Design: Cross-sectional multi-system EHR study
Population: 1,130,961 adults in primary care at three US health systems
Primary outcome: Prevalence of recorded CKD family history; association with CKD and kidney failure
Effect: Recorded in 5.4%; CKD OR 1.39 (1.24–1.57); kidney failure OR 3.15 (1.92–5.22)

A cross-sectional study in Kidney International (28 September) examined primary care records of 1.1 million adults in three US health systems.

Almost nine in ten records had some family history field completed, but a family history of CKD appeared in only 5.4%, against 39% for diabetes and 35% for hypertension. It was recorded more often in more advanced CKD (6.6% at stage 2, 17.7% at stage 5), and less often in men and people under 40. Where recorded, it was associated with CKD (OR 1.39) and more strongly with kidney failure (OR 3.15), independent of demographic and clinical factors.

The practical gap is simple: clinicians ask about diabetes and heart disease in the family, but rarely about kidney disease. Adding one question could identify people — including young adults — who warrant earlier eGFR and albuminuria testing, and in some cases genetic evaluation.

Ask specifically about kidney disease, dialysis or transplant in first-degree relatives.
Consider eGFR and albuminuria testing in adults with a family history of kidney failure.
Record kidney family history in structured fields so it can trigger screening.
Consider genetic evaluation where several relatives have kidney disease at young ages.

Why it matters

A strong risk marker for kidney failure is missing from most records because nobody asks.

The statistics, in plain English

An odds ratio of 3.15 for kidney failure means about three times the odds among those with a recorded family history. The study is cross-sectional and relies on what was documented, so under-recording may distort the estimates.