地域医療と健康教育

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Evaluation of the Scored Questionnaire to Identify Individuals with Chronic Kidney Disease in a Community-based Screening Program in Rural North Carolina

Donna H Harward, Heejung Bang, Yichun Hu, Andrew S Bomback and Abhijit V Kshirsagar

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.