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

Rationale & Objective 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. Study Design This survey-based study evaluated patients' self-reported demographic characteristics, kidney disease history, PCC exposure and understanding, and interactions with the health care system. Setting & Participants 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 Exposures of interest included sociodemographic characteristics, clinical CKD presentation, and health care utilization patterns. Outcomes 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. Analytical Approach Cross-sectional analysis used χ 2 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. Results 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. Limitations Findings may lack generalizability given the single-center, English-speaking population and potential recall bias from self-reported data. Conclusions 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. Plain Language Summary Chronic kidney disease (CKD) is associated with health risks to both the pregnant person and the baby. Therefore, preconception counseling (PCC) is recommended for all patients and is especially important for individuals with chronic disease, like CKD. We surveyed 108 patients who received nephrology care at an urban academic medical center to understand how often and how well PCC is provided. We found that 26% of patients report no receipt of PCC. Maternal-fetal medicine doctors provided more comprehensive PCC and were more likely to discuss medication safety, future childbearing plans, maternal complications, and fetal complications.