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Click
here to take the SCORED evaluation
Simple
screening questionnaire for Kidney Disease
outperforms current Clinical Practice
Guidelines
Newswise — In a community-based study and
national survey, a team of public health and
medical researchers from Weill Cornell
Medical College and the University of North
Carolina (UNC) at Chapel Hill show that a
simple screening questionnaire, SCreening
for Occult REnal Disease (SCORED), is better
able to identify patients at risk for CKD
than the current National Kidney Foundation
(NKF) clinical practice guidelines, the
Kidney Early Evaluation Program (KEEP).
The study has just been published in the
Archives of Internal Medicine.
The general public is not sufficiently aware
that chronic kidney disease (CKD) is a
serious and progressive medical condition.
It remains under-diagnosed and
under-treated. Understandably so, since in
its early stages CKD is often asymptomatic,
making individuals with the disease and
their health-care providers unaware of its
"silent" yet threatening presence.
However, if CKD is detected and treated
early, its widespread consequences -- which
include kidney failure, cardiovascular
disease (CVD) and even death -- may be
prevented or delayed.
SCORED demonstrates greater accuracy and
greater predictive power in identifying
individuals at high-risk for CKD than KEEP.
In addition, SCORED defines 25 percent fewer
screeners as high risk, resulting in fewer
unnecessary follow-up tests.
SCORED demonstrates 88 to 95 percent
sensitivity (how well the test correctly
identifies people who have the disease) and
a specificity of 55 to 65 percent (how well
the test correctly identifies people who do
not have the disease).
In comparison, KEEP demonstrates a
sensitivity of 86 to 92 percent and a
specificity of 24 to 35 percent.
Predictive values (the chance that a
positive or negative test result will be
correct) and the ability to distinguish CKD
and non-CKD were also shown to be
significantly improved using SCORED.
"Recent national health statistics indicate
that about 13 percent of the U.S. population
has CKD, while awareness of kidney disease
among the general public remains very low,"
states Dr. Heejung Bang, assistant professor
in the Division of Biostatistics and
Epidemiology in the Department of Public
Health at Weill Cornell Medical College and
lead author of the study.
"This information underscores the need to be
more vigilant in detecting those at risk of
CKD in the general population," she says.
SCORED remains the first and only scoring
instrument rigorously developed by
statistical modeling for general population
screening, as reported one year ago -- in
the Feb. 26, 2007, Archives of Internal
Medicine.
It employs a user-friendly questionnaire and
a simple scoring system based on seven risk
factors for CKD -- age, sex, hypertension,
diabetes, cardiovascular disease (CVD),
anemia and proteinuria (the presence of
excessive protein in the urine).
All risk factors for CKD are supported by
scientific theory and have been validated by
national surveys and community health
studies.
"If your total score from the SCORED test is
4 or higher, it doesn't mean you have CKD,
but we strongly recommend further blood
testing for creatinine (a marker for
impaired kidney function) and/or urine exam
by a physician.
"Similarly, having a low score does not
guarantee you are free of this disease, but
it means you are likely at low risk," says
Dr. Bang. (The SCORED questionnaire is
available below.)
In contrast, KEEP defines high-risk
individuals as those who are 18 years or
older with at least one of the following:
diabetes; high blood pressure; or a family
history of diabetes, high blood pressure or
kidney disease.
"The SCORED model seems to improve
diagnostic performance because of the use of
additional variables, different weights for
age groups, and questions about underlying
CVD. Indeed, most CKD patients die of CVD
before reaching end-stage renal disease (ESRD).
"Currently,
researchers are trying to understand a
potential bi-directional relationship
between CKD and CVD," says Dr. Abhijit
Kshirsagar, assistant professor of medicine
at the University of North Carolina (UNC) at
Chapel Hill and senior author of the paper.
"In addition, SCORED is easily accessible
for self-assessment, which we believe gives
it greater applicability in detecting
persons at increased risk of CKD," says Dr.
Kshirsagar.
SCORED can also serve as an educational tool
to raise CKD awareness.
The SCORED questionnaire is currently
distributed via ESRD networks and the UNC
Kidney Center's Kidney Education Outreach
Program, and has been highlighted in
Nature Clinical Practice Nephrology
(2007).
The researchers hope their model will be
used in primary care and nephrology clinics,
as well as in public health initiatives and
education programs.
"We believe that screening tools such as
SCORED will provide a cost-effective tool
for health-care practitioners to identify
individuals who are at high risk for
developing CKD.
"The
early detection of high-risk individuals is
critical for both the development and
implementation of strategies to prevent the
progression to ESRD," says Dr. Christie M.
Ballantyne, director of the Methodist
DeBakey Heart Center and professor of
medicine at Baylor College of Medicine in
Houston.
Screening is a public health strategy for
identifying an unrecognized disease in
asymptomatic populations.
Subjects are asked questions or offered a
test to identify those individuals who are
more likely to be helped than harmed by
further tests or treatments that may reduce
the risk of a disease or its complications.
Diseases suitable for screening are those
with serious consequences, those in which
treatment is more effective at an earlier
stage, and conditions with a long
preclinical phase.
CKD is deemed to fulfill these criteria;
however, it is not known whether screening
will in fact result in improved outcomes.
The benefits of screening for CKD are yet to
be determined.
Co-authors include Dr. Madhu Mazumdar,
associate professor of public health and
chief of the Division of Biostatistics and
Epidemiology in the Department of Public
Health; Dr. Lisa Kern, the Nanette Laitman
Clinical Scholar in Public Health-Clinical
Evaluation; and Dr. Phyllis August, the
Ralph A. Baer Professor of Medical
Research—all of Weill Cornell Medical
College; and Dr. David Shoham and Dr.
Abhijit Kshirsagar, both of the University
of North Carolina at Chapel Hill. (Dr.
Shoham is now at Loyola University in
Chicago.)
Weill Cornell Medical
College
Weill Cornell Medical College, Cornell
University's medical school located in New
York City, is committed to excellence in
research, teaching, patient care and the
advancement of the art and science of
medicine, locally, nationally and globally.
Weill Cornell, which is a principal academic
affiliate of NewYork-Presbyterian Hospital,
offers an innovative curriculum that
integrates the teaching of basic and
clinical sciences, problem-based learning,
office-based preceptorships, and primary
care and doctoring courses.
Physicians and scientists of Weill Cornell
Medical College are engaged in cutting-edge
research in areas such as stem cells,
genetics and gene therapy, geriatrics,
neuroscience, structural biology,
cardiovascular medicine, infectious disease,
obesity, cancer, psychiatry and public
health -- and continue to delve ever deeper
into the molecular basis of disease in an
effort to unlock the mysteries of the human
body in health and sickness. In its
commitment to global health and education,
the Medical College has a strong presence in
places such as Qatar, Tanzania, Haiti,
Brazil, Austria and Turkey.
Through the historic Weill Cornell Medical
College in Qatar, the Medical College is the
first in the U.S. to offer its M.D. degree
overseas. Weill Cornell is the birthplace of
many medical advances -- including the
development of the Pap test for cervical
cancer, the synthesis of penicillin, the
first successful embryo-biopsy pregnancy and
birth in the U.S., the first clinical trial
of gene therapy for Parkinson's disease, the
first indication of bone marrow's critical
role in tumor growth, and most recently, the
world's first successful use of deep brain
stimulation to treat a minimally-conscious
brain-injured patient. For more information,
visit
http://www.med.cornell.edu.
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