"They are nae worrying about it… so …what's the point in asking?": A qualitative study of candidacy for early CKD care in areas of multiple deprivation.

backgroundChronic kidney disease (CKD) is common, associated with substantial comorbidity and strong socioeconomic gradients. Early CKD care focuses on preventing disease progression and reducing cardiovascular risk. However, inequities in access to CKD care are most pronounced early in the disease course, a critical window for equitable population-level prevention within primary care. Understanding how these inequities arise within primary care, where early identification and management largely occur, is therefore essential. This study explored how people living with CKD in deprived areas of Scotland, a setting characterised by marked health inequalities, establish candidacy for early kidney care at a point when prevention should begin but is often lacking.

methodsA qualitative study informed by critical realism combined semi-structured interviews with 38 adults with CKD (predominantly Stage 3 and primarily managed in primary care) and focus groups or interviews with 23 primary care professionals (N = 61). Participants were drawn from the most deprived 40% of neighbourhoods across three Scottish health boards, ensuring variation in CKD stage, diagnosis timing, professional role, and urban-rural setting. Data were analysed using reflexive thematic analysis informed by the Candidacy Framework.

resultsEarly kidney care for working-age adults living in deprived areas is often delayed, with CKD detected when personal resources, including time, finances, and support, are already stretched. Diagnosis is typically explained briefly, if at all, leading to uncertainty about its significance and next steps. Communication and care vary widely, with many patients relying on personal persistence to navigate fragmented healthcare systems. Care frequently depends on professional discretion, with uneven community and voluntary resources bridging gaps in care. These patterns reflect structural constraints rather than individual disengagement.

conclusionEarly kidney care in communities experiencing deprivation represents a constrained preventive window within primary care. The "triple invisibility" of early CKD, at population, system, and symptom levels, undermines sustained engagement at the point when intervention is most effective. Strengthening equitable prevention requires service-level redesign and workforce models that embed kidney health within routine cardiometabolic care, address structural constraints in deprived areas, and integrate physical and psychosocial risk management.

trial registrationNot applicable.