TOPLINE:

Among patients with chronic kidney disease (CKD), having a family history of kidney failure was associated with a 16% higher risk for disease progression, even after accounting for APOL1 risk alleles and social determinants of health. Black participants were more likely than White participants to report such a family history, regardless of APOL1 status.

METHODOLOGY:

• Researchers conducted a longitudinal analysis of 5623 patients with CKD (mean age, 59.6 years; 44% female) to assess the relationship between family history of kidney failure and progression of CKD and whether this association was influenced by social determinants of health and APOL1 risk alleles.
• Family history of kidney failure was self-reported at baseline via questionnaires and was defined as a first-degree relative treated for kidney failure with dialysis or transplant.
• APOL1 genotyping was performed in non-Hispanic Black patients, who were then grouped as low-risk (zero to one risk alleles) or high-risk (two risk alleles) patients.
• Social determinants of health included household income, levels of educational attainment, marital status, and health insurance coverage.
• The outcome was progression to CKD, defined as incident end-stage kidney disease or a 50% decline in estimated glomerular filtration rate from baseline; the median follow-up duration was 5.98 years.

TAKEAWAY:

• Overall, 17% of patients reported a family history of kidney failure.
• Black patients had higher odds of reporting a family history of kidney failure than White patients, regardless of APOL1 status (adjusted odds ratios, 2.42 for low-risk patients and 3.83 for high-risk patients).
• All social determinants of health except insurance coverage were associated with a family history of kidney failure in an unadjusted analysis; however, these associations did not hold significance after multivariable adjustment.
• The incidence rate of progression to CKD was higher among those with a family history of kidney failure than among those without (15.88 vs 11.93 per 1000 person-years). After adjusting for demographics, APOL1 status, social determinants of health, and clinical factors, having a family history of kidney failure was associated with a 16% higher risk for progression (hazard ratio, 1.16; 95% CI, 1.02-1.33).

IN PRACTICE:

“Our study suggests the prognostic value of family history of kidney failure for people with established diagnosis of CKD, but also its possible utility in assessing racial and ethnic disparities that underlie a familial aggregation of kidney disease,” the authors of the study wrote.

“In summary, this work highlights the need to document an individual’s family history in CKD risk assessment, a challenge where many individuals in the US are unaware of their family history,” experts wrote in an editorial accompanying the journal article.

SOURCE:

The study was led by Wei Lin, MD, ScM, Johns Hopkins Bloomberg School of Public Health, Baltimore. It was published online in the American Journal of Kidney Diseases.

LIMITATIONS:

The database used in this study excluded patients with polycystic kidney disease, which is known to have genetic causes, and those with glomerulonephritis on active immunosuppression, which typically has a more progressive course. The researchers did not include genetic risk factors other than APOL1 in their analysis. The social determinants of health included in the study covered only individual-level factors and did not capture neighborhood or environmental conditions.

DISCLOSURES:

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional support from the Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Johns Hopkins University, Baltimore; the University of Maryland, College Park, Maryland; and other institutions. The authors reported having no relevant financial interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.