Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (≤ 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.

We describe the case of a 72-year-old housewife who presented to a primary care specialist clinic for reassessment following multiple hospitalisations for heart failure within the past 9 months. She presented with decreased effort tolerance and tiredness for the past 1 year. Her symptoms had remained the same despite current treatment. During the initial history-taking, she did not report any medical illnesses or surgeries. She had been well and had not undergone any screening for almost 30 years before the first hospitalisation for heart failure. There was neither cough, constipation, dyspepsia, abdominal pain, stool changes, haematuria, per vaginal bleeding nor hoarse voice. The physical examination findings were remarkable for slow movement and speech. Her skin was dry with a markedly increased serum lipid profile. Further investigation and management confirmed the suspected diagnosis.
Heart Failure ; Geriatrics ; Primary Health Care