Preliminary audit on early identification and management of chronic kidney disease in adults in an acute general medical unit in Sri Lanka

Abstract

This was the first round of an audit to analyze how closely the National Institute of Clinical Excellence (NICE) guidelines on early identification and management of chronic kidney disease in adults is adhered to by a medical ward in the National Hospital of Sri Lanka. One hundred consecutive patients who were not diagnosed to have chronic kidney disease (CKD) but had risk factors for future development of CKD were selected from the male and female wards of the University Medical Unit, National Hospital, Colombo, Sri Lanka. Data were collected by interviewing patients and from the case notes, and entered on a proforma designed based on the recommendations outlined in the NICE guidelines on the prevention of CKD. Target blood pressure was achieved in 66% (n=66). Urine ward test was performed only in 58% of the patients, and this was positive for protein in 15 patients. Investigations to exclude urinary tract infection were performed in 12%. Measurement of serum creatinine was carried out in 40%, but estimated glomerular filtration rate, albumin:creatinine ratio and protein:creatinine ratio were not carried out in any of the patients. Forty percent of the patients were educated by ward staff regarding CKD, 22% on risk factor modification, 23% regarding renal replacement therapy, 34% regarding dietary modifications and 67% regarding importance of exercise. Twenty-six percent of the patients were not educated on any of the above components. ACEI, ARB and statins were prescribed only in 47%, 9% and 64%, respectively. Although follow-up was indicated in all these patients, it was arranged only in 17%. The concurrence with NICE guidelines on CKD prevention was found to be poor. Strategies for improvement are discussed.