Harward Donna H, Bang Heejung, Hu Yichun, Bomback Andrew S, Kshirsagar Abhijit V
Director of Education and Outreach, University of North Carolina at Chapel Hill, USA.
Professor, Clinical trials and observational studies, University of California Davis, USA.
J Community Med Health Educ. 2014 Apr;4(Suppl 2):007. doi: 10.4172/2161-0711.S2-007. Epub 2014 Mar 28.
Just over 10 percent of US adults over twenty years of age have chronic kidney disease (CKD). Early detection is essential to delay or halt CKD's progression, but screening and early detection of CKD in high risk populations is inconsistent, especially in rural and underserved communities.
The objective of this study was to evaluate the effectiveness of the Screening for Occult Renal Disease questionnaire as a simple, self-report tool to identify individuals with increased likelihood of prevalent CKD in a rural North Carolina setting.
Over an eight month period, in the context of the Kidney Education Outreach Program (KEOP), sixteen CKD screenings were conducted in two underserved, rural NC communities. For this study, the SCORED questionnaire was administered prior to the execution of the regular KEOP screening protocol.
For 172 participants for whom both blood and urine specimens were collected, there were fifteen (8.7%) who demonstrated less than normal kidney function. The SCORED sensitivity and specificity were 100% and 42%, respectively. The positive predictive value was 14% and the negative predictive value was 100%. The positive likelihood ratio for low eGFR was 1.7 and conversely, the negative likelihood ratio for low eGFR was zero.
In this study, the SCORED performed comparably to previous settings in established datasets and cohort studies, with high sensitivity and negative predictive values that allow for ruling out the presence of disease. SCORED appears to provides a practical alternative to the administration of regular CKD screening protocols that can be difficult to organize and administer in rural settings. The need for further evaluation of SCORED in underserved, high-risk communities is recommended.
美国20岁以上的成年人中，仅有略多于10%的人患有慢性肾脏病（CKD）。早期检测对于延缓或阻止CKD的进展至关重要，但在高危人群中对CKD进行筛查和早期检测的情况并不一致，尤其是在农村和服务欠缺的社区。
本研究的目的是评估隐匿性肾脏疾病筛查问卷作为一种简单的自我报告工具，在北卡罗来纳州农村地区识别患有CKD可能性增加的个体的有效性。
在为期八个月的时间里，在肾脏教育外展项目（KEOP）的背景下，在北卡罗来纳州两个服务欠缺的农村社区进行了16次CKD筛查。在本研究中，在执行常规KEOP筛查方案之前发放了SCORED问卷。
对于172名同时采集了血液和尿液样本的参与者，有15人（8.7%）的肾功能低于正常水平。SCORED的敏感性和特异性分别为100%和42%。阳性预测值为14%，阴性预测值为100%。低估算肾小球滤过率（eGFR）的阳性似然比为1.7，相反，低eGFR的阴性似然比为零。
在本研究中，SCORED的表现与既定数据集中和队列研究中的先前情况相当，具有高敏感性和阴性预测值，能够排除疾病的存在。SCORED似乎为常规CKD筛查方案的实施提供了一种实用的替代方法，而常规筛查方案在农村地区可能难以组织和实施。建议在服务欠缺的高危社区对SCORED进行进一步评估。
