Missed Opportunities for Chronic Kidney Disease Recognition in Irish Primary Care: A Nationwide Electronic Health Record Study
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Objectives
To examine chronic kidney disease (CKD) diagnostic coding in Irish primary care using electronic health records (EHRs).
Methods
This retrospective cohort study used EHR data from 592,888 active patients across 66 Irish primary care practices. Adults aged ≥20 years meeting laboratory-based CKD criteria were identified. CKD coding was defined by the presence of an ICD-10 or ICPC-2 diagnosis code. Coding rates were evaluated overall and by CKD stages, comorbidities, and practices.
Results
Among 19,382 adults with laboratory-confirmed CKD (median age 76 years; 55.7% female), 14.6% had a documented CKD diagnosis code. Coding increased with disease severity, from 4.8% in stages 1-2 to 19.6% in stages 3-5, and varied by comorbidity burden, with only 10.1% of patients without major cardiometabolic comorbidities coded. Substantial practice-level variation was observed, with over half of practices (34/61) recording coding rates below 10%, while four exceeded 40%. Most patients (85.4%) remained uncoded throughout follow-up.
Conclusions
This first nationwide study of CKD coding in Irish primary care network demonstrates substantial under-coding despite laboratory evidence, with marked variation between practices. Improving coding consistency and completeness may enhance CKD recognition, support earlier intervention, and improve patient outcomes.
