Preliminary Validation of a Modified Screening Tool for the Early Detection of Chronic Kidney Disease in a Pilot Sample.

Background

The early detection of chronic kidney disease (CKD) is critical to preventing progression and reducing associated morbidity. The original SCreening for Occult REnal Disease (SCORED) tool has been widely adopted for CKD screening. However, its length and inclusion of items with limited predictive value affect its practicality in specific settings. This study aimed to validate a modified version of the tool (SCORED-M), which has fewer items and improved predictive performance for the early detection of disease.

Methods

A cross-sectional pilot project was conducted and the diagnostic performance of the revised tool (SCORED-M) was evaluated using receiver operating characteristic analysis, sensitivity, specificity, positive predictive value, and negative predictive value (NPV). Items were selected or excluded based on their statistical significance, odds ratios, and clinical relevance to CKD risk. The optimal threshold score for mass screening was determined through a comparative analysis.

Results

A total of 116 eligible participants enrolled in this pilot study. SCORED-M, comprising six items, rather than nine, as in the original version, demonstrated superior screening performance. It achieved a higher area under curve (0.89 vs. 0.79), sensitivity (0.97), and NPV (0.97), indicating its improved capability to identify individuals with CKD and rule out those without the condition. The age-related scoring range was recalibrated from 2 to 4 points to a narrower span of 1-3 points, to moderate the influence of age as a standalone risk factor for CKD. Items with limited predictive contribution, such as 'I am a woman', 'I have a history of heart attack or stroke', and 'I have circulation disease in my legs', were removed, while clinically relevant variables like 'I am diabetic', 'I have a history of congestive heart failure or heart failure', 'I have protein in my urine', 'I have uncontrolled high blood pressure', and 'I have a history of renal disease' were retained. A threshold score of ≥4 was identified as optimal, balancing sensitivity and specificity while supporting resource-efficient screening and ensuring the reproducibility of results.

Conclusions

This pilot study provided preliminary evidence that the SCORED-M tool offers a more concise and accurate approach to CKD/diagnosis. While the findings are promising, validation in larger and more diverse populations is necessary to confirm the generalizability of the model and refine it for broader clinical application in mass screening programmes.