Despite the fact that chronic kidney disease almost always presents warning signs, 30-50 percent of new renal patients in BC “crash” onto dialysis or are referred late for assessment of kidney disease. Both scenarios are associated with increased morbidity (severity of symptoms), increased hospital stays, reduced opportunities for more ambulatory modes of care, such as peritoneal dialysis or early kidney transplant, and increased mortality (incidence of death). There is much to be learned about the range of possible determinants that may influence renal patients’ ability to access treatment. Nancy Blythe will investigate the social determinants of health of 1300 renal patients who initiated dialysis in BC in 2001-2002. Her aim is to determine whether certain social structural barriers in society (availability of social support, adequate income, etc.) constrains patients from seeking treatment before their chronic illness advances to an acute stage, resulting in late referral to the health system or the onset of dialysis under emergency conditions. Subsequently she will study whether those same social barriers and suboptimal initial access negatively influence ongoing access to dialysis as well as morbidity and mortality. It is anticipated that the research results will contribute to better ways of assisting renal patients to obtain optimal access to this life support treatment.