Risk score for first-screening of prevalent undiagnosed chronic kidney disease in Peru: The CRONICAS-CKD risk score

Rodrigo M. Carrillo-Larco, J. Jaime Miranda, Robert H. Gilman, Josefina Medina-Lezama, Julio A. Chirinos-Pacheco, Paola V. Muñoz-Retamozo, Liam Smeeth, William Checkley, Antonio Bernabe-Ortiz, Juan P. Casas, George Davey Smith, Shah Ebrahim, Luis Huicho, Germán Málaga, J. Jaime Miranda, Víctor M. Montori, Gregory B. Diette, Fabiola León-Velarde, Robert A. Wise, Héctor H. GarcíaJ. Jaime Miranda

Research output: Contribution to journalArticle

Abstract

Background: Chronic Kidney Disease (CKD) represents a great burden for the patient and the health system, particularly if diagnosed at late stages. Consequently, tools to identify patients at high risk of having CKD are needed, particularly in limited-resources settings where laboratory facilities are scarce. This study aimed to develop a risk score for prevalent undiagnosed CKD using data from four settings in Peru: a complete risk score including all associated risk factors and another excluding laboratory-based variables. Methods: Cross-sectional study. We used two population-based studies: one for developing and internal validation (CRONICAS), and another (PREVENCION) for external validation. Risk factors included clinical- and laboratory-based variables, among others: sex, age, hypertension and obesity; and lipid profile, anemia and glucose metabolism. The outcome was undiagnosed CKD: eGFR < 60 ml/min/1.73m2. We tested the performance of the risk scores using the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive/negative predictive values and positive/negative likelihood ratios. Results: Participants in both studies averaged 57.7 years old, and over 50% were females. Age, hypertension and anemia were strongly associated with undiagnosed CKD. In the external validation, at a cut-off point of 2, the complete and laboratory-free risk scores performed similarly well with a ROC area of 76.2% and 76.0%, respectively (P = 0.784). The best assessment parameter of these risk scores was their negative predictive value: 99.1% and 99.0% for the complete and laboratory-free, respectively. Conclusions: The developed risk scores showed a moderate performance as a screening test. People with a score of ≥ 2 points should undergo further testing to rule out CKD. Using the laboratory-free risk score is a practical approach in developing countries where laboratories are not readily available and undiagnosed CKD has significant morbidity and mortality.

Original languageEnglish (US)
Article number343
JournalBMC Nephrology
Volume18
Issue number1
DOIs
StatePublished - Nov 29 2017

Keywords

  • Chronic kidney disease
  • Kidney
  • Latin America
  • Risk assessment

ASJC Scopus subject areas

  • Nephrology

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    Carrillo-Larco, R. M., Miranda, J. J., Gilman, R. H., Medina-Lezama, J., Chirinos-Pacheco, J. A., Muñoz-Retamozo, P. V., Smeeth, L., Checkley, W., Bernabe-Ortiz, A., Casas, J. P., Smith, G. D., Ebrahim, S., Huicho, L., Málaga, G., Jaime Miranda, J., Montori, V. M., Diette, G. B., León-Velarde, F., Wise, R. A., ... Jaime Miranda, J. (2017). Risk score for first-screening of prevalent undiagnosed chronic kidney disease in Peru: The CRONICAS-CKD risk score. BMC Nephrology, 18(1), [343]. https://doi.org/10.1186/s12882-017-0758-4