By Reed Abelson and Katie Thomas

New York Times News Service

President Donald Trump issued a sweeping set of proposals aimed at improving medical care for the tens of millions of Americans who have kidney disease, a long-overlooked condition that kills more people than breast cancer.

“This is a first, second and third step. It’s more than just a first step,” Trump said in a speech Wednesday, which was attended by patients, advocates and industry executives.

Trump signed an executive order directing federal agencies to educate and treat people with early forms of kidney disease, to make kidney transplants easier to get and to shift the financial incentives for clinics and doctors away from the existing system that relies heavily on dialysis.

“The result will be more and faster transplants for those in need,” said Trump, who said his administration would work to encourage the development of new treatments like artificial kidneys.

“For 50 years, we have had basically a stagnant system of how we treat people with chronic kidney disease,” Alex Azar, the Health and Human Services secretary, said in a briefing held Wednesday morning. Azar has made kidney disease one of his priorities because his father needed dialysis for several years and later received a kidney transplant.

Trump did not mention his wife’s kidney surgery last year, and at the press briefing, White House officials did not answer a reporter’s question about whether Melania Trump was involved in these efforts.

The president set an ambitious goal to remake how Americans with kidney disease get treated, by aggressively seeking to lower the costs by encouraging in-home dialysis and organ donation. Both options are seen as better treatment for patients than clinic-based dialysis. However, transforming the area may prove daunting, and many of previous efforts have fallen short.

In sharp contrast to treatments in areas like cancer or HIV, the main treatment for people with end-stage kidney disease — dialysis — has not changed much over the years.

“Dialysis has been a wonderful technology, but it has suffered from little innovation,” said Dr. John Sedor, a kidney specialist at the Cleveland Clinic who works with federal officials in a program to foster new developments. “It’s a government-run program that has discouraged private investment.”

Officials said they wanted 80% of newly diagnosed people with end-stage kidney disease to be moved from clinic-­based dialysis by the year 2025 and to reduce the number of Americans who develop end-stage disease by 25% before 2030. Today, only about 12% of Americans get dialysis at home, an amount that lags other countries.

The Trump administration wants to encourage living donors by adding reimbursements for lost wages and child care, as a way to double the number of kidneys available for transplant by 2030. Organs from living donors are considered the best option for people who need transplants, but they too require recuperative time.

“We, in the United States, have too much in-center dialysis,” Azar said. “It is mentally and physically draining on you as an individual.”

If the administration is successful, the initiative could lead to a shake-up of the dialysis industry, which is dominated by two companies, DaVita and Fresenius Medical Care. They operate about 70% of the country’s dialysis clinics.

His decision to focus on kidney care was met with a mix of surprise and praise.

“We are very optimistic and excited that there is great attention at the presidential level,” Tonya Saffer, vice president for health policy at the National Kidney Foundation, a nonprofit advocacy group, said in an interview before the announcement. “It’s really been four decades since anybody has paid attention to this space in a very meaningful way.”