Addressing chronic kidney disease in F ar N orth Q ueensland: gains and opportunities

Objective To determine whether people seen by the F ar N orth Q ueensland S pecialist M edical O utreach S ervice ( SMOS ) with chronic kidney disease ( CKD ) and proteinuria were treated according to established guidelines. Design Audit of SMOS clinical reports from 18th M ay to 27th J uly 2012. Clinical markers were compared with the C aring for A ustralians with R enal I mpairment and N ational H eart F oundation management guidelines. Setting Reports covering primary health care centres located in remote communities of C ape Y ork P eninsula and T orres S trait, F ar N orth Q ueensland. Main outcome measure(s) The proportion of people with CKD and proteinuria on appropriate renoprotective treatment with an angiotensin‐converting enzyme inhibitor ( ACE ‐inhibitor) or angiotensin‐2 receptor blocker ( ARB ). The proportion of people with CKD and proteinuria reaching blood pressure targets as per National Heart Foundation guidelines. The proportion of people with stage 4 CKD appropriately referred to a specialist renal service. Results One hundred and eighty‐six clinical reports were reviewed; 48 people had markers of CKD . Forty‐five of the 48 (94%) had been prescribed an ACE ‐inhibitor or ARB according to management guidelines. Nineteen of the 48 (40%) had blood pressures within the target range. Four of six people with late‐stage CKD (stage 4 or 5) had been referred to a specialist renal service. Conclusions This audit confirms the high rate of CKD in the people of F ar N orth Q ueensland, although this is a highly selected sample. It shows appropriate prescribing of renoprotective treatment in most cases. However, it also highlights the need for a more vigorous approach to blood pressure control.