Bang H et al. (2007) SCreening for Occult REnal Disease (SCORED): a simple prediction model for chronic kidney disease. Arch Intern Med 167: 374–381

Although serum creatinine measurement is inexpensive and routinely available, a considerable proportion of patients are still diagnosed with chronic kidney disease (CKD) only when nearing end-stage renal failure. Earlier diagnosis would allow more-timely initiation of therapy to slow progression. To aid early detection of CKD, Bang et al. have developed and validated a scoring system that can identify individuals with a high likelihood of having underlying CKD.

Data were obtained for 8,530 adults who participated in National Health and Nutrition Examination Surveys conducted in the US in 1999–2000 and 2001–2002. CKD was defined as an estimated glomerular filtration rate of less than 60 ml/min/1.73 m2; 601 participants had CKD. Multivariate analysis of data from a training cohort comprising 5,666 individuals detected nine variables (age, female sex, hypertension, diabetes, peripheral vascular disease, history of cardiovascular disease, history of congestive heart failure, proteinuria, and anemia) that were significantly associated with CKD.

Validation of the model in an internal cohort (n = 2,864), and an external cohort derived from the Atherosclerosis Risk in Communities study (n = 12,038), produced areas under the receiver operating characteristic curve of 0.88 and 0.71, respectively. At a cutoff score of ≥4, the model had a sensitivity of 92% and a specificity of 68%. Although the specificity of the model was relatively poor, the authors concluded that the consequences of misclassification would be minimal, given the ease and low cost of confirmatory serum creatinine testing.