Guidelines on monitoring, on their own, are not sufficient

EDITOR—Kalra et al's paper describing an audit of monitoring renal function in general practice suggests that practice is often less than optimal, although associated with some uncertainty.1 Unfortunately, the authors do not give confidence intervals around their estimates of effect—which we provide here. The fact that only 34% (95% confidence interval 28% to 39%) of practitioners checked renal function after initiating angiotensin converting enzyme inhibitors and 15% (11% to 19%) never checked it is an important finding. We disagree, however, with the authors' conclusion that producing guidelines on monitoring, on its own, will lead to an improvement in practice.

The authors state that renal monitoring has been neglected in recent guidelines and cite the North of England evidence based guidelines on the use of angiotensin converting enzyme inhibitors in primary care (to which we contributed) …