Contraceptive, Reproductive Health Counseling Crucial for Women With CKD

There are key barriers to contraceptive use and reproductive health management in women with chronic kidney disease (CKD), wrote authors of research published in American Journal of Kidney Diseases. These barriers include provider discomfort because of limited training and exposure, lack of clear guidelines, and fragmented care, all of which can be addressed through preparation, education, and establishing a framework of care.¹

CKD is a public health problem that impacts up to 6% of women in their childbearing years, but the true prevalence may be higher because of diagnostic challenges during pregnancy. Compared with the general population, women with CKD face increased health risks, including a 10-fold higher chance of developing preeclampsia and a 6-fold greater risk of preterm delivery. Pregnancy following kidney disease is also associated with the progression of CKD and is a risk factor for glomerular filtration rate decline.¹

CKD is also believed to be associated with reduced fertility; however, the landscape of reproductive health for women with kidney disease has evolved significantly. From 2002 to 2015, the number of deliveries among women undergoing dialysis and those who had received kidney transplants markedly increased. This trend is further underscored by the establishment of new pregnancy and kidney disease clinics, which are dedicated programs designed for women with kidney disease who are either pregnant or seeking to conceive.

Despite this, the rate of contraceptive use in women with CKD remains low at less than 10%, and patients report a lack of adequate counseling and coordinated care, particularly regarding contraception and pregnancy management. The majority of US and Canadian nephrologists reported lacking confidence in managing women’s health issues, including menstrual disorders, preconception counseling, and pregnancy management.¹

“We know the risks are even higher for patients with advanced CKD and those on dialysis. 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,” lead study author Silvi Shah, MD, UC Health transplant nephrologist and associate professor in the Division of Nephrology and Hypertension in the Department of Internal Medicine, said in a news release. “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. Yet no study has previously examined reproductive health and contraceptive use among those with CKD from the perspective of nephrologists.”²

This qualitative study suggests a comprehensive exploration of nephrologists’ beliefs and experiences on contraception and reproductive health in women with kidney disease. The study authors conducted semistructured virtual interviews with a cohort of US nephrologists. The interviews addressed provider knowledge gaps, counseling practices, and perceived barriers, as well as patient experiences during decision-making, concerns about pregnancy risks, and emotional burden when navigating life with chronic illness.¹

Overall, the interviewed nephrologists identified the following 4 themes and their respective subthemes: physician discomfort regarding discussion of contraception and reproductive health, including reliance on patient initiation, hesitation with counseling, uncertainty about scope of practice; insufficient training and inadequate guidelines regarding contraception and reproductive health, such as paucity of formal guidelines, limited exposure, reliance on self-education; lack of interdisciplinary coordination regarding contraceptive use and reproductive health, in which the patient is an intermediary, fragmentation of care; and the need for holistic and patient-centered care (e.g., comprehensive and sustained approach, shared decision-making).¹

“We know the topic of contraception doesn’t always come up,” study author Nedas Semaska, third-year UC College of Medicine student from Cleveland, said in the news release. “Some physicians mentioned that not many have open lines of dialogue. Nephrologists are aware of the gap in communication.”²

The main study limitation raised by the authors was potential biases in the recruitment process. Additionally, most nephrologists were early-career academics, potentially limiting the generalizability to private and community-based settings in which barriers may be different. They wrote that further research that includes a more diverse population of nephrologists alongside additional specialists, such as fertility experts or those in reproductive care, can include expanded perspectives in the findings.¹

“Nephrologists understand the value of empathetic conversations, patient counseling and shared decision-making,” Semaska explained. “We are here to support our patients in whatever decisions they ultimately make.”²

REFERENCES

1. Semaska N, Nolan R, Shah S. Contraceptive Use and Reproductive Health in Women With CKD: A Qualitative Study of Nephrologists in the United States. Am J Kidney Dis. 2025. doi:10.1053/j.ajkd.2025.07.007

2. University of Cincinnati. University of Cincinnati study urges more reproductive care for those with chronic kidney disease. News release. November 3, 2025. Accessed November 4, 2025. https://www.eurekalert.org/news-releases/1104375