For patients who develop kidney failure, or end-stage renal disease (ESRD), the kidney care they received while their kidneys were still functioning is critically important. Using a comprehensive national dataset and advanced statistical modeling techniques. Improved outcomes among the chronic kidney disease population depend on earlier identification of patients with kidney disease who may require ESRD treatment, as well as greater awareness of patient morbidity and mortality, quality of life, and the financial benefits of kidney transplantation over dialysis. While disparities in pre-ESRD care were more likely in certain geographic areas, they existed in diverse locations and in most US counties. The overall percentage of patients who received care from a kidney specialist at least 12 months before ESRD was lowest in Hispanics (20.0%), intermediate in blacks (23.8%), and highest in whites (30.0%). In an analysis of 1270 counties, black patients' odds of receiving care from a kidney specialist were 10% to 54% lower than that of whites in approximately two-thirds of the counties. Among 613 counties, Hispanics' odds of receiving nephrologist care were 10% to 48% lower than that of whites in nearly all of the counties.