Introduction:
Women with chronic kidney disease (CKD) face significant challenges across their lifespan, including increased risks associated with hormonal contraception, fertility issues, menstrual irregularities, and a heightened likelihood of osteoporosis and fractures. As CKD progresses, these women experience higher rates of complications during pregnancy, such as pre-eclampsia, preterm delivery, and the need for cesarean sections. Despite the importance of tailored family planning and preconception care, studies show that nephrologists often fail to consistently address these concerns with their patients, leaving many women feeling uninformed and unsupported in managing their reproductive health. This issue is part of a broader disparity in healthcare access for women, as highlighted by the 2022 Women’s Health Strategy for England, which emphasises the need for improved education, training, and guidance for healthcare providers on women’s health. We wished to understand how confident UK nephrologists and trainees are in discussing and managing women’s health issues, how often these topics are addressed in everyday practice, and what barriers prevent the provision of comprehensive care for women with CKD.
Methods:
We compiled a 23-point survey and Google forms and disseminated this via a variety of methods to the relevant stakeholders. We used different question types, including Likert scales, multiple choice and open-ended questions. The survey was developed following an extensive review of qualitative and quantitative studies on women’s health in CKD. Three key themes emerged from this process: participant characteristics and fellowship training, current clinical practices, and confidence levels in counselling and managing women’s health. Questions were also developed to assess demographics, the frequency that certain women’s health issues were consulted or managed, confidence in managing certain conditions and clinical scenarios.
Results:
There were 145 respondents of which 52.4% were female, 51.7% (n=75) were Caucasian, and 41.4% (n=60) were aged 31-45 years old. The majority 71.1% (n=101) were UK graduates. Consultants were the largest group of respondents (57.9%, n=84) and renal registrars formed the second largest group (38.7%, n=56).
In the last year, 43.4% (n=62) admitted to counselling less than 5 women on average with CKD/ESRD regarding menstrual problems and 53.1% admitted to counselling less than 5 patients.
Most respondents admitted to managing or counselling less than 5 women in the past year with CKD/ESRD with regards to menstrual problems, menopause and breast-feeding: 43.4%, 53.1% and 51% respectively. In contrast at least a quarter had managed 5-10 patients with CKD/ESRD who were pregnant or offered pre-conception counselling: 26.9% and 30.3% respectively. Over their entire career, less than half of respondents had experience of managing less than 5 pregnant patients who required dialysis. However up to a quarter (24.9%) had no experience of managing pregnant patients requiring dialysis.
The majority of the UK renal centres (78.9) provided pre-conception counselling for women with CKD/ESRD with up to two-thirds of patients with CKD/ESRD planning pregnancy seen in a dedicated Combined Nephrology and Obstetrics clinic.
69.2% (n=99) of respondents had received formal teaching in obstetrics or women’s health; with both inpatient and outpatient consultations forming the next two largest methods of learning; 55.9% and 65% respectively.
When asked about how confident they feel in counselling women, most respondents were not at all confident in counselling menstrual disorders (n=61), menopause (n=77), decreased libido (n=84). The corresponding numbers not confident at all for counselling on contraception, pre-conception counselling, pregnancy and foetal outcomes and optimal timing of pregnancy with relation to kidney disease were much lower. In contrast only 6 (4.2%) were not at all confident in recognising pre-eclampsia.
Most respondents felt that time constraints, knowledge and inexperience were the major barriers that limited them from discussing and managing women's health matters during routine clinical practice
Conclusions:
In conclusion, our survey highlights a significant gap in the confidence and experience of UK nephrologists and trainees in managing women’s health issues in CKD, particularly regarding menstrual disorders, menopause, and sexual health. While there is some comfort in managing pregnancy-related concerns, many respondents admitted to limited experience and confidence in addressing broader women’s health needs. Time constraints, knowledge gaps, and inexperience were identified as the primary barriers to providing comprehensive care. These findings underscore the need for enhanced education, training, and dedicated clinical resources to better support women with CKD throughout their reproductive lifespan.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.