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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A 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                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200961). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Early 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early kidney care in communities experiencing deprivation represents a constrained preventive window within primary care. The \u201ctriple invisibility\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-026-05084-9","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:34:57Z","timestamp":1781159697000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cThey are nae worrying about it\u2026 so \u2026what\u2019s the point in asking?\u201d: A qualitative study of candidacy for early CKD care in areas of multiple deprivation"],"prefix":"10.1186","volume":"27","author":[{"given":"Buse","family":"Keskindag","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Blakeman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Melvin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiko","family":"Nakamaru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melany","family":"Gray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhautesh","family":"Jani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhairi","family":"Mackenzie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Scholes-Robertson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eilidh","family":"Cowan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Cockwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Sawhney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena Rzewuska","family":"Diaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"5084_CR1","unstructured":"ALLIANCE. 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The study was approved by Health and Social Care Research Ethics Committee A (reference 24\/NI\/0037). Written, verbal, or online informed consent was obtained from all participants for participation in interviews or focus groups, for audio-recording, and for the use of anonymised quotations in research outputs and publications. Patient participants were additionally invited to provide optional consent for access to relevant medical records relating to kidney health status. All participants were additionally invited to provide optional consent for future contact regarding ethically approved studies and for receipt of a lay summary of the study findings. Ongoing verbal consent was reconfirmed at the start of each interview and focus group. Interviews and focus groups were audio-recorded, transcribed verbatim, and anonymised prior to analysis, with field notes also anonymised prior to analysis. Audio and text files were stored securely in password-protected folders in accordance with UK data protection regulations.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. No identifiable individual data are presented in this article.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"MRD is an Advanced Research Fellow and qualitative health researcher specialising in health services research and equity-focused implementation science; she is also an accredited community-based counsellor. BK is a Postdoctoral Researcher with a background in health psychology and expertise in qualitative health research. SS and PC are clinical academic nephrologists with a focus on population kidney health and deprivation-related inequalities. TB and BJ are academic general practitioners with expertise in multimorbidity and primary care service organisation. SB is a clinical epidemiologist specialising in chronic disease outcomes. MMa is a Professor of Medical Sociology with expertise in structural determinants of health and health inequalities. NSR and EC are academic researchers contributing to chronic disease and health services research. AH, MG, MMe and FN are Patient and Public Involvement contributors.","order":3,"name":"Ethics","label":"Authors\u2019 information","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"TB is also funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (Grant NIHR204295). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health and Care Research, or the Department of Health and Social Care.SB has received consulting fees from AstraZeneca, GSK, Stada UK, and Novo Nordisk, and research support from AstraZeneca. These relationships are outside the scope of the present study.The remaining authors declare that they have no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"485"}}