UC study: New treatment guidelines needed for chronic kidney disease patients

The study, recently published in Kidney International Reports, began as an electronic survey of 104 nephrologists across the country. They were questioned on 52 items with topics including sexual and reproductive health, menstrual health, contraception, pregnancy, infertility and breastfeeding.

The survey results showed sexual health and menstrual health were least talked about among nephrologists to their patients.

“Our results show more than 80% of nephrologists surveyed were not confident in counseling their patients on sexual dysfunction. More than 60% were not confident in counseling their patients on menstrual disorders,” said Silvi Shah, the study’s lead author, an associate professor in the Division of Nephrology in the Department of Internal Medicine and a UC Health transplant nephrologist.

The survey revealed that nephrologists face several key barriers when counseling patients on their reproductive health.

Those include a persistent lack of established national guidelines, which contributes to the second barrier, a lack of guidance and knowledge on reproductive and sexual health topics. Nephrologists also noted time constraints during patient visits or limited appointment times.

“Due to systemic and physician factors, certain topics are not being talked about. We are falling short for our patients. We need the consensus that would come with best practices and national guidelines,” said Shah, noting that such guidelines exist in some European countries.

The survey results also revealed certain patient populations are more likely to receive counseling on reproductive health than others.

“Kidney transplant recipients are more likely to receive counseling, followed by patients who are on dialysis,” said Nedas Semaska, the study’s first author and a third-year UC medical student from Cleveland, Ohio.

Semaska added that the survey results revealed a trend when he compared nephrologists’ answers to their reported demographics.

“We found that as doctors treated more patients of reproductive age who have CKD, they were more confident in counseling those patients on issues including breastfeeding, contraception, anti-hypertensive medications and immunosuppression,” he said. 

This study follows one that Shah and Semaska recently published in the American Journal of Kidney Diseases, which also highlighted the need for nephrologists to play a more active role in family planning discussions with their patients.

The previous study called for more extensive nephrology fellowship training on reproductive health and the development of national guidelines on contraceptive counseling when treating patients with CKD.

Featured image at top: Left to right: Nedas Semaska, medical student; Silvi Shah, MD; Darren Lee, medical student. Photo/Connor Boyle/UC Marketing + Communications.