Family History in the Context of CKD

Key Points Family history of kidney disease was not associated with kidney disease progression in the context of established CKD. Family history of diabetes was a risk factor of CKD progression independently of diabetes status, polygenic risk, and traditional risk factors. Background A family history of health conditions may reflect shared genetic and/or environmental risk. It is not well known to what extent family history affects outcomes among patients with CKD. In this study, we investigated the associations of family history of CKD, diabetes, and other conditions with common comorbidities and kidney disease progression among patients with CKD. Methods We performed an observational study of two prospective CKD cohorts, 2573 adults and children from the Cure Glomerulopathy Network and 3939 Chronic Renal Insufficiency Cohort adult participants. Self-reported first-degree family history of CKD, diabetes, and other common diseases was tested for associations with the risk of comorbidities and CKD progression using multivariable models. Results Family history of common comorbid conditions was associated with higher risk of these conditions in the context of CKD, including approximately by over three-fold for diabetes (adjusted odds ratio [OR], 3.37; 95% confidence interval [CI], 2.73 to 4.15), 48% for cancer (adjusted OR, 1.48; 95% CI, 1.05 to 2.09), and 69% for cardiovascular disease (adjusted OR, 1.69; 95% CI, 1.36 to 2.10 in combined cohorts). While polygenic risk score (PRS) for CKD was associated with kidney disease progression (adjusted hazards ratio, 1.11; 95% CI, 1.06 to 1.16 in combined cohorts), family history of kidney disease was not an independent risk factor of disease progression in the context of existing CKD. By contrast, family history of diabetes was significantly associated with a higher risk of CKD progression independently of diabetes occurrence or PRS for diabetes (adjusted hazards ratio, 1.19; 95% CI, 1.05 to 1.35 in combined cohorts). Conclusions Broad collection of family history in the context of CKD improved clinical risk stratification. Family history of diabetes was consistently associated with a higher risk of CKD progression independently of diabetes status or PRS for diabetes in both cohorts.