Addressing chronic kidney disease in Far North Queensland: gains and opportunities

Objective: To determine whether people seen by the Far North Queensland Specialist Medical Outreach Service (SMOS) with chronic kidney disease (CKD) and proteinuria were treated according to established guidelines. Design: Audit of SMOS clinical reports from 18th May to 27th July 2012. Clinical markers were compared with the Caring for Australians with Renal Impairment and National Heart Foundation management guidelines. Setting: Reports covering primary health care centres located in remote communities of Cape York Peninsula and Torres Strait, Far North Queensland. 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 Far North Queensland, 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