People with chronic kidney disease often lack adequate contraception counseling, care coordination, and access to a full range of contraceptives, new research suggests. Patients also report emotional challenges surrounding reproductive health.1
“Pregnancy in people with kidney disease is associated with a higher risk of poor fetal outcomes,” says Silvi Shah, MD, MS, FNKF, lead study author and an associate professor of medicine in the division of nephrology at the University of Cincinnati College of Medicine. “It’s extremely important that these women have contraception to prevent unintentional pregnancy. Use of contraception is extremely low for women going on dialysis; it’s 5% vs. 60% in the general population.”
Researchers sought patients’ perspectives on using contraception. Women with kidney disease face a high risk of pre-eclampsia and cesarean delivery. There also is the risk of worsening kidney function during pregnancy and adverse fetal outcomes, including pre-term birth, low birth weight babies, stillbirths, and neonatal mortality.
“We looked at previous studies, and it is known that outcomes worsen according to the stage of kidney disease,” Shah explains. “The higher the stage and the worse the kidney function is, the worse the outcomes.”
Given these outcomes and the risk to women to continue pregnancies on dialysis, contraceptive counseling should be a priority for providers. But Shah and colleagues found that it was not a priority among the patients’ kidney care providers.
Physicians do not talk about reproductive health or contraception routinely with their patients. There is a perception that women on dialysis cannot get pregnant and were told by their physicians that they could not, Shah says. “That’s not true. We did show that the rate of pregnancy is high for women on dialysis, as well,” she adds. “The study showed that contraception use is extremely low, and they received insufficient counseling.”
The focus group participants had variable knowledge about their reproductive health. “Everybody agreed that they did not receive adequate counseling on contraception use from their doctors, especially kidney doctors,” Shah says. “They mentioned there was a lack of interdisciplinary coordination between kidney doctors, OB/GYNs, and primary care providers.”
Kidney patients also mentioned receiving insufficient educational sources regarding contraceptive use. This often led to patient anxiety and the use of resources like Google and Facebook groups to get their information.
“There was a lack of contraceptive educational resources available from their doctors,” Shah says. “The other important finding was there is very little research being done for women’s health and kidney disease, and more research is needed in this area. Solutions are to improve interdisciplinary care and to have specialized care for patients with kidney disease. At my hospital, we have a special clinic for family planning for high-complexity patients and patients with kidney disease.”
Another solution is to make educational resources available, such as brochures. This information also should be in the electronic health record. “Then, of course, we need to improve patient and physician communication. I think this is extremely important,” Shah says. “All patients shared that they did not receive enough information from their physicians.”
Physician training should include managing reproductive health for all providers, especially those who work with patients with kidney disease. “That’s an intervention that could be done to ensure all kidney doctors are given enough education on this important area of reproductive health and family planning,” Shah says.
Another intervention is to raise awareness among people with kidney disease that they can become pregnant — even while on dialysis — and there are multiple risks to themselves and their fetuses. Also, to improve care coordination, health systems and other entities could create more specialty clinics where women receive primary care, chronic illness care, and contraceptive care under one roof.
“Our goal is to prevent all these unplanned pregnancies,” Shah adds. “We want to improve access to family planning and contraception.”
REFERENCE
- Shah S, Katz-Greenberg G, Gudsoorkar P, et al. Contraceptive use in females with advanced CKD: A qualitative study. Kidney Med 2023;5:100738.
People with chronic kidney disease often lack adequate contraception counseling, care coordination, and access to a full range of contraceptives, new research suggests. Patients also report emotional challenges surrounding reproductive health.
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