Bang et al developed a simple model for identifying a patient at risk for chronic renal disease. This can help identify a patient who may benefit from closer monitoring of renal function. The authors are from Weill Medical College of Cornell University and the University of North Carolina in Chapel Hill.
NOTE: The acronym SCORED comes from screening (SC), occult (O), renal (RE) and disease (D).
Patient selection: adult >= 50 years of age
Endpoint: creatinine clearance < 60 mL per min per 1.73 square meters BSA
Parameters:
(1) age of the patient in years
(2) gender
(3) anemia
(4) hypertension
(5) diabetes
(6) history of cardiovascular disease
(7) history of congestive heart disease
(8) peripheral vascular disease
(9) proteinuria on a urine dipstick
|
Parameter
|
Finding
|
Points for Simple Score
|
Points for Logistic Model
|
|
age of the patient in years
|
50 - 59 years of age
|
2
|
1.55
|
|
|
60 - 69 years of age
|
3
|
2.31
|
|
|
>= 70 years of age
|
4
|
3.23
|
|
gender
|
male
|
0
|
0
|
|
|
female
|
1
|
0.29
|
|
anemia
|
absent
|
0
|
0
|
|
|
present
|
1
|
0.93
|
|
hypertension
|
absent
|
0
|
0
|
|
|
present
|
1
|
0.45
|
|
diabetes
|
absent
|
0
|
0
|
|
|
present
|
1
|
0.44
|
|
history of cardiovascular disease
|
absent
|
0
|
0
|
|
|
present
|
1
|
0.59
|
|
history of CHF
|
absent
|
0
|
0
|
|
|
present
|
1
|
0.45
|
|
peripheral vascular disease
|
absent
|
0
|
0
|
|
|
present
|
1
|
0.74
|
|
proteinuria
|
absent
|
0
|
0
|
|
|
present
|
1
|
0.83
|
where:
• Proteinuria did not have a threshhold level.
simple score =
= SUM(points for all 9 parameters)
value of X for logistic regression model =
= SUM(points for all 9 parameters) - 5.4
probability of chronic kidney disease =
= 1 / (1 + EXP((-1) * X))
Interpretation:
• minimum simple score: 2
• maximum simple score 12
• A patient with a simple score >= 4 should have serum creatinine measured and the estimated creatinine clearance calculated.
• A simple score >= 4 can be seen in someone 50-59 years of age with 2 risk factors.
Performance:
• With a cutoff of >= 4 the sensitivity was 92% and specificity 68%.
