More reproductive care encouraged for those with chronic kidney disease

A study from the University of Cincinnati College of Medicine calls for more extensive nephrology fellowship training on reproductive health and the development of national guidelines on contraceptive counseling when treating female patients with chronic kidney disease (CKD).

The study, recently published in the American Journal of Kidney Diseases, highlights the need for nephrologists to play a more active role in family planning discussions with their patients.

Females with CKD face increased chances of high-risk pregnancies, preeclampsia and preterm births, yet their rates of contraceptive use remain relatively low, said Silvi Shah, MD, the study’s lead author.

“We know the risks are even higher for patients with advanced CKD and those on dialysis. The majority have preterm births,” said Shah, an associate professor in the Division of Nephrology and Hypertension in the Department of Internal Medicine and a UC Health transplant nephrologist. “However, there is a belief among some female patients with advanced CKD and those on dialysis that they can’t get pregnant. We know that’s not always the case.”

Shah added that female patients are typically advised to wait at least one year after a kidney transplant before trying to conceive.

“As nephrologists, we are well-positioned to offer more comprehensive care, including contraceptive and family planning counseling to females of reproductive age, because we often maintain long-term relationships with our patients,” she said. “Yet no study has previously examined reproductive health and contraceptive use among those with CKD from the perspective of nephrologists.”

Study’s major themes

Shah and her collaborators conducted in-depth interviews with 25 adult general and transplant nephrologists from across the United States. The 20- to 50-minute conversations explored how physicians approach reproductive health and contraceptive counseling with female CKD patients.

Researchers then analyzed the transcripts and identified four major themes. One key finding was that many nephrologists reported feeling uncomfortable about discussing reproductive health and contraception.

“We know the topic of contraception doesn’t always come up,” said Nedas Semaska, the study’s first author and a third-year UC College of Medicine student from Cleveland.

Some nephrologists said they viewed the topic as outside their scope of practice or felt they lacked adequate training. Others noted formal guidelines don’t sufficiently address contraceptive use in this patient population. Meanwhile, some respondents said they educated themselves on the topic to become more comfortable.

The study also revealed limited interdisciplinary communication among nephrologists and other clinicians such as gynecologists and obstetricians and primary care providers, resulting in more fragmented care and often leaving patients to bridge the gaps.

“Some physicians mentioned that not many have open lines of dialog,” said Semaska. “Nephrologists are aware of the gap in communication.”

Study’s insights

Despite these challenges, physicians acknowledged the importance of holistic, patient-centered care using a comprehensive approach that integrates reproductive counseling into overall treatment.

“Nephrologists understand the value of empathetic conversations, patient counseling and shared decision-making,” said Semaska.

Shah emphasized that the ultimate goal is to support patients’ autonomy.

“We are here to support our patients in whatever decisions they ultimately make,” she said.