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Kidney Week

Abstract: PO2593

Evaluation of Reproductive Care Provided to Adolescent Patients in Pediatric Nephrology Clinics

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Hefley, Shyanne, Texas Tech University Health Sciences Center, Amarillo, Texas, United States
  • Howard, Noel, Texas Tech University Health Sciences Center, Amarillo, Texas, United States
  • Almaani, Salem, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Ayoub, Isabelle, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Hladunewich, Michelle A., University of Toronto, Toronto, Ontario, Canada
  • O'Shaughnessy, Michelle M., University College Cork National University of Ireland, Cork, Ireland
  • Wadhwani, Shikha, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Zee, Jarcy, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Smoyer, William E., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Wenderfer, Scott E., Baylor College of Medicine, Houston, Texas, United States
  • Twombley, Katherine, Medical University of South Carolina, Charleston, South Carolina, United States
  • Vasylyeva, Tetyana L., Texas Tech University Health Sciences Center, Amarillo, Texas, United States
Background

An increasing number of adolescents are living with end-stage renal disease (ESRD) or chronic kidney disease (CKD) in the US. Therefore; it is important that nephrologists can manage reproductive and women’s health issues in adolescents with CKD. In this study, we aimed to determine the confidence levels of nephrologists in the US in managing women’s health issues in adolescent females with CKD.

Methods

Using Qualtrics Online Survey Platform, a survey was distributed by email to members of the Pediatric Nephrology Research Consortium. The survey contained 19 questions pertaining to provider demographics, training, current practice, frequency of documenting and/or discussing women’s health issues, and level of confidence in managing women’s health issues in adolescent female patients.

Results

Seventy-five nephrologists participated, with a majority practicing in academic centers (88%). For most providers, adolescents comprised 25-74% of all patients. Ninety-eight percent denied formal training in women’s health or obstetric nephrology. History of pregnancy termination/loss, last menstrual period (LMP), contraceptive use, sexual activity, number of sexual partners, and history of sexually transmitted infections were infrequently documented. Most providers documented discussions about risks of teratogenicity with use of ACEi/ARBs or mycophenolate and risks of infertility and fertility-preserving options with use of cyclophosphamide. Most providers weren’t comfortable managing pregnant adolescents and referred them to adult nephrologists. Most were uncomfortable discussing fetal risks with pregnancy in CKD. While most were confident discussing barrier methods, they were much less confident discussing oral contraceptives and long-acting reversible contraceptives (LARCs).

Conclusion


Sexual development and pregnancy appear not to be a focus of nephrologists caring for adolescent females with CKD. Providers also appeared to have a low level of confidence in discussing and managing fertility and pregnancy-related issues in adolescents. Nephrology training needs to incorporate focused women’s health content to improve healthcare delivery to adolescent girls.