Ask about family history of kidney disease: it is rarely recorded, and it flags higher risk

Design

Cross-sectional study of electronic health records in three US health systems with pooled random-effects analysis

Population

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

Primary outcome

Prevalence of recorded family history of kidney disease, and its association with chronic kidney disease and kidney failure

Effect

Family history recorded in 5.4%; pooled OR 1.39 (95% CI 1.24 to 1.57) for CKD and 3.15 (95% CI 1.92 to 5.22) for kidney failure

This cross-sectional study used electronic records of 1,130,961 adults aged 18 to 80 receiving primary care in three US health systems between 2020 and 2023. Family history of chronic kidney disease or kidney failure was taken from structured fields and free-text comments.

At least one family history field was recorded in 87.2% of people, but kidney disease family history in only 5.4%, against 39.1% for diabetes and 35.3% for hypertension. Reporting rose with advancing disease: 6.6% in stage 2, 10.3% in stage 3B and 17.7% in stage 5. Men and people under 40 had lower reporting. A family history of kidney disease was associated with chronic kidney disease (pooled OR 1.39, 95% CI 1.24 to 1.57) and with kidney failure (pooled OR 3.15, 95% CI 1.92 to 5.22), independent of demographic and clinical factors.

This is an association in health-system records, and it does not show that recording family history changes outcomes. Family history is also a cheap question to ask and may help prioritise who gets kidney function and albuminuria tests, though the study did not test that.

• Family history of kidney disease was recorded in 5.4% of patients, vs 39.1% for diabetes.
• It was associated with chronic kidney disease (OR 1.39) and with kidney failure (OR 3.15).
• Recording was lower in men and in people under 40.
• Ask about relatives with kidney disease, dialysis or transplant, and record it in a structured field.
• Consider eGFR and urine albumin testing earlier in people with a positive family history.

Why it matters

A free question that is hardly ever documented carries a signal as large as many lab tests.

Don't overread it

A cross-sectional record study shows association and cannot show that recording family history leads to earlier diagnosis or better outcomes.

The statistics, in plain English

An odds ratio of 3.15 for kidney failure means people with a family history had about three times the odds of kidney failure compared with those without, after adjustment. Because family history was recorded unevenly, some people without a recorded history will have one, so the true gap may differ.

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