The prevalence and incidence of chronic kidney disease (CKD) is growing at an alarming rate. Estimates suggest that CKD affects an estimated 13 percent of Americans, and West Virginia leads the way, with the highest per capita rate in the country of patients with kidney failure starting dialysis. There is a great lack of awareness about the risks of CKD among the general population, many of whom are unaware of their risk status or even the presence of CKD. The increasingly older, diabetic and obese populations likely account for the high prevalence of advanced CKD in West Virginia, as well as the fact that a large percentage of the state's population lives 2-3 hours' distance from specialized care. Additionally, there are relatively few physicians in West Virginia specifically trained to treat the growing numbers of patients with kidney disease, which is usually silent until well past the time when medical intervention can be successful in reversing or slowing the rate of progression to kidney failure. Worse, even in its early stages, kidney disease poses significant cardiovascular risk; indeed, individuals with advanced CKD are more likely to die of cardiovascular disease than live long enough to need kidney replacement therapy.