Background and Aims Current guidelines recommend that all patients with Chronic Kidney Disease (CKD) stage 3b or higher should be monitored and treated for anaemia, mineral bone disorder (BMD) and metabolic acidosis. We audited the prevalence and management of these complications in a cohort of patients with diabetes and advanced CKD. Method A retrospective audit was undertaken using KDIGO guidelines as standard and necessary approvals were secured from the governance team at University Hospitals Birmingham. We included patients with (a) diabetes (b) eGFR 30 and 15 ml/min/1.73 m2) and (c) attending diabetes clinics as of 30/09/2022. Using electronic patient records, we collected: demographics, co-morbidities, complications, treatments, body weight, BMI, blood pressure and serial biochemistry (creatinine, Hba1c, cholesterol, UAlb/Creat ratio, bicarbonate, haemoglobin, vitamin D, parathyroid hormone (PTH). Following definitions were applied: anaemia as Hb <13 g/dl for men and <12 g/dl for women, BMD as vitamin D <40 nmol/l plus raised PTH, acidosis as bicarbonate <22 meq/l. Data was analysed using SPSS 26. Descriptive statistics (frequencies and cross tabulations) were used to estimate prevalence. Independent means test was used for continuous variables. Comparison between groups was undertaken using the Chi Square test and one way ANOVA test. Results Data for 192 subjects (110 European (EUR), 40 South Asian (SA), 42 African-Caribbean (AFC) /other) was analysed. Mean age (SD) was 73 (+/-11) years. There were no significant differences in general characteristics between the ethnic groups except for albuminuria which was greater in SA and AFC compared to EUR (193 v 133 v 95.5mg/mmol; p=.038). 47% of the cohort had at least one diabetes related complication. 63/192 (32.8%) had cardiovascular disease, 49/192 (25.5%) had retinopathy and 19/192 (9.9%) had neuropathy. Insulin was the most common prescribed glucose lowering agent 105/192 (55%) with proportionately more SA treated with insulin (65%). Anaemia was present in 171/183 (93.4%) of the patients. 82/101 (81.2%) had BMD, and 135/168 (82.8%) of patients had metabolic acidosis. 65/192 (33.9%) of patients had all 3 complications. Only 38/133 (22%) of those with anaemia were receiving treatment out of which only 36.8% were treated adequately with a Hb of >10g/l. Corresponding figures for BMD and metabolic acidosis were: BMD: 39/82 (47.6%) treated and 42% optimally corrected, metabolic acidosis: 54/135 (40%) treated and 53% optimally corrected. There were no significant differences between ethnic groups in prevalence or treatment of these complications. Conclusion The prevalence of CKD related complications is high. The management of these complications however, is suboptimal. Increased emphasis on the management of these complications is required to improve outcomes in patients with advanced CKD.