{"title":"Contraceptive Use and Reproductive Health in Women With CKD: A Qualitative Study Of Nephrologists in the United States.","authors":"Nedas Semaska,Rachael Nolan,Silvi Shah","doi":"10.1053/j.ajkd.2025.07.007","DOIUrl":null,"url":null,"abstract":"RATIONALE & OBJECTIVE\r\nWomen 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 aimed to explore nephrologists' perspectives on contraception and reproductive health management in women with CKD.\r\n\r\nSTUDY DESIGN\r\nQualitative study using semi-structured interviews.\r\n\r\nSETTING & PARTICIPANTS\r\nInterviews were conducted with 25 adult general and transplant nephrologists from both academic and private practice settings across the United States.\r\n\r\nANALYTICAL APPROACH\r\nVirtual 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.\r\n\r\nRESULTS\r\nThe following four 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).\r\n\r\nLIMITATIONS\r\nGeneralizability may be limited due to participants being predominantly early-career academic nephrologists.\r\n\r\nCONCLUSIONS\r\nKey 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.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"78 1","pages":""},"PeriodicalIF":8.2000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Kidney Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.ajkd.2025.07.007","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
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 aimed to explore nephrologists' perspectives on contraception and reproductive health management in women with CKD.
STUDY DESIGN
Qualitative study using semi-structured 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 four 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.
期刊介绍:
The American Journal of Kidney Diseases (AJKD), the National Kidney Foundation's official journal, is globally recognized for its leadership in clinical nephrology content. Monthly, AJKD publishes original investigations on kidney diseases, hypertension, dialysis therapies, and kidney transplantation. Rigorous peer-review, statistical scrutiny, and a structured format characterize the publication process. Each issue includes case reports unveiling new diseases and potential therapeutic strategies.