Kidney family history was rarely recorded but strongly predictive

Design

Multisite cross-sectional EHR study

Population

1,130,961 adults in primary care at three US health systems

Primary outcome

Recorded CKD family history and association with CKD and kidney failure

Effect

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

This cross-sectional study examined electronic records of 1,130,961 adults in primary care at three US health systems between 2020 and 2023. Published in Kidney International on 28 September 2026.

A family history of chronic kidney disease (CKD) was recorded for only 5.4%, against 39% for diabetes and 35% for hypertension. It was recorded more often as CKD stage advanced, from 6.6% at stage 2 to 17.7% at stage 5, and less often in men and those under 40. After adjustment, a recorded family history was associated with CKD (OR 1.39) and kidney failure (OR 3.15).

Family history points to inherited disease such as polycystic kidney disease, Alport syndrome or APOL1-related disease, and to shared risk. Few clinicians ask about it.

This is cross-sectional and reflects what was recorded, not what was true.

• Ask every patient with CKD, hypertension or diabetes about kidney disease in relatives
• Ask specifically about dialysis, transplant and polycystic kidneys in the family
• Consider screening relatives of patients with inherited or early-onset kidney failure
• Refer for genetic evaluation when the family pattern suggests an inherited cause

Why it matters

A single history question may identify people at high risk long before their creatinine rises.

Don't overread it

Association from recorded data; it does not show that recording family history improves outcomes.

The statistics, in plain English

An odds ratio of 3.15 for kidney failure is large, but under-recording means many people with an affected relative were counted as having none, which may distort the estimate either way.

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