Study highlights importance of pregnancy counseling and planning for women with kidney disease
Credit: Colleen Kelley/University of Cincinnati Creative + Brand
New research from the University of Cincinnati (UC) finds that women with kidney failure have low rates of contraceptive use. The study, published in the journal Kidney Medicine, finds an overall contraceptive use rate of 5.3% among women with kidney failure undergoing dialysis in the United States.
“Although end-stage kidney disease adversely impacts fertility, conception is common among women on dialysis. Kidney failure increases the risk of adverse pregnancy outcomes, including pre-eclampsia, fetal growth restriction and preterm babies,” says Silvi Shah, MD, assistant professor in the Division of Nephrology, Kidney CARE Program 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 evaluated 35,732 women of childbearing age between Jan. 1, 2005 and Dec. 31, 2014. They were all between the ages of 15-44 years, on dialysis and with Medicare as the primary payer, using the United States Renal Data System. Overall, the rate of contraceptive use was 5.3%. The mean age at study entry was 30±7 years for women with any contraceptive use. The contraceptive use was highest among women aged 15-24 years (11.1%) and lowest among women aged 40-44 years (2.6%). The study showed that younger age, Native American and black race/ethnicity, kidney failure due to glomerulonephritis, hemodialysis modality, and predialysis nephrology care were associated with a higher likelihood of contraceptive use. The analysis also found that the socioeconomic status did not impact the likelihood of contraceptive use.
Shah says study unique in that it addresses a comprehensive group of women undergoing dialysis of all racial and ethnic groups in the United States from 2005-2014 to better understand the incidence of contraceptive use and factors associated with it. The study further took into account patients with complete Medicare coverage, thus avoiding the potential shortfalls of registries dependent on voluntary reporting or patient recall. This research shows for the first time that contraceptive usage rates in women with kidney failure who are undergoing dialysis remains very low in the United States.
“We were not able to account for use of natural methods or use of condoms in our study, which remains a limitation,” says Shaw. “However, the results highlight that contraceptive use among women with kidney failure is extremely low which may account for higher rates of unintentional pregnancies in this high-risk population. We need to include contraceptive counselling for women of child-bearing age in routine clinical care. Additionally, the present study emphasizes the importance of formulating policies that promote awareness of reproductive health and contraception among women with kidney failure.”
Assisting Shah in the research were Annette Christianson and Karthikeyan Meganathan, research associates in the UC Department of Environmental Health, Charuhas Thakar, MD and Samantha Kramer, BS of the UC Division of Nephrology Kidney C.A.R.E. Program, and Anthony Leonard, PhD, research associate professor in the UC Department of Family and Community Medicine. Shah is supported by a career development award from the Center for Clinical and Translational Science and Training, the Dialysis Clinic Inc., grant, and the intramural funds.
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