Study Led by Weill Cornell Medical College and University of North Carolina Kidney Center Confirms Link Between Two Global Health Problems
NEW YORK (April 30, 2009) — Patients with cardiovascular disease (CVD) are more likely to have chronic kidney disease (CKD). The good news is that a simple screening questionnaire may improve early diagnosis, leading to better outcomes. The findings are reported in a new study led by scientists at Weill Cornell Medical College and the University of North Carolina Kidney Center and published online in the journal Nephrology Dialysis Transplantation.
Over the past few years, the research team developed and validated a user-friendly tool to identify people who are likely to have CKD. This simple risk-factor checklist, called Screening for Occult Renal Disease (SCORED), uses eight risk factors (see the checklist below). Now, their new study confirms the utility of the test for cardiovascular patients, and finds that 30 percent of these patients also had CKD (stage 3 or above), compared with 5 percent of healthy individuals.
The study follows a recent recommendation of a joint science advisory board from the American Heart Association and the National Kidney Foundation calling for screening for decreased kidney function among patients with known CVD.
"Our research shows that SCORED could help meet this mandate by providing the means to catch kidney disease early, opening the door to more effective treatment," says first author Dr. Heejung Bang, associate professor of biostatistics in the Department of Public Health at Weill Cornell Medical College, and leader of the team that originally developed the SCORED tool. "Early identification of CKD would provide the best opportunity to implement strategies known to slow down the loss of renal function, whereas late referral is associated with a worsening of the renal condition as well as cardiovascular complications."
The researchers note, however, that there is little awareness of kidney disease risk among cardiovascular patients — and physicians. "Primary care physicians, cardiologists, and neurologists involved in the treatment of patients with CVD too often think their patients have been tested for kidney disease when they haven't been," says senior author Dr. Abhijit V. Kshirsagar of the University of North Carolina. "Doctors may be aware that a particular patient with CVD has underlying kidney disease, but may incorrectly assume that the patient knows of the condition and is having it appropriately monitored. SCORED would provide another way to highlight to care providers that even early deteriorations in renal function require heightened surveillance and, often, concomitant care by a nephrologist. In general, these duties are managed best by nephrologists."
The SCORED questionnaire might remedy the situation. "If placed in patient waiting rooms, the SCORED questionnaire could empower patients to discuss their risk for CKD with their physicians and motivate themselves to be screened. The SCORED tool is patient-friendly and easy to use; many high-risk patients may not know what their creatinine or glomerular filtration rate is (or what these mean) yet will be able to complete and understand their SCORED testing. At the same time it could re-emphasize to cardiologists, neurologists and primary care physicians the importance of screening for early kidney disease," says Dr. Phyllis August, the Ralph A. Baer Professor of Medical Research and professor of public health at Weill Cornell Medical College, and a co-author of the article.
The authors point out that the benefits of jointly screening for and treating the two conditions go both ways — just as CVD patients should be screened for CKD, CKD patients should be screened for CVD.
"Patients with kidney disease are more likely to die of cardiovascular complications than from renal failure, particularly for older patients," notes Dr. August, who is also chief of the Division of Hypertension at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
The study used the data collected from two recent multicenter cardiovascular clinical trials, Enhancing Recovery in Coronary Heart Disease (ENRICHD) and Vitamin Intervention for Stroke Prevention (VISP), both sponsored by the NIH.
According to the American Heart Association, 80 million Americans have one or more forms of CVD. The National Kidney Foundation reports that 26 million U.S. adults have CKD.
Additional study co-authors include Dr. Madhu Mazumdar, professor of biostatistics in public health and chief of the Division of Biostatistics and Epidemiology at Weill Cornell Medical College; Dr. George Newman, chairman of the Department of Neurosensory Sciences at Albert Einstein Medical Center in Philadelphia, Pa.; Dr. Andrew S. Bomback of the University of North Carolina Kidney Center; Dr. Christie Ballantyne, director of the Methodist DeBakey Heart Center and professor of medicine at Baylor College of Medicine in Houston, Texas; and Dr. Allan S. Jaffe, professor of medicine in the Cardiovascular Division at the Mayo Clinic in Rochester, Minn.
Risk assessment chart for CKD using SCORED
Age: I am between 50 and 59 years of age if yes, score 2: ____
I am between 60 and 69 years of age if yes, score 3: ____
I am 70 years old or older if yes, score 4: ____
I am a woman if yes, score 1: ____
I had/have anemia if yes, score 1: ____
I have high blood pressure if yes, score 1: ____
I am diabetic if yes, score 1: ____
I have a history of heart attack or stroke if yes, score 1: ____
I have a history of congestive heart failure or heart failure if yes, score 1: ____
I have circulation disease in my legs if yes, score 1: ____
I have protein in my urine if yes, score 1: ____
Total ____
Total score Probability of chronic kidney disease in general healthy persons Cardiovascular patients
≤1 <2% <6%
2 <2% ~10%
3 2-3% 10-15%
4 5-6% 10-15%
5 10-15% 20-25%
6 15-25% ~30%
7 25-35% 40-45%
8 35-45% 45-65%
≥9 >40% >60%
Weill Cornell Medical College
Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in areas such as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, transplantation medicine, infectious disease, obesity, cancer, psychiatry and public health — and continue to delve ever deeper into the molecular basis of disease and social determinants of health in an effort to unlock the mysteries of the human body in health and sickness. In its commitment to global health and education, the Medical College has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, Cornell University is the first in the U.S. to offer a M.D. degree overseas. Weill Cornell is the birthplace of many medical advances — including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, the first indication of bone marrow's critical role in tumor growth, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. For more information, visit www.med.cornell.edu.
Lezlie Greenberg
leg2003@med.cornell.edu