaimer: The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or the United States government.
Introduction
The AAKP Veterans Health Initiative is a nationwide effort aimed at improving kidney care for U.S. Veterans. AAKP has a long history of advocating for Veterans by partnering with the Department of Veterans Affairs (VA), community clinicians, and Veterans themselves to promote kidney health. The initiative provides clear and practical education for patients and their families. In honor of Veterans Day, the latest issue of aakpRENALIFE highlights this work and its impact.
The VA cares for millions of Veterans, a group that has a notably higher rate of chronic kidney disease than the general population. Early detection of kidney disease can significantly help in preserving kidney function. As the Veteran population ages, the need for evidence-based care, patient education, and patient empowerment is more important than ever. This issue provides an overview of key programs and services available to Veterans with kidney disease, as well as an explanation of how the VA and community providers collaborate to deliver timely, high-quality care.
Over the last few decades, Congress has passed several acts to improve Veterans’ access to care. Two major laws—the VA MISSION Act and the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act—aim to make care more accessible and easier to navigate. The MISSION Act allows eligible Veterans to see in-network community doctors when VA wait times are long or travel distances are extensive. It also introduced a VA-paid urgent care option for minor health needs, expanded support and stipends for family caregivers, and invested in modernizing facilities and enhancing the healthcare workforce, especially in rural areas. The Dole Act further streamlined community care referrals, improved mental health and homelessness services, and increased long-term and home-based care supports. Together, these reforms provide Veterans with more choices, more timely care, and greater support for the challenges they face in daily life.
In 2020, the VA issued Directive 1053, which established a comprehensive plan to prevent, identify early, and treat chronic kidney disease
(CKD) across all VA facilities. This directive clarifies the roles and responsibilities of hospital leaders, primary care teams, and kidney specialists, requiring each VA facility to implement a coordinated kidney health program. It also established a national Kidney Health Committee and provided practical tools and clear educational resources for both patients and clinicians. The directive was implemented in response to the increasing prevalence of kidney disease among Veterans—approximately one in six Veterans receiving VA care is affected—strengthening both access to and quality of kidney care.
For Veterans living with kidney disease, these reforms create more opportunities to receive appropriate care promptly. Here’s what these changes mean for a Veteran needing to see a kidney specialist: Referrals may come from either a VA or community-based primary care provider. Once a referral is made at the VA, the nephrology provider receives it, and a scheduler will contact the Veteran to provide available appointment dates. If the Veteran has a lengthy travel time (more than a 60-minute drive) to the nearest VA nephrologist, if there is no local nephrologist available, or if the wait time exceeds 28 days, the Veteran has the option to seek community care. Furthermore, the Veteran and their primary care provider (PCP) may opt for community care if the Veteran has an established relationship with a community provider or if the PCP determines it is in the Veteran’s best medical interest. If the Veteran opts for community care, the Office of Integrated Veteran Care (OIVC) will assist in scheduling an appointment with an in-network specialist. The OIVC will also share necessary VA medical records with the community provider before the visit, and ensure the specialist’s visit notes are added to the Veteran’s chart, keeping everyone well-informed.
To facilitate more straightforward navigation of healthcare, the VA has expanded its digital tools and resources. My HealtheVet, now part of VA.gov, serves as the online gateway to VA care. From any smart phone, tablet or computer, Veterans can refill and track prescriptions, send and receive secure messages to their care team (including specialists), and view test results and visit notes. The platform features include appointment management, ordering specific medical supplies, and uploading health readings, enabling care teams to monitor patients more effectively between visits. Signing into My HealtheVet is easy with Login.gov or
ID.me. Veterans can also contact their local VA My HealtheVet Coordinator Office for assistance with the sign-up process.
Another valuable resource is VA Health Connect, an on-demand help line for everyday care needs. By calling their local VA medical center, Veterans can speak with a nurse who can discuss symptoms, answer questions, and help determine the next steps—this might include arranging a same-day video visit or connecting to tele-emergency care when appropriate. This service can also assist with booking or changing appointments and addressing questions related to pharmacy refills.
Specifically designed for Veterans with kidney disease, the VA eKidney Clinic is an accessible online hub that simplifies kidney health information. It provides clear explanations, short videos, and easy-to-interpret graphics covering essential topics—such as how kidneys function, the implications of chronic kidney disease, and daily steps for protecting kidney health. The site also explains common lab tests and how to monitor metrics over time, empowering Veterans for their clinic visits. The website also offers information on dialysis modalities, kidney transplant, and conservative kidney care, facilitating informed discussions with healthcare teams.
Additionally, the eKidney Clinic includes necessary dietary counseling for Veterans with kidney disease. Many local VA facilities offer access to renal dietitians who create personalized nutrition plans, translating dietary guidelines into practical meal ideas that protect kidney function and align with other health needs. For Veterans dealing with obesity, the VA MOVE! weight-management program provides coach-guided tools for losing weight and maintaining a healthy weight. Available classes include group sessions, one-on-one counseling, and telehealth check-ins that fit individual schedules. For Veterans who travel, the Traveling Veteran and Social Work services help coordinate care—arranging appointments, refills, or dialysis at other locations—ensuring treatment continuity no matter where they are.
The VA continues to expand programs and services to support Veterans with kidney disease and their families. For more information, please reach out to your local VA provider or eligibility office.
AAKP Resources:
Watch Dr. Holliday in this OnDemand recording from AAKP’s 2025 National Patient Meeting: Navigating Dual Healthcare Systems - VA and Civilian Kidney Care. https://bit.ly/4p1Js9S
Dr. Holliday is a staff nephrologist at the Michael E. DeBakey VA Medical Center, where he cares for Veterans with kidney disease. As Chief of Renal Clinics, he works to improve access to quality kidney care at the VA and improve coordination with community partners. He also serves as core faculty for the Baylor College of Medicine Nephrology Fellowship and remains active in clinical research and the development of patient education programs.
