Missed Opportunities for Chronic Kidney Disease Recognition in Irish Primary Care: A Nationwide Electronic Health Record Study

B. M. Jacob; K. Eyers; M. M. Hayes; H. Dickinson; D. Jin; A. Coughlan; E. Ryan; B. van Hecke; P. Redmond; A. Stack; D. J. Sexton; D. Bailey

doi:10.64898/2026.10.27.26366613

AI summary · DOI: 10.64898/2026.10.27.26366613 · medRxiv: Nephrology

Missed Opportunities for Chronic Kidney Disease Recognition in Irish Primary Care: A Nationwide Electronic Health Record Study

B. M. Jacob, K. Eyers, M. M. Hayes, H. Dickinson, D. Jin, A. Coughlan, E. Ryan, B. van Hecke,

and 4 more authors

P. Redmond, A. Stack, D. J. Sexton, D. Bailey

How to read this summary? Illustrated guide

The essentials

A nationwide Irish primary-care study found that only 14.6% of adults with laboratory-confirmed CKD had a recorded diagnosis, with substantial variation across disease stages and practices.

Based on the abstract only: check the details in the original paper.

Question

How often is chronic kidney disease (CKD) documented in Irish primary-care records when patients meet laboratory-based criteria, and how does coding vary by disease stage, comorbidities, and practice?

Method

This retrospective cohort study analyzed electronic health records for 592,888 active patients across 66 Irish primary-care practices. It identified adults aged 20 years or older meeting laboratory-based CKD criteria and assessed whether records contained an ICD-10 or ICPC-2 diagnosis code, including differences by stage, comorbidity burden, and practice.

Findings

Result Among 19,382 adults with laboratory-confirmed CKD, 14.6% had a documented CKD diagnosis code.
See the passage in the paper
Among 19,382 adults with laboratory-confirmed CKD (median age 76 years; 55.7% female), 14.6% had a documented CKD diagnosis code.
Result Coding was more common in stages 3–5 than in stages 1–2.
See the passage in the paper
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.
Result Coding rates differed substantially between practices, with most practices coding fewer than one in ten patients.
See the passage in the paper
Substantial practice-level variation was observed, with over half of practices (34/61) recording coding rates below 10%, while four exceeded 40%.
Authors’ interpretation The authors conclude that CKD is substantially under-coded in Irish primary care despite laboratory evidence of disease.
See the passage in the paper
This first nationwide study of CKD coding in Irish primary care network demonstrates substantial under-coding despite laboratory evidence, with marked variation between practices.

Limitations

The abstract does not report study limitations; the analysis is limited to CKD coding in the included Irish primary-care records and the specified laboratory-based criteria.

Why it matters

The authors argue that more consistent and complete CKD coding may improve recognition, support earlier intervention, and improve patient outcomes. The study documents the scale and variation of under-coding in Irish primary care.

Written by AI from the paper. Passages are checked word for word against the text we analysed; the rest may contain errors.

AI-generated keywords: chronic kidney disease primary care diagnosis coding electronic health records Ireland

Read further

Comprehensive Summary
Layman's Summary
Blog article
Original abstract

This study examined how often chronic kidney disease (CKD) was documented in Irish primary care records when laboratory results indicated the condition. The authors assessed whether patients who met laboratory-based CKD criteria had a diagnosis recorded in their electronic health records and whether coding rates varied by disease stage, comorbidities, and practice. The researchers conducted a retrospective cohort study using electronic health record data from 592,888 active patients across 66 Irish primary care practices. They identified adults aged 20 years or older who met laboratory-based criteria for CKD. A patient was considered coded if their record contained an ICD-10 or ICPC-2 diagnosis code for CKD. The study compared coding rates across CKD stages, comorbidity groups, and practices. The supplied abstract does not specify the laboratory thresholds, follow-up duration, or statistical methods. The study identified 19,382 adults with laboratory-confirmed CKD. Their median age was 76 years, and 55.7% were female. Overall, only 14.6% had a documented CKD diagnosis code. Thus, most patients whose laboratory results met the study criteria did not have CKD recorded as a diagnosis. Coding was more common among patients with more severe disease: 4.8% of those with stage 1–2 CKD were coded, compared with 19.6% of those with stage 3–5 CKD. Even in the latter group, however, most patients had no recorded code. Coding also varied with comorbidity burden. Among patients without major cardiometabolic comorbidities, 10.1% had CKD coded. The abstract does not report coding percentages for other comorbidity groups, so the full pattern and differences between groups cannot be assessed. Practice-level coding varied substantially. Of the 61 practices included in that analysis, 34 had coding rates below 10%, while four had rates above 40%. The abstract also reports that 85.4% of patients remained uncoded throughout follow-up, indicating that the low overall coding rate was not merely a snapshot at a single point in time. The authors conclude that CKD was substantially under-coded in the primary care records studied despite laboratory evidence of the disease, and that coding practices differed markedly between practices. They suggest that more consistent and complete CKD coding could support recognition of the condition and earlier intervention, potentially improving patient outcomes. These are proposed benefits: the study did not test an intervention or measure its effects on treatment or health outcomes. Interpretation is limited because only the title and abstract were supplied; the full text was unavailable under the paper’s license. As a result, important details—including the precise laboratory criteria, how persistent abnormalities and follow-up were handled, the representativeness of participating practices, and potential sources of missing or inaccurate records—cannot be assessed. The findings describe diagnosis coding in the included records; they do not establish why codes were absent or whether every uncoded patient had been clinically recognized as having CKD.

Missed Opportunities for Chronic Kidney Disease Recognition in Irish Primary Care

Chronic kidney disease (CKD) can develop quietly, with laboratory results sometimes showing signs of the condition before a diagnosis appears in a patient’s record. A study titled “Missed Opportunities for Chronic Kidney Disease Recognition in Irish Primary Care: A Nationwide Electronic Health Record Study” examined how often CKD was documented when patients’ laboratory results met criteria for the disease.

The findings point to a substantial gap between laboratory evidence and recorded diagnoses. Across the participating Irish primary care practices, fewer than one in six adults identified as having CKD had a CKD diagnosis code in their electronic health record. The researchers also found considerable variation in coding between practices.

How the study was conducted

The researchers carried out a retrospective cohort study using electronic health record data from 592,888 active patients across 66 Irish primary care practices. They identified adults aged 20 or older who met laboratory-based criteria for CKD. A patient counted as coded if their record included an ICD-10 or ICPC-2 diagnosis code for the condition.

The study compared coding rates across CKD stages, comorbidity groups, and practices. The supplied abstract does not provide the precise laboratory thresholds, the follow-up duration, or the statistical methods used. Those details matter when interpreting how the researchers identified CKD and assessed whether it was recorded over time.

Most laboratory-confirmed cases had no diagnosis code

The analysis identified 19,382 adults with laboratory-confirmed CKD. Their median age was 76, and 55.7% were female. Overall, just 14.6% had a CKD diagnosis code in their records. Put another way, 85.4% were uncoded during follow-up, suggesting that the finding was not simply a one-time snapshot.

This result does not establish that every uncoded patient’s CKD went unnoticed in clinical care. A diagnosis might have been recognized or discussed without being entered as a code. But it does show that, in the records studied, laboratory evidence of CKD often did not correspond to a documented diagnosis.

Coding was more common in later-stage CKD

Documentation rates differed by disease stage. Among people with stage 1–2 CKD, 4.8% had the condition coded. For those with stage 3–5 CKD, the figure was higher, at 19.6%. The increase suggests that more severe disease was more likely to be recorded, yet most patients in the stage 3–5 group still had no CKD code.

The abstract also reports coding for one comorbidity group: 10.1% of patients without major cardiometabolic comorbidities had CKD recorded. It does not provide coding percentages for the other comorbidity groups, so the full relationship between comorbidities and documentation cannot be assessed from the available information.

Large differences between practices

Practice-level results revealed another important pattern. Of the 61 practices included in that analysis, 34 had CKD coding rates below 10%, while four had rates above 40%. This spread indicates that the likelihood of a diagnosis appearing in a record varied considerably across practices.

The study does not explain why these differences arose. They could reflect variation in recording routines, clinical workflows, or other factors, but the abstract does not establish a cause. Practice-level variation is therefore best understood as a signal that documentation was inconsistent—not as proof of why it was inconsistent.

Why documentation may matter

Consistent coding could help make CKD visible within primary care records and support clinicians in identifying patients who may benefit from closer attention. The authors suggest that more complete documentation could contribute to earlier intervention and better outcomes. These are proposed benefits, however: the study did not test a coding intervention or measure its effects on treatment, disease progression, or patient health.

Diagnosis codes are also only one part of care. A missing code does not, on its own, show whether a clinician recognized the condition, explained the results to a patient, or acted on the findings. The study measures what was documented in the records, not every aspect of clinical decision-making.

What the findings cannot tell us

Interpretation is limited because only the title and abstract were available; the full text was unavailable under the paper’s license. As a result, key details cannot be evaluated, including the exact laboratory criteria, how persistent abnormalities and follow-up were handled, and how representative the participating practices were. The available summary also does not allow assessment of possible missing or inaccurate records.

Overall, the study identifies a clear documentation gap in the Irish primary care records examined: laboratory results met the study’s CKD criteria far more often than diagnosis codes appeared. Understanding why that gap exists—and whether improving coding changes care—will require further research. For now, the findings highlight the value of checking whether significant laboratory evidence is consistently reflected in the health record.

Created on 02 Nov. 2026

Was this synthesis useful?

Score: 0

Ask questions about this paper to our AI assistant

How to chat with this paper? Illustrated guide

You can also chat with multiple papers at once here.

⚠The license of the paper does not allow us to build upon its content and the AI assistant only knows about the paper metadata rather than the full article.

AI assistant instructions?

Tools for this paper

Explain it differently 3 free rewrites left today

Save to a collection Group papers in collections to compare them, chat with them and export them. Create a free account Log in

Export BibTeX · RIS (Zotero, Mendeley, EndNote) · Obsidian (Markdown) · Notion (Markdown)

Advanced tools Premium

For researchers who follow a field closely: citation alerts, journal-club slides, version comparison and Zotero export. Discover Premium

Zotero

Citation alerts Citation alerts guide

Who works on it? The people and institutions who publish on its topic

Weekly letter Presented in "Biology and medicine this week" of 2 November 2026. Biology and medicine this week: Hidden partners, adjustable gates and overlooked disease

Journal club Premium+ Slides to present it Propose for the journal club

Talk about it in public Premium+ Press kit: release, questions, hype check Press kit guide

Papers around this one

See them on a map

Ranked by how close their title and abstract are to this paper’s. Select some to read them together.

Closest papers

Very close Same question
Multi-level clinical inertia in chronic kidney disease management in primary care: A retrospective cross-sectional analysis of coding, reclassification and risk stratification.
A. Zafar, C. Scarlata, A. Saeed et al. · 2026 · Primary Care Diabetes · Not summarized yet

Multi-level clinical inertia examines CKD coding and risk stratification in primary-care records, focusing on adults with coded CKD.

Abstract
AIMS/HYPOTHESIS Accurate coding, longitudinal stage review and complete risk stratification underpin chronic kidney disease (CKD) care in primary care, especially in people with diabetes, where CKD modifies cardiovascular risk, prescribing safety and referral thresholds. We hypothesised that, beyond well-described inertia in pharmacological treatment intensification, primary care records would also exhibit inertia in diagnostic coding, longitudinal reclassification and albuminuria-based risk stratification, clustering with higher kidney and cardiovascular risk. METHODS We performed a retrospective cross-sectional analysis of adult primary care records with coded CKD. The latest estimated glo…
Very close* Same question
Prevalence and Management of Chronic Kidney Disease in Irish Primary Care Network
B. Jacob, K. Eyers, D. Jin et al. · 2026 · medRxiv · preprint, not peer reviewed · Not summarized yet

Prevalence and Management examines CKD prevalence and care in the Irish Primary Care Network, the same setting and disease.
Very close Same question
B-285 Underdiagnosis and Gaps in Guideline-Recommended Testing for Chronic Kidney Disease in an Academic Health System: A Population-Based Race, Ethnicity, Language, and Sex Analysis
Zheng-Chun Lu, Y. Lyu, Siouxzanna Downs et al. · 2026 · Clinical Chemistry · Not summarized yet

B-285 measures CKD underdiagnosis and testing gaps in a health system, examining recognition among patients assessed under CKD guidelines.

Abstract
Chronic kidney disease (CKD) is underdiagnosed, and adherence to National Kidney Foundation (NKF) screening recommendations among high-risk patients remains suboptimal. NKF guidelines recommend annual assessment with both estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR) among patients with diabetes or hypertension. We evaluated CKD diagnosis, risk burden, and testing gaps using the NKF CKD framework, stratified by race, ethnicity, language, and sex variables. We conducted a retrospective population-based analysis of 407,894 adults aged 18–85 years with at least one clinical encounter in the Oregon Health & Science University (OHSU) health system betwee…
Very close Broader context
Prevalence, risk factors and renoprotective treatment of chronic kidney disease among internal medicine outpatients at a Central European tertiary care centre: a cross-sectional study
I. Zahradka, V. Petr, F. Tichanek et al. · 2026 · BMJ Open · Not summarized yet

The outpatient study assesses CKD prevalence, risk factors, and renoprotective treatment in a Central European tertiary-care setting.

Abstract
Abstract Objectives To determine the prevalence of chronic kidney disease (CKD) in internal medicine outpatients in a Central European tertiary care setting, identify associated risk factors and assess use and potential impact of renoprotective therapies. We hypothesised that CKD is common, underdiagnosed and undertreated. Design Cross-sectional observational study. Setting Tertiary care outpatient clinics in Central Europe. Participants 1933 adult outpatients at risk for CKD were screened; an expanded cohort of 2903 patients with available laboratory data was included for secondary analyses. Inclusion required assessment of estimated glomerular filtration rate (eGFR) and urine albumin-creat…
Close Broader context
Prevalence and significance of family history of kidney disease in the electronic health record in three United States health systems.
Andrei Bucaloiu, Aditya L. Surapaneni, Sneha S. Mehta et al. · 2026 · Kidney International · Not summarized yet

The family-history study examines kidney disease documentation in EHRs, but focuses on family history rather than patients' CKD diagnosis coding.

Abstract
INTRODUCTION Family history is a key predictor of chronic kidney disease (CKD) and kidney failure, yet its documentation in electronic health records (EHRs) remains poorly characterized. Here, we examined the prevalence of kidney-related family history across three large United States. health systems and assessed associations with kidney disease outcomes. METHODS We conducted a cross-sectional study of 1,130,961 adults (age 18-80) receiving primary care at Geisinger, New York University Langone Health, and University of Utah Health from 2020-2023. Family history of CKD and kidney failure was ascertained from structured EHR fields and relevant search terms in comments in the family history se…
Close Broader context
Ethnic inequalities in kidney function and progression to advanced CKD in T2D: a primary care study
T. Alobaid, J. Karalliedde, M. O'Connell et al. · 2026 · European Journal of Public Health · Not summarized yet

The T2D study tracks ethnic differences in kidney-function trajectories and progression to advanced CKD in primary care.

Abstract
Abstract Background Chronic kidney disease (CKD) is a major complication of type 2 diabetes (T2D) and a key contributor to health inequalities. Patterns of kidney function decline are heterogeneous, yet little is known about how these trajectories differ across ethnic groups in primary care settings. Understanding early divergence in risk is essential for prevention and equitable care. Methods We conducted a retrospective cohort study using Lambeth DataNet, London, UK, including 24,716 adults with T2D and ≥2 eGFR measurements (2004–2018). Group-based trajectory modelling identified distinct kidney function patterns. Multinomial logistic regression examined determinants of trajectory membersh…
Close* Broader context
Prevalence of Undertreated CKD among Hospital Inpatients: A Prospective Cross-Sectional Study.
L. Wynter, Brendan Smyth, John Saunders et al. · 2026 · Kidney360 · Not summarized yet

The inpatient study concerns undertreated CKD in hospitals rather than diagnosis coding in primary care.
Close Broader context
Comprehensive trends in Chronic Kidney Disease prevalence and comorbidities across eGFR and albuminuria categories: a 20-year analysis of NHANES data
Youssef M. K. Farag, Zi-He Zheng, Aqsa H. Dar et al. · 2026 · Renal Failure · Not summarized yet

The NHANES analysis tracks CKD prevalence and comorbidities across eGFR and albuminuria categories in the United States.

Abstract
Abstract Chronic kidney disease (CKD) represents a major public health challenge, contributing to over 1.2 million global deaths annually and ranking as the 12th leading cause of mortality. This study provides a 20-year trend analysis (1999–2018) of CKD prevalence and its associated comorbidities among adults in the United States using the NHANES dataset. Employing the CKD-EPI 2021 equation without the race component, the study revealed a stable CKD prevalence of 20% in adults aged ≥20 years, alongside trends in nine comorbidities. Obesity and diabetes showed significant increases, while hypertension, anemia, hyperkalemia, and cardiovascular disease remained stable. Hypertriglyceridemia and …

Go further

How are these papers found?

We compare the title and abstract of this paper with those of every paper summarized on this site, and with the papers Semantic Scholar recommends, those it cites and those citing it (for a much-cited paper, its most recent citations and, from OpenAlex, the most cited ones). Among the prior work and the follow-ups, the papers that use each other in depth, a method it uses and the much-cited follow-ups come a little higher. The levels (very close, close, related) come from the similarity of the texts, not from a judgment of quality; * marks a paper without an abstract, compared by its title. The sentence under a paper is written by an AI from the two abstracts: check it in the papers. A paper marked not relevant by three readers leaves the list.

Updated on 2 November 2026.

Disclaimer: The AI-based summarization tool and virtual assistant provided on this website may not always provide accurate and complete summaries or responses. We encourage you to carefully review and evaluate the generated content to ensure its quality and relevance to your needs.

Missed Opportunities for Chronic Kidney Disease Recognition in Irish Primary Care: A Nationwide Electronic Health Record Study

The essentials

Question

Method

Findings

Limitations

Why it matters

Read further

Definitions

Missed Opportunities for Chronic Kidney Disease Recognition in Irish Primary Care

How the study was conducted

Most laboratory-confirmed cases had no diagnosis code

Coding was more common in later-stage CKD

Large differences between practices

Why documentation may matter

What the findings cannot tell us

Ask questions about this paper to our AI assistant

Tools for this paper

Advanced tools Premium

Papers around this one

Closest papers

Go further

Cite this paper (BibTeX)