{
  "abstract": "Introduction Socioeconomic inequities in chronic kidney disease (CKD) outcomes are recognised and greater at early stages, but where exactly inequities arise within early care remains unclear. This distinction is critical: if disparities occur before clinical recognition, strategies focused on management after diagnosis may have limited impact. Methods We conducted a population-based cohort study linking healthcare and Census data for adults in North-East Scotland, 2011-2020. We examined sequential components of early kidney care from initial clinical detection (eGFR <60 mL/min/1.73 m^2). Exposures were household and neighbourhood deprivation and living circumstances (rurality, living alone, mental health). Components of early kidney care were: prior surveillance; presentation (including late/unmonitored); confirmation/monitoring; treatment initiation; and unplanned emergency care. Adjusted risk ratios were estimated using modified Poisson models. Mortality was assessed up to 10 years using Cox regression with separate short-term (<1 year) and long-term estimates. Results Among 44,252 individuals, inequities were most pronounced at initial clinical detection. Individuals from deprived households were more likely to present late (adjusted RR 1.69, 95% CI 1.48-1.93). Inequities in planned monitoring after presentation were less evident (RR 1.00, 0.95-1.05). Urine albumin testing was infrequent among those with cardiovascular risk factors. Late presentation was also associated with increased mortality (adjusted HR 1.78, 1.70-1.87), persisting beyond the first year. Conclusions Socioeconomic inequities in CKD are greatest at or before initial clinical detection, with late presentation a measurable indicator. Emphasis on primary care monitoring and prescribing is unlikely to reduce disparities if early detection and awareness are not also addressed.",
  "abstract_shown": true,
  "affiliations": [
    "University of Aberdeen"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "name": "E. Cowan"
    },
    {
      "name": "M. Rzewuska Diaz"
    },
    {
      "name": "S. Bell"
    },
    {
      "name": "S. Fraser"
    },
    {
      "name": "A. Hughes"
    },
    {
      "name": "B. Keskindag"
    },
    {
      "name": "S. Methven"
    },
    {
      "name": "M. Nath"
    },
    {
      "name": "D. Nitsch"
    },
    {
      "name": "N. Scholes-Robertson"
    },
    {
      "name": "R. Smith"
    },
    {
      "name": "P. Traill"
    },
    {
      "name": "T. Blakeman"
    },
    {
      "affs": [
        0
      ],
      "name": "S. Sawhney"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/avpckbkeezx6n.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.30.26366923",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366923v1.full",
  "id": "avpckbkeezx6n",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366923v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "nephrology"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366923v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/avpckbkeezx6n.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T00:20:24Z",
      "native_id": "10.64898/2026.10.30.26366923",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366923v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:nephrology",
      "subfield": "general"
    }
  ],
  "title": "Socioeconomic Inequities in Early Kidney Care Concentrate at Late Initial Clinical Detection Rather Than Planned Care: A Population-Based Study",
  "title_text": "Socioeconomic Inequities in Early Kidney Care Concentrate at Late Initial Clinical Detection Rather Than Planned Care: A Population-Based Study",
  "type": "preprint",
  "updated_at": "2026-11-04T00:20:58Z",
  "url": "https://research.draconitic.com/paper/avpckbkeezx6n",
  "venue": "medRxiv",
  "versions": []
}