Nephrology Survey on Reproductive Health and Kidney Disease

Chronic kidney disease (CKD) affects ≤6% of females of childbearing age, with pregnancy posing considerable health risks. Despite this, contraceptive use among this population remains low, and nephrologists' perspectives remain underexplored.

In this cross-sectional study, we used a 52-item electronic survey of US nephrologists to assess their practices and confidence related to reproductive health care for female patients with CKD. Descriptive and bivariate analyses were used to explore associations with provider characteristics.

Among 104 respondents, most practiced in academic settings, and more than half had seen > 15 female patients of childbearing age with CKD in the past year. Reproductive health issues were infrequently addressed, with most "rarely/never" discussing sexual dysfunction (82%), menstrual disorders (59%), or contraception (31%). More than half were "not at all confident" in managing sexual dysfunction (54%), followed by menstrual disorders (42%). Common barriers included lack of standardized guidelines (39%), limited time (38%), and knowledge gaps (33%). More than half reported that the absence of guidelines decreased their likelihood of counseling. A patient receiving a kidney transplant was the factor that most positively influenced the provider's decision to provide reproductive health counseling. Nephrologists who saw more female patients annually reported significantly higher confidence in managing contraception (30% vs. 11%, P = 0.043), breastfeeding (38% vs. 14%, P = 0.0107), antihypertensives (85% vs. 57%, P = 0.0029), and immunosuppression (63% vs. 36%, P = 0.0117).

US nephrologists reported limited confidence and inconsistent practices in reproductive counseling, underscoring the need for a standardized approach and best practices at a national level to guide care for female patients.