title: Access to health care among adults evaluated for CKD: findings from the Kidney Early Evaluation Program (KEEP).
abstract: BACKGROUND
  Data are scant regarding access to health care in patients with chronic kidney disease (CKD). We performed descriptive analyses using data from the National Kidney Foundation's Kidney Early Evaluation Program (KEEP), a nationwide health screening program for adults at high risk of CKD.
  
  
  METHODS
  From 2000-2010, a total of 122,502 adults without end-stage renal disease completed KEEP screenings; 27,927 (22.8%) met criteria for CKD (10,082, stages 1-2; 16,684, stage 3; and 1,161, stages 4-5). CKD awareness, self-rated health status, frequency of physician visits, difficulty obtaining medical care, types of caregivers, insurance status, and medication coverage and estimated costs were assessed.
  
  
  RESULTS
  Participants with CKD were more likely to report fair/poor health status than those without CKD. Health care utilization increased at later CKD stages; ~95% of participants at stages 3-5 had visited a physician during the preceding year compared with 83.7% of participants without CKD. More Hispanic and African American than white participants at all CKD stages reported not having a physician. Approximately 40% of participants younger than 65 years reported fair/poor health status at stages 4-5 compared with ~30% who were 65 years and older. Younger participants at all stages were more likely to report extreme or somewhat/moderate difficulty obtaining medical care. Comorbid conditions (diabetes, hypertension, and prior cardiovascular events) were associated with increased utilization of care. Utilization of nephrology care was poor at all CKD stages; <6% of participants at stage 3 and <30% at stages 4-5 reported ever seeing a nephrologist.
  
  
  CONCLUSIONS
  Lack of health insurance and perceived difficulty obtaining medical care with lower health care utilization, both of which are consistent with inadequate access to health care, are more likely for KEEP participants who are younger than 65 years, nonwhite, and without previously diagnosed comorbid conditions. Nephrology care is infrequent in elderly participants with advanced CKD who are nonwhite, have comorbid disease, and have high-risk states for cardiovascular disease.
authors.affiliation: Division of Nephrology and Hypertension, Fletcher Allen Health Care, Burlington, VT 05401, USA. varunagrawal1996@yahoo.com
authors.forename: Varun
authors.initials: V
authors.lastname: Agrawal
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Xenia Y
authors.initials: XY
authors.lastname: Frisby
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Yang
authors.initials: Y
authors.lastname: Qiu
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Adam T
authors.initials: AT
authors.lastname: Whaley-Connell
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bomback
mesh_terms: D000368:Aged; D005260:Female; D006293:Health Promotion; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014481:United States