Taiwan’s experience demonstrates that a high disease burden can be mitigated through sustained policy commitment and structured data-driven care. Universal health-care coverage, when coupled with outcomes-linked reimbursement, standardized multidisciplinary synergy and institutional certification, can maximize population-level outcomes. Nevertheless, suboptimal controls of key modifiable risk factors, labour workforce scarcity in a super-aged society and climate change warrant continued efforts to attain sustainable kidney care. A sophisticated kidney care transformation involving non-nephrologist physicians, proactive early intervention and digital, precision-enabled health management will offer a credible pathway towards that goal, and its outcomes will carry important lessons for high-burden nephrology systems worldwide.