Kshirsagar et al developed 3 models (continuous, categorical, simplified categorical) for identifying an adult at risk for incident chronic kidney disease. The simplified categorical model can help to identify an adult at risk for chronic kidney disease. The authors are from the University of North Carolina and Cornell University.
Endpoint: incident chronic kidney disease, defined as a glomerular filtration rate < 60 mL per minute per 1.73 square meter BSA
Parameters:
(1) age of the patient in years
(2) gender
(3) anemia
(4) hypertension
(5) diabetes mellitus
(6) history of cardiovascular disease
(7) history of heart failure
(8) peripheral arterial disease (PAD)
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
< 50 years of age
|
0
|
|
|
50 to 59 years of age
|
1
|
|
|
60 to 69 years of age
|
2
|
|
|
>= 70 years of age
|
3
|
|
gender
|
male
|
0
|
|
|
female
|
1
|
|
anemia
|
absent
|
0
|
|
|
present
|
1
|
|
hypertension
|
absent
|
0
|
|
|
present
|
1
|
|
diabetes mellitus
|
absent
|
0
|
|
|
present
|
1
|
|
history of cardiovascular disease
|
no
|
0
|
|
|
yes
|
1
|
|
history of heart failure
|
no
|
0
|
|
|
yes
|
1
|
|
peripheral arterial disease
|
absent
|
0
|
|
|
present
|
1
|
where:
• The nonsimplified categorical score included 2 additional parameters: (1) ethnicity (white vs black) and (2) HDL level (low if <= 40 mg/dL). The maximum score is 12.
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the greater the risk of chronic kidney disease.
• The rate of incident chronic kidney diseases increases about 5% for each point.
|
Total Score
|
Rate of Incident Chronic
Kidney Disease
|
|
0 or 1
|
<= 5%
|
|
2
|
8%
|
|
3
|
13%
|
|
4
|
20%
|
|
5
|
25%
|
|
6
|
30%
|
|
7
|
35%
|
|
8, 9 or 10
|
>= 50%
|
Performance:
• The negative predictive value is good (92-94%) but the positive predictive value is low (around 20%).
• At a cutoff of >= 4, the sensitivity is 45% and the specificity is 80%.
Limitations:
• The study population involved Blacks and Whites from several communities in the United States. It may not apply equally to all other populations.
