Prevalence and significance of family history of kidney disease in the electronic health record in three United States health systems.

INTRODUCTION

Family history is a key predictor of chronic kidney disease (CKD) and kidney failure, yet its documentation in electronic health records (EHRs) remains poorly characterized. Here, we examined the prevalence of kidney-related family history across three large United States. health systems and assessed associations with kidney disease outcomes.

METHODS

We conducted a cross-sectional study of 1,130,961 adults (age 18-80) receiving primary care at Geisinger, New York University Langone Health, and University of Utah Health from 2020-2023. Family history of CKD and kidney failure was ascertained from structured EHR fields and relevant search terms in comments in the family history section. Pooled prevalence of family history CKD was calculated overall and by CKD stage, using a validated EHR-based CKD phenotype. Associations between CKD family history and personal history of CKD and kidney failure were assessed using multivariable logistic regression, with pooled estimates derived via random-effects meta-analysis.

RESULTS

At least one family history field was recorded in 87.2% of individuals, with lower reporting of CKD family history (5.4%), compared to family history of diabetes (39.1%) or hypertension (35.3%). Prevalence of CKD family history was generally higher with advancing CKD stage, ranging from 6.6% for stage 2 CKD, 10.3% for stage 3B CKD, and 17.7% for stage 5 CKD. Men and individuals under 40 years had lower family history of CKD reporting. Family history of CKD was significantly associated with CKD (pooled odds ratio 1.39, 95% confidence interval: 1.24, 1.57) and kidney failure (pooled odds ratio 3.15, 95% confidence interval: 1.92, 5.22) across cohorts, independent of demographic and clinical factors.

CONCLUSIONS

CKD family history is underreported relative to other cardiometabolic conditions and positively associated with CKD and kidney failure. Improving systematic recording of CKD family history may improve early identification of high-risk individuals and inform precision medicine approaches to CKD prevention and care.