KEEP is the world's only sustained chronic disease screening and awareness program. Its success is partially attributable to the continued dedication and commitment of stakeholders (the National Kidney Foundation, local affiliates, and the academic community), but also to a unique set of methods that balance detail with simplicity and place efficiency and patient care at a premium. Early access to health care through primary care or nephrology referral is critical to improving CKD-related outcomes. However, our understanding of barriers to such care is limited. KEEP participants appear to experience a lack of adequate health care access and nephrology care. This finding may be influenced by the nature of a largescale screening program dedicated to providing some level of access to participants who are concerned about the personal possibility of CKD. Not surprisingly, we observed a low rate of CKD awareness in participants with CKD newly recognized through the KEEP screening, findings not modified by insurance or prescription drug coverage. However, the strongest association occurred between perceived difficulty obtaining access to care and greater CKD awareness. These findings may partially explain the findings of high-level cardiovascular risk factors and mortality in patients receiving nephrologist care. The KEEP Steering Committee continues to work to expand the understanding of barriers to care, awareness of CKD, and measures to improve cardiovascular and renal risk (Fig 1).We anticipate that future findings from our longitudinal program will continue to shape our understanding of CKD and the complex interface between recognition of the disease, navigation of the health care system, and related consequences.