Contraceptive Use and Reproductive Health in Women With CKD: A Qualitative Study of Nephrologists in the United States

RATIONALE & OBJECTIVE: Women with chronic kidney disease (CKD) face elevated risks during pregnancy, yet contraceptive use and reproductive health counseling remain low. Nephrologists, who often maintain longitudinal relationships with patients, may be well-positioned to engage in these discussions. This study explored nephrologists' perspectives on contraception and reproductive health management in women with CKD. STUDY DESIGN: Qualitative study using semistructured interviews. SETTING & PARTICIPANTS: Interviews were conducted with 25 adult general and transplant nephrologists from both academic and private practice settings across the United States. ANALYTICAL APPROACH: Virtual interviews were recorded, transcribed, and analyzed using thematic analysis until thematic saturation was achieved. A grounded theory approach guided coding and identification of key themes related to provider experiences and perspectives. RESULTS: The following 4 themes and their respective subthemes were identified: (1) physician discomfort regarding discussion of contraception and reproductive health (reliance on patient initiation, hesitation with counseling, uncertainty about scope of practice); (2) insufficient training and inadequate guidelines regarding contraception and reproductive health (paucity of formal guidelines, limited exposure, reliance on self-education); (3) lack of interdisciplinary coordination regarding contraceptive use and reproductive health (the patient as an intermediary, fragmentation of care); (4) need for holistic and patient-centered care (comprehensive and sustained approach, shared decision-making). LIMITATIONS: Generalizability may be limited due to participants being predominantly early-career academic nephrologists. CONCLUSIONS: Key barriers to contraceptive use and management of reproductive health for women with CKD include provider discomfort due to limited exposure and training, lack of clear guidelines, and fragmented care. Despite these challenges, providers recognize the importance of holistic, patient-centered care. These findings highlight the need to improve contraceptive counseling to support appropriate contraceptive use and shared decision making for the reproductive health of patients with kidney disease. PLAIN-LANGUAGE SUMMARY: Women with kidney disease can face challenges with fertility, sexual health, and menstruation. Pregnancy is often riskier for these women due to complications such as high blood pressure and preterm birth. Despite these risks, the use of birth control among women with kidney disease remains low. This study looked at the experiences of nephrologists in providing contraception and reproductive health counseling for their female patients. The interviews revealed that many nephrologists feel uncomfortable discussing these topics due to a lack of training and the absence of standardized guidelines. Communication between different health care providers involved in a patient's care, such as gynecologists and primary care doctors, is also often limited. These challenges can make it harder for women to make informed decisions about contraception and family planning. There is a need for better training and resources for nephrologists so they can improve reproductive health counseling and help women make informed choices about contraception.