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.

Socioeconomic Measures and CKD in the United States and The Netherlands

“…First, access to health care in the United States is income dependent. Therefore, along with affecting health lifestyle choices (e.g., access to healthy diet), low income additionally affects health care access in the United States and ultimately affects the prevalence of CKD (26). Second, in the United States income inequalities are bigger (27), as also reflected by the higher PIR between the fifth and first quintiles in our study.…”

Glomerular Filtration Rate Equations Overestimate Creatinine Clearance in Older Individuals Enrolled in the Baltimore Longitudinal Study on Aging: Impact on Renal Drug Dosing

“…Age-related decline in kidney function is seen in a substantial portion of the older population. 1 Nearly 40% of adults 70 years and older have an estimated glomerular filtration rate (eGFR) below 60 ml/minute/l.73 m 2 . 2 Most of these older adults have no obvious source of loss of kidney function other than physiologic aging.…”

Association of the kidney allocation system with dialysis exposure before deceased donor kidney transplantation by preemptive wait‐listing status

“…Unequal access may be driven in part by lack of health insurance among many US individuals with nondialysis‐dependent chronic kidney disease (CKD), a disparity which may be narrowing with the national gains in insurance coverage under the Affordable Care Act (ACA) . In addition to providing affordable health insurance coverage options, efforts to improve access to preemptive wait‐listing should also include educational interventions targeted to those most likely to lack CKD awareness and predialysis health care, including low‐income individuals with CKD …”