SCreening for Occult REnal Disease (SCORED)

Abstract

Background: Despite the wide availability and low cost of serum creatinine measurement, at-risk populations are not routinely tested for chronic kidney disease (CKD). Methods: We used a cross-sectional analysis of a nationally representative, population-based survey to develop a system, SCORED (SCreening for Occult REnal Disease), that uses routinely available demographic and medical information to identify individuals with an increased likelihood of CKD. The analysis included 8530 adult participants in the National Health and Nutrition Examination Surveys conducted from 1999 to 2000 and 2001 to 2002 in the United States. Chronic kidney disease was defined as a glomerular filtration rate less than 60 mL/min per 1.73 m 2. Univariate and multivariate associations between a comprehensive set of risk factors and CKD were examined to develop a prediction model. The optimal characteristics of the model were examined with internal measures. External validation was performed using the Atherosclerosis Risk in Communities study. A model-based numeric scoring system was developed. Results: Age (PϽ.001), female sex (P=.02), and various health conditions (hypertension [P=.03], diabetes [P=.03], and peripheral vascular disease [P=.008]; history of cardiovascular disease [P=.001] and congestive heart failure [P=.04]; and proteinuria [PϽ.001] and anemia [P=.003]) were associated with CKD. The multivariate model was well validated in the internal and external data sets (area under the receiver operating characteristic curve of 0.88 and 0.71, respectively). A score of 4 or greater was chosen by internal validation as a cutoff point for screening based on the diagnostic characteristics (sensitivity, 92%; specificity, 68%; positive predictive value, 18%; and negative predictive value, 99%). Conclusion: This scoring system, weighted toward common variables associated with CKD, may be a useful tool to identify individuals with a high likelihood of occult kidney disease.

Evaluation of an Instrument for Screening Patients at Risk for Chronic Kidney Disease: Testing SCORED (Screening for Occult Renal Disease) in a Portuguese Population

“…The screening was announced in the local media and those wishing to participate were registered and scheduled. The study protocol included collection of demographic data, measuring blood pressure after sitting for 5 min, measuring blood glucose and cholesterol, testing urine for proteins with a urine dipstick and taking the SCORED questionnaire (9 questions) [5]. Two additional questions were included regarding personal and family history of renal disease.…”

“…SCORED (Screening for Occult Renal Disease) is a validated tool for screening high-risk patients for CKD [5], with a high sensitivity and high negative predictive value [6]. Using SCORED is inexpensive and is a good tool to select a population at high risk for CKD to perform further analysis of kidney function and imaging, sparing useless exams and inappropriate referral to nephrologists.…”

Aplicação do questionário SCORED para rastreamento da doença renal crônica entre pacientes hipertensos e diabéticos

“…As respostas "sim" geram pontuação diferenciada de acordo com cada pergunta. A pontuação final varia de 0 a 12, e se ela for maior ou igual a 4, trata-se de alerta para risco de DRC, como validado anteriormente 18,19 . Após a coleta dos dados, os agentes de saúde agendavam a data para realização dos exames laboratoriais de urina para detecção de proteinúria (por fitas reagentes Multistick 10 SG da Siemens ® ) e dosagem sérica de creatinina (pela técnica da reação de Jaffé com reagente da Roche ® ).…”

“…Em nosso estudo, o SCORED apresentou especificidade de 23% em detectar DRC, índice menor do que a especificidade encontrada nos estudos de validação populacional nos Estados Unidos e no Brasil, respectivamente, com 68 e 65% 18,19 . A diferença é decorrente dos tipos de amostra: indivíduos com risco para DRC em nosso estudo e base populacional nos estudos de validação.…”

“…Ainda que o diagnóstico da DRC seja feito por exames laboratoriais simples e amplamente disponibilizados pelos laboratórios, há dados que mostram que: a detecção da DRC é baixa na atenção primária de saúde 14 ; a grande parcela de pessoas com DRC desconhece a doença até necessitarem de terapia renal substitutiva (TRS) 15 ; o grande número de diabéticos e de hipertensos é acompanhado sem ter a creatinina sérica dosada 16 ; o rastreamento da DRC entre diabéticos acompanhados por clínicos gerais é menor que 10% (mesmo após número médio de dez consultas) 17 . Nos Estados Unidos, foi idealizado um questionário denominado Screening for Occult Renal Disease (SCORED), que rastreia e alerta sobre um risco aumentado de DRC em fase inicial, com a vantagem de apenas utilizar variáveis facilmente entendidas por leigos, sem necessidade de exames laboratoriais 18 . No Brasil, o SCORED foi traduzido para o português, adaptado culturalmente e validado em amostra de funcionários da Universidade Federal de Juiz de Fora, demonstrando sensibilidade de 80% e valor preditivo negativo de 97% para detecção da DRC 19 .…”