Family history of kidney disease was recorded in one in twenty records but linked to three times the odds of kidney failure

Design

Cross-sectional study of electronic health records in three health systems

Population

1,130,961 US adults aged 18 to 80 in primary care, 2020 to 2023

Primary outcome

Prevalence of recorded CKD family history and association with CKD and kidney failure

Effect

Recorded in 5.4%; kidney failure OR 3.15 (95% CI 1.92 to 5.22)

This cross-sectional study examined primary care records of 1,130,961 adults aged 18 to 80 across three US health systems (Geisinger, NYU Langone and University of Utah Health) from 2020 to 2023.

Almost nine in ten records had some family history recorded, but a family history of CKD appeared in only 5.4%, against 39.1% for diabetes and 35.3% for hypertension. It was recorded more often at later CKD stages (6.6% at stage 2, 17.7% at stage 5), and less often in men and under-40s. After adjustment, a recorded family history of CKD was associated with CKD (pooled OR 1.39, 95% CI 1.24 to 1.57) and kidney failure (OR 3.15, 1.92 to 5.22).

Family history is a cheap risk marker that often goes unasked. Recording it systematically identifies people who may benefit from earlier testing, and in some families points towards a genetic kidney disease such as polycystic kidney disease or APOL1-associated disease.

• Ask every patient with diabetes, hypertension or CKD whether a parent or sibling has kidney disease or needed dialysis.
• Record family history of CKD in a structured field, not free text.
• Offer eGFR and urine albumin-to-creatinine testing to first-degree relatives of people with kidney failure.
• Consider genetic kidney disease, including polycystic kidney disease, when several relatives are affected.

Why it matters

A question that takes seconds identifies people at markedly higher kidney risk, and it is rarely asked.

Don't overread it

Cross-sectional data; it cannot show that recording family history improves outcomes.

The statistics, in plain English

An odds ratio of 3.15 means people with a recorded family history had about three times the odds of kidney failure. This is cross-sectional, so it shows association; and because family history is under-recorded, the true association may be different.

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