Half a million Americans depend on dialysis to survive, but the treatment they receive today isn’t substantially different from what was available 50 years ago. This lack of innovation poses critical risks in an era of climate change and natural disasters. Current dialysis technology requires enormous resources — consuming vast quantities of water per treatment session, with 70% of that water rejected and never reaching the patient. Dialysis also demands significant electricity and ties many patients to physical facilities for hours-long sessions multiple times per week, creating quality-of-life challenges even when systems function properly.

Current market conditions and public policies offer little incentive for the industry to innovate. At the same time, climate emergencies are creating immediate threats to treatment access. During Hurricane Helene in 2024, a factory that produced peritoneal dialysate production went offline, forcing patients across the country onto reduced treatment schedules — demonstrating how supply chain disruptions can have life-threatening consequences, even far away from disaster zones.

The KidneyX Innovation Accelerator was already investing in longer-term advancements like artificial kidneys and regenerative therapies — and while those innovations are critical, they will take years to develop and reach patients. Meanwhile, people on dialysis today need immediate solutions that address the treatment’s resource intensity and its vulnerability to disruption. KidneyX, a public-private partnership between the U.S. Department of Health and Human Services (HHS) and the American Society of Nephrology (ASN), wanted to continue supporting long-term innovation while also incentivizing near-term solutions, making existing dialysis technologies more sustainable and resilient without waiting for breakthrough innovations that might be years away.

Rising global temperatures are linked to increased chronic kidney disease cases, and healthcare systems contribute to ongoing environmental issues through resource-intensive treatments. Dialysis represents approximately 7% of government healthcare expenditures — $28 billion in Medicare spending each year — making sustainability improvements both an environmental and economic imperative.

Natural disasters are exposing the fragility of centralized healthcare supply chains and bringing a greater sense of urgency to dialysis innovation. When manufacturing facilities become inaccessible due to flooding or infrastructure damage, the impacts ripple nationwide. A single point of disruption can affect hundreds of thousands of patients. Healthcare organizations need tools and incentives to adapt their technologies and delivery models for climate resilience now, before the next emergency strikes.

In partnership with HHS and ASN, Luminary Labs designed the KidneyX Sustainability Prize as a $7.25 million, single-phase challenge to surface and reward innovative solutions that could make dialysis more resilient and resource-efficient.

Our approach began with comprehensive problem analysis to identify where a prize could create the most impact, with the goal of encouraging rapid innovation in a field where technological advancement has stagnated. We worked within the dual goals of emergency preparedness and sustainability, recognizing that solutions needed to address both resource conservation and treatment accessibility during disruptions. The design process balanced the need for technical rigor with a broad call to attract a diversity of solvers and approaches.

Throughout the process, we elevated patient perspectives. We invited patient advocates to join our “meeting of the minds” convening during the challenge design phase, and we included patient representation on the judging panel, casting a wide net to identify federal employees with requisite expertise and a range of perspectives. ASN leveraged its clinical networks to assemble subject matter experts including patient advocates, academics, and clinicians, who provided critical input on challenge design.

The prize attracted solutions across multiple approaches, including machines that use less water, portable devices that can operate during emergencies, and technologies for local dialysate manufacturing that reduce supply chain vulnerabilities. We conducted extensive outreach to known solvers in kidney care, as well as experts with relevant expertise in analogous spaces, expanding the community of KidneyX innovators.

Recognizing the urgency of the need, we executed the entire process on a compressed timeline, completing challenge design, launch, evaluation, and winner announcement within 12 months. This rapid execution allowed us to distribute substantial non-dilutive funding to promising solutions as quickly as possible, even while maintaining rigorous technical evaluation standards.

The challenge successfully attracted and funded innovative solutions that address dialysis sustainability from multiple angles. Seven winning teams each received equal shares of the $7.25 million prize purse, representing diverse technological approaches — from dialysate regeneration systems that dramatically reduce water usage to portable devices that can operate on battery power during emergencies. A few months after the winner announcement, post-challenge outcomes have already demonstrated real momentum in advancing these solutions. Several winners have secured additional funding, and two winning teams filed patents related to their solutions. Qidni Labs’ portable dialysis technology was recently named a “world-changing idea” by Fast Company magazine.