Family history of end-stage renal disease does not predict dialytic survival

Familial aggregation of end-stage renal disease (ESRD) is frequently observ ed in the common causes of kidney failure. It is unknown whether the clinic al course of nephropathy differs based on an individual's family history of ESRD. The ESRD Network 6 Family History of ESRD database was analyzed to c ompare dialytic survival among patients with first- or second-degree relati ves on dialysis therapy (positive family history) with those lacking relati ves with ESRD (negative family history). Study participants included 3,442 adult, black or white, incident patients with ESRD who initiated dialysis t herapy in ESRD Network 6 facilities in 1995 and participated in the Network -sponsored Family History of ESRD study. All deaths were reported to the Ne twork and used to calculate mortality rates. The relative risk for death wa s used to compare rates between levels of patient characteristics. Multivar iate analyses used proportional hazards regression. Overall, 730 patients ( 21.2%) had a positive family history of ESRD. Black patients, those who wer e younger at the onset of ESRD, patients with greater degrees of functional status, and women were more likely to have a positive family history. Duri ng 9,000 patient-years of follow-up, 1,599 patients died (17.8 deaths/100 d ialysis-years). Univariate analyses showed that patients with a positive fa mily history of ESRD had 20% lower mortality than those with a negative fam ily history of ESRD (relative risk, 0.80; 95% confidence interval, 0.7 to 0 .9; P = 0.001). Older age, white race, diabetic nephropathy, lower function al status, lower serum albumin level, congestive heart failure, and ischemi c heart disease also were associated with greater mortality rates. Multivar iate analyses showed that only older age at onset of ESRD, white race, low functional status, ESRD caused by diabetes, and congestive heart failure we re associated with increased mortality. A family history of ESRD in either first- or second-degree relatives was no longer a significant determinant o f survival. We conclude that familial clustering of ESRD does not significa ntly impact on dialytic survival after controlling for the competing effect s of patient race, age of ESRD onset, and the presence of diabetes mellitus . (C) 2001 by the National Kidney Foundation, Inc.