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A Model and Questionnaire for Predicting Chronic Kidney Disease

Mar 6, 2007

A new tool is developed to identify patients who are most at risk for chronic kidney disease (CKD). Chronic kidney disease (CKD) has been and remains under-identified. To better identify those at increased risk for potentially undiagnosed CKD, researchers from Weill Cornell Medical College and the University of North Carolina at Chapel Hill performed the first study of its kind to develop a tool to identify patients who are most at risk for CKD.

"Kidney disease often occurs in conjunction with a number of other conditions, including diabetes and high blood pressure, but many patients and their family members are not aware of this association," says Heejung Bang, PhD, assistant professor in the Division of Biostatistics and Epidemiology in the Department of Public Health at Weill Cornell Medical College. Bang is the primary author of the study, which is published in last week’s Archives of Internal Medicine.

"Unfortunately, many patients do not find out they have CKD until it has progressed to end-stage kidney disease," says Abhijit V. Kshirsagar, MD, of the Kidney Center and Division of Nephrology, University of North Carolina School of Medicine, the senior author and major medical investigator of the research project. "The purpose of the study was to determine which patient characteristics are most associated with CKD, and to develop a simple method to identify individuals who should be screened in a variety of different settings in real life."

The researchers examined comprehensive demographic, clinical and medical history variables as potential risk factors of CKD, based on the medical literature on this subject. Through statistical modeling and validation, they were able to determine that only seven factors — age, female gender, hypertension, diabetes, cardiovascular disease, proteinuria and anemia — had significant associations with CKD in the study group. These characteristics are easily identified by the general public and health-care providers through a user-friendly questionnaire. They frequently occur together and cumulatively affect underlying kidney disease.

If a patient completes the questionnaire with a total score of four or higher, a confirmatory testing for creatinine concentration and/or glomerular filtration rate (GFR), directed by a health-care professional, would be strongly recommended. Thirty-six percent of the 8,530 study participants scored four or higher on the questionnaire.

"Although current clinical practice guidelines recommend screening of individuals 18 years or older with a family history of diabetes, hypertension or kidney disease, or a personal history of diabetes or hypertension, these recommendations focus on single risk factors and do not quantify the cumulative effect of multiple risk factors. Our method made use of the coexisting risk factors that were identified by a valid scientific approach, greatly enhanced upon the concept-based selection, and rigorously followed the practice of evidence-based research," said Bang.

In the future, the questionnaire will be tested in several settings, including a community-based screening program. The researchers hope their model will be used not only in medical encounters such as in primary care or nephrology clinics, but also in public health initiatives and education programs. The scoring algorithm will be posted on medical information Web sites for public use, including the UNC Kidney Center Web site, to make people more familiar with associated risk factors and to increase awareness of this serious disease.  For a copy of the questionnaire See this weeks Tool for Your Practice