Navigating the Complexities of Reproductive Health for Women with CKD
It's a stark reality: women battling chronic kidney disease (CKD) face significant hurdles when it comes to contraception and managing their reproductive health. This critical issue demands our attention, as research highlights the urgent need for improved care within the field of nephrology.
In a study published in the American Journal of Kidney Diseases, researchers shed light on the barriers women with CKD encounter. These challenges include a lack of provider comfort due to insufficient training and experience, the absence of clear guidelines, and a fragmented healthcare system. Fortunately, these obstacles can be addressed through better preparation, education, and a more structured approach to care.
Let's delve deeper: CKD affects up to 6% of women during their childbearing years. But here's where it gets controversial... the actual prevalence may be even higher due to diagnostic difficulties during pregnancy. Compared to the general population, women with CKD are at a higher risk of health complications. For instance, they have a 10-fold increased chance of developing preeclampsia and a 6-fold greater risk of preterm delivery. Pregnancy following kidney disease can also worsen the condition and accelerate the decline of kidney function.
Interestingly, while CKD is often associated with reduced fertility, the landscape of reproductive health for women with kidney disease has been evolving. From 2002 to 2015, there was a noticeable increase in deliveries among women undergoing dialysis and those who had received kidney transplants. This trend is further supported by the emergence of specialized clinics dedicated to women with kidney disease who are either pregnant or planning to conceive.
However, the story doesn't end there. Despite these advancements, the rate of contraceptive use among women with CKD remains low, at less than 10%. Patients often report a lack of adequate counseling and coordinated care, especially regarding contraception and pregnancy management. Shockingly, the majority of nephrologists in the US and Canada have admitted to feeling unprepared to manage women's health issues, including menstrual disorders, preconception counseling, and pregnancy management.
"We know the risks are even higher for patients with advanced CKD and those on dialysis," explains lead study author Dr. Silvi Shah. "The majority have preterm births; 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." Dr. Shah emphasizes the crucial role nephrologists play in offering comprehensive care, including counseling on contraception and family planning, as they often have long-term relationships with their patients. Yet, no previous study has examined reproductive health and contraceptive use among women with CKD from the perspective of nephrologists.
This qualitative study offers a deep dive into nephrologists' beliefs and experiences concerning contraception and reproductive health in women with kidney disease. Through virtual interviews with US nephrologists, the study explored knowledge gaps, counseling practices, perceived barriers, and patient experiences. The study uncovered 4 key themes:
- Physician discomfort when discussing contraception and reproductive health, including relying on patient initiation, hesitation with counseling, and uncertainty about the scope of practice.
- Insufficient training and inadequate guidelines regarding contraception and reproductive health, such as a lack of formal guidelines, limited exposure, and reliance on self-education.
- Lack of interdisciplinary coordination regarding contraceptive use and reproductive health, with the patient often acting as an intermediary, leading to fragmented care.
- The need for holistic and patient-centered care, including a comprehensive and sustained approach and shared decision-making.
"We know the topic of contraception doesn’t always come up," notes study author Nedas Semaska. "Some physicians mentioned that not many have open lines of dialogue. Nephrologists are aware of the gap in communication."
One limitation of the study was the potential for biases in the recruitment process. Additionally, the majority of nephrologists were early-career academics, which may limit the generalizability of the findings to private and community-based settings where barriers may differ. Further research involving a more diverse group of nephrologists and other specialists, like fertility experts, could provide expanded perspectives.
"Nephrologists understand the value of empathetic conversations, patient counseling, and shared decision-making," Semaska explains. "We are here to support our patients in whatever decisions they ultimately make."
What are your thoughts? Do you think enough is being done to address the reproductive health needs of women with CKD? Share your perspective in the comments below!
