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NDT Advance Access originally published online on March 26, 2009
Nephrology Dialysis Transplantation 2009 24(8):2452-2457; doi:10.1093/ndt/gfp124
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Screening for kidney disease in vascular patients: SCreening for Occult REnal Disease (SCORED) experience

Heejung Bang1, Madhu Mazumdar1, George Newman2, Andrew S. Bomback3,4, Christie M. Ballantyne5, Allan S. Jaffe6, Phyllis A. August7,8 and Abhijit V. Kshirsagar3,4

1 Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, NY 2 Department of Neurosensory Sciences, Albert Einstein Medical Center, Philadelphia, PA 3 Division of Nephrology and Hypertension, School of Medicine, University of North Carolina 4 University of North Carolina Kidney Center, Chapel Hill, NC 5 Section of Atherosclerosis and Lipoprotein Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, TX 6 Cardiovascular Division, Mayo Clinic, Rochester, MN 7 Division of Nephrology and Hypertension, Department of Medicine 8 Division of Outcomes and Effectiveness Research, Department of Public Health, Weill Medical College of Cornell University, New York, NY, USA

Correspondence and offprint requests to: Heejung Bang; E-mail: heb2013{at}med.cornell.edu



  Abstract

Background. SCreening for Occult REnal Disease (SCORED) is a novel screening guideline recently developed to identify individuals with a high likelihood of having prevalent chronic kidney disease (CKD). This simple scoring system, developed from general US representative samples and independently validated, was shown to outperform current clinical practice guidelines. Recently, CKD screening in individuals with cardiovascular disease (CVD) has been emphasized. We therefore evaluated the SCORED model in CVD patients in order to better understand the implications of CKD screening in this population.

Methods. Two clinical trials that enrolled patients with heart attack (N = 2481) or stroke (N = 3680) were combined to create our sample. The performance of the SCORED guideline was evaluated by standard diagnostic measures. Correlations among various risk scores and their predictive abilities for recurrent CVD were ascertained.

Results. For heart attack and stroke patients, respectively, the SCORED guideline yielded sensitivity of 94 and 97%, specificity of 27 and 11%, positive predictive value of 32 and 30%, negative predictive value of 93 and 89%, with AUC of 0.75 and 0.68. SCORED was strongly correlated with other risk scores and exhibited a similar performance in the prediction of recurrent CVD.

Conclusions. The higher risk of CKD in CVD patients with high SCORED values is demonstrated. This simple education and screening tool may help promote awareness of CKD in CVD patients, in addition to general populations, and assess the CKD risk and its relationship with recurrent CVD.

Keywords: CKD; CVD; ENRICHD; VISP

Received for publication: 29.10.08
Accepted in revised form: 2. 3.09


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