Background: Urea Reduction Ratio (URR) is a widely accepted indicator of haemodialysis adequacy, reflecting the efficiency of uremic toxin removal. Maintaining a URR ≥65% is associated with improved patient outcomes, while suboptimal URR is linked to increased morbidity and reduced quality of life. Preliminary unit data indicated fluctuating and often suboptimal URR levels, necessitating a structured clinical audit to identify gaps and implement targeted improvements.

Aim: To assess and improve the average URR in patients undergoing haemodialysis at a tertiary care hospital.

Methods: A Descriptive Analytical clinical audit was conducted in two phases: Retrospective (April–November 2024) and Prospective (December 2024–March 2025). Adult maintenance haemodialysis patients with valid paired pre- and post-dialysis BUN measurements were included. Data was collected using a standardized audit checklist from laboratory information systems, dialysis machine records, and clinical charts. Key measures included monthly mean URR and the proportion of sessions achieving ≥65%. Interventions included optimization of dialysis duration, standardization of dialyzer selection, reinforcement of correct sampling protocols, Logistics, Staff Duty Roster reallocation and staff training. Data was analyzed using descriptive statistics and trend analysis.

Results: Baseline analysis showed a mean URR of 63.63% during April–November 2024, indicating suboptimal dialysis adequacy. Following targeted interventions, mean URR improved to 66.57% during December 2024–March 2025. The overall annual mean URR was 64.61%, demonstrating progressive improvement toward the benchmark of ≥65%. Improvements were associated with better adherence to prescribed dialysis duration, enhanced dialyzer selection, trained staff duty reallocation cum logistics and stricter monitoring practices thus leading to a effective Quaity Improvement.

Conclusion: The QIP effectively identified modifiable factors affecting dialysis adequacy and demonstrated that structured interventions can significantly improve URR within a short period. Strengthening process reliability, staff training, and continuous monitoring are critical to sustaining outcomes. The audit highlights the value of multidisciplinary collaboration and data-driven quality improvement in enhancing haemodialysis care and patient outcomes.

KEYWORDS: Urea Reduction Ratio, Haemodialysis Adequacy, Clinical Audit, Quality Improvement, Dialysis Outcomes.