MA KHANAM1, J RADFORD2, R CASTELINO2, MD JOSE2, A KITSOS2, J STANKOVICH2, ST ZAIDI2, L KINSMAN1, GM PETERSON2,3
1School of Health Sciences, University of Tasmania; 2School of Medicine, University of Tasmania, 3Faculty of Health, University of Tasmania
Aim: To describe aspects of monitoring amongst chronic kidney disease (CKD) patients within Australian general practice.
Background: Appropriate management of CKD in primary care is essential to reduce morbidity and mortality. We aim to describe patterns of monitoring in CKD using MedicineInsight data. MedicineInsight is a primary care quality improvement initiative from NPS MedicineWise, collecting de-identified patient information from 557 participating general practices to create a longitudinal database of over 3.5 million Australians.
Methods: Data collected between 01/01/2013 to 01/06/2016 was used for this analysis. We have analysed clinical and laboratory assessments for stage-3 CKD only, comprising blood pressure, urine ACR/albuminuria, serum lipids, and biochemical profile including urea, creatinine and electrolytes; and HbA1c in the presence of co-morbid diabetes. The recommendations for monitoring these parameters are at least once for CKD stage-3a and twice for CKD stage-3b, or as required, per year. We have included assessments conducted at least once in the study period.
Results: Data with two or more eGFR results <60ml/min/1.73m2, at least 90 days apart were available for 61,102 patients. The number of patients in stage-3 CKD was 42,524. Blood pressure was recorded for 95.9%, tests for albuminuria for 46.5%, serum lipids 51.0%; urea, creatinine and electrolytes were done for 98.6%, 99.1%, and 60.6%, respectively. The total number of CKD stage-3 patients with co-morbid diabetes was 12,591, of whom 99.9% had been tested for HbA1c.
Conclusions: Measurements of albuminuria, used to finesse the staging of CKD, were conducted in less than half of the patients. There appears to be room for improvement in the monitoring of CKD stage-3 patients.