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Kidney Week

Abstract: PO2235

Narrowing Communication Gaps to Optimize Patient-Centered Pregnancy Counseling for Women with CKD

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Oliverio, Andrea L., University of Michigan, Ann Arbor, Michigan, United States
  • Lewallen, Maryn, University of Michigan, Ann Arbor, Michigan, United States
  • Weber, Kassandra, University of Michigan, Ann Arbor, Michigan, United States
  • Hawley, Sarah, University of Michigan, Ann Arbor, Michigan, United States
  • Wright Nunes, Julie A., University of Michigan, Ann Arbor, Michigan, United States
Background

Women with chronic kidney disease (CKD) face unique pregnancy decision-making challenges. Although there is an increased risk of adverse pregnancy outcomes in women with CKD, many women report strong pregnancy desires. There is little evidence on how to support pregnancy communication and decision-making needs in women with CKD.

Methods

We performed semi-structured interviews with women 18-45 years of age who have CKD stages I-V (n=30), and their practicing nephrologists (n=12) at one academic medical center. The average age of patients was mean(SD) 32.4(6.9) years; 50% already had children. 50% (n=15) identified as white, 26.7% (n=8) as Black, 13.3% (n=4) as Hispanic, 6.7% (n=2) as Asian, and one declined to answer. CKD etiologies included lupus nephritis (n=7, 23.3%), other nephrotic/nephritic syndromes (n=9, 30%), diabetes (n=4, 13%), hypertension (n=3, 10%), other (n=4, 13%), and unknown (n=3, 10%). Interview questions probed patients about counseling experiences and reproductive health in CKD, approaches to pregnancy decision-making, barriers and facilitators to effective counseling, and desires for future support. A codebook was iteratively developed, with double coding of transcripts and discrepancies resolved via consensus.

Results

Most women with CKD preferred their nephrologist introduce the concept of reproductive planning to elicit their values in care and reduce barriers to pregnancy counseling. Specific information about individual pregnancy risks and risks to potential offspring were desired. Women with strong reproductive intentions more often sought pregnancy information and indicated a higher risk tolerance especially when compared to physicians. Among women considering pregnancy, discussion of risks alone without discussion of strategies to manage or mitigate risks was perceived as alienating. Nephrology providers acknowledged importance of patient pregnancy desires, however, prioritized decision-making communication about absolute numerical risks to patients, and expressed high risk-aversion.

Conclusion

Patient-provider pregnancy communication and decision-making are critical for women who have CKD. Further research is needed to ensure nephrologists have tools to support pregnancy decision-making that incorporates patients’ needs, values and goals in care.

Funding

  • NIDDK Support