OBJECTIVES: Previous research has shown there is a geographical clustering in health behaviors, access to healthcare, and healthcare utilization. Few studies have assessed geographical variation in processes of care in chronic kidney disease (CKD) patients across the United States. This study aimed to explore local variations in receiving nephrologist services, use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs), and hospitalization among CKD patients with Part D coverage. METHODS: This retrospective cohort study was conducted using the 2013-2014 Medicare 5% sample claim data. CKD patients covered by a stand-alone Part D plan were selected. A one-year baseline period (2013) was applied to assess patients’ medical history, and utilization of health services was assessed for year 2014. Geographically weighted logistic regression was used to explore predictors of using ACEIs/ARBs. In addition, utilization rate of nephrologist services, ACEIs/ARBs, and hospitalization rate were calculated at county level. Moran's I was calculated to examine spatial autocorrelation at county level and results were presented in spatial maps.  RESULTS: A total of 100,159 CKD patients residing in 3022 counties of the United States were selected. About 27%, 56% and 36% of them had receiving nephrologist services, ACEIs/ARBs and experiencing hospitalization in 2014. CKD patients with non-white race, having mild and moderate damage, having onset of diabetes and hypertension were more likely using ACEIs/ARBs (all p<0.05 in multivariate geographically weighted regressions). Patients with Part D Low-income subsidy were less likely using ACEIs/ARBs. Significant spatial clustering was observed in all of investigated health services.  CONCLUSIONS: Findings from this study indicated there were spatial effects associated with use of nephrologist services, guideline-recommended ACEIs/ARBs, as well as hospitalization. Local interventions are needed to promote access to healthcare, healthcare utilizations, and in turn reduced CKD disparities.