Study explores barriers to contraceptive use in females with kidney disease

The percentage of females with kidney disease who use contraception is much lower than the rate of contraceptive use by females in the general population, according to a new study from researchers at the University of Cincinnati.

The study was published in the journal Kidney Medicine.

"Although kidney disease adversely impacts fertility, conception is common among women with chronic kidney disease, kidney failure on dialysis and kidney transplant. History of kidney disease increases the risk of adverse pregnancy outcomes, including preeclampsia, fetal growth restriction and preterm babies," says Silvi Shah, MD, associate professor in the Division of Nephrology at UC and lead author of the study.

"Unplanned pregnancies occur in women with kidney disease. It is of paramount importance that pregnancies in this high-risk population are planned and gives us the opportunity to counsel women about family planning and the impact of pregnancy on kidney disease, and the impact of kidney disease on maternal and fetal outcomes."

The study found 5% to 10% of females use contraception, compared to 60% in the general population. Inadequate counseling, insufficient educational resources, lack of multidisciplinary coordination and variable knowledge are the barriers reported by patients for low contraceptive use with kidney disease.

In the study, the investigators conducted focus group interviews in adult female patients with chronic kidney disease, kidney transplant and kidney failure requiring dialysis. The following five themes were identified with the qualitative analysis:

1. varying knowledge regarding reproductive health with kidney disease
2. inadequate counseling about contraceptive use
3. lack of interdisciplinary coordination regarding contraceptive use
4. insufficient educational resources available to guide the contraceptive discussion
5. need for research to better understand reproductive needs in females with kidney disease

"Qualitative studies such as this one show us the importance of listening to our patients and communicating better with them and the larger care team. Simply telling a patient the risks is not enough anymore," says co-author Meredith Pensak, MD, associate professor in the Department of Obstetrics and Gynecology at the UC College of Medicine.

Shah says the study is unique in that it addresses perspectives and barriers facing females with kidney disease with regards to contraceptive use in the United States. The study highlights the importance of increasing awareness and improving multidisciplinary care for reproductive health for patients with kidney disease.