Identification, Monitoring, and Management of Chronic Kidney Disease at University Hospital Kerry: Findings from a Multidisciplinary Clinical Audit

Background: Chronic kidney disease (CKD) affects a substantial proportion of adults and is associated with cardiovascular risk, progression to kidney failure, and medication-related harm [1-4]. Structured identification, staging, and guideline-directed management are central to improving outcomes.

Aim: To assess local compliance with evidence-based standards for the identification, monitoring, and management of patients with CKD at University Hospital Kerry (UHK), and to identify targets for quality improvement.

Methods: A retrospective multidisciplinary clinical audit of 38 patient records was undertaken against eight locally agreed standards derived from national and international CKD guidance [1, 2]. Data on CKD staging, albuminuria assessment, blood pressure monitoring and control, renoprotective prescribing, medication review, renal function monitoring, and nephrology referral were collected and compared against target thresholds.

Results: The cohort was predominantly female (68.4%, 26/38) with an age range of approximately 53–92 years. Only two of eight standards were met: blood pressure monitoring (100%, 38/38) and renal function monitoring (100%, 38/38). CKD stage was documented in 34.2% (13/38) of patients against a 95% standard; urine albumin-to-creatinine ratio (ACR) was recorded in 28.9% (11/38) against a 90% standard, with no patient having a documented albuminuria category. Medication review performance was mixed: nephrotoxic medicines were reviewed in 86.8% (33/38) of patients, whereas regular/ongoing medicines were reviewed in only 31.6% (12/38), against a 90% standard for each. Nephrology referral was completed in 62.9% (17/27) of patients meeting referral criteria, against a 100% standard.

Conclusion: Routine monitoring activities were well embedded, but structured CKD staging, albuminuria assessment, renoprotective prescribing, and nephrology referral fell substantially short of target standards. A standardised CKD documentation and alert tool, together with staff education, is proposed, with re-audit planned at 6 months.