You want a baby? CKD, fertility and pregnancy: don't fail to plan

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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS).

In this discussion, consultant nephrologists Prof Jeremy Levy and Dr Andrew Frankel are joined by Dr Phil Webster to examine fertility and pregnancy in the context of chronic kidney disease (CKD). They highlight that while many CKD patients are older, a significant number of younger individuals, especially those with inherited or congenital kidney conditions, will face issues related to fertility and pregnancy. CKD affects approximately 3% of pregnancies, and the severity of kidney disease directly influences fertility and pregnancy outcomes.

The conversation is structured into three key areas: fertility in men and women with CKD, pre-pregnancy counselling for women with CKD, and management during pregnancy. They emphasise that fertility is usually preserved in mild CKD but may decline with worsening kidney function. All women with CKD considering pregnancy should receive pre-pregnancy counselling to review medications, optimise blood pressure, and understand potential risks such as pre-eclampsia and accelerated kidney function decline. During pregnancy, specialist monitoring is essential. Women with CKD should ideally be managed through multidisciplinary maternal medicine networks, and contraceptive advice should be part of routine nephrology care.

Key Takeaways:

1. Fertility is generally unaffected in early CKD but declines as kidney function worsens; both men and women with advanced CKD may require specialist input.
2. Women with CKD should receive pre-pregnancy counselling to adjust medications, optimise kidney and blood pressure control, and assess risks, particularly of pre-eclampsia and kidney function loss.
3. Pregnancy in CKD requires enhanced monitoring through specialist clinics, with coordinated care across nephrology and obstetrics to ensure maternal and fetal health.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

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