Reproductive Planning and Preconception Counseling in Kidney Disease (REPKID):A Cross-Sectional Survey

Chronic kidney disease (CKD) increases risks of adverse maternal and fetal outcomes. Preconception counseling (PCC) aims to minimize health risks by optimizing prepregnancy health and modifiable risk factors. Although PCC is recommended for all patients, PCC's utilization and impact among patients with CKD are unknown. This study identified the current utilization and impact of PCC among patients with CKD at an urban academic medical center.

This survey-based study evaluated patients' self-reported demographic characteristics, kidney disease history, PCC exposure and understanding, and interactions with the health care system.

Participants included 108 patients assigned female sex at birth and aged 18-45 years at an urban, academic nephrology clinic surveyed between January and May 2024.

Exposures of interest included sociodemographic characteristics, clinical CKD presentation, and health care utilization patterns.

The primary outcome was self-reported receipt of PCC. Secondary outcomes included the specialty of the provider offering PCC, specific PCC topics discussed, and patient-reported levels of concern and knowledge.

Cross-sectional analysis used χ² or Fisher exact tests to compare respondents who reported they did vs did not receive PCC. Logistic regressions identified characteristics associated with self-reported lack of PCC.

Overall, 74% of respondents reported receiving PCC. PCCs from a maternal-fetal medicine provider were more likely to discuss medication safety, childbearing plans, and maternal and fetal complications. PCC recipients also reported greater concern about fertility but less knowledge about preconception and pregnancy with CKD.

Findings may lack generalizability given the single-center, English-speaking population and potential recall bias from self-reported data.

As PCC is recommended for all patients, especially those with a comorbid condition, PCC for patients with CKD remains suboptimal, with 26% reporting no PCC. Differing discussion topics between maternal-fetal medicine and nephrologists suggest a need for PCC standardization and equitable access to multidisciplinary specialists.