Abstract
Even though fertility is reduced, conception and delivery are possible in all stages of CKD. While successful planned pregnancies are increasing, an unwanted pregnancy may have long-lasting deleterious effects, hence the importance of birth control, an issue often disregarded in clinical practice. The evidence summarized in this position statement is mainly derived from the overall population, or other patient categories, in the lack of guidelines specifically addressed to CKD. Oestroprogestagents can be used in early, non-proteinuric CKD, excluding SLE and immunologic disorders, at high risk of thromboembolism and hypertension. Conversely, progestin only is generally safe and its main side effect is intramestrual spotting. Non-medicated intrauterine devices are a good alternative; their use needs to be carefully evaluated in patients at a high risk of pelvic infection, even though the degree of risk remains controversial. Barrier methods, relatively efficacious when correctly used, have few risks, and condoms are the only contraceptives that protect against sexually transmitted diseases. Surgical sterilization is rarely used also because of the risks surgery involves; it is not definitely contraindicated, and may be considered in selected cases. Emergency contraception with high-dose progestins or intrauterine devices is not contraindicated but should be avoided whenever possible, even if far preferable to abortion. Surgical abortion is invasive, but experience with medical abortion in CKD is still limited, especially in the late stages of the disease. In summary, personalized contraception is feasible, safe and should be offered to all CKD women of childbearing age who do not want to get pregnant.
Highlights
While several recent studies have been addressed to women with Chronic kidney disease (CKD) and their desire, still too often frustrated, to give birth, contraception is not a part of the routine work-up for CKD patients, notwithstanding the fact that, albeit with lower rates, pregnancy is possible in all CKD stages, including transplantation and dialysis [1, 2, 8,9,10,11,12]
– Combined hormonal contraceptives (CHCs) are widely used and highly effective, but the cardiovascular and thrombotic risks are high and this can be of particular relevance for CKD patients
Progestin-only contraceptives represent an effective alternative to CHCs, mainly due to a better cardiovascular profile
Summary
Chronic kidney disease (CKD) is usually cited as a cause of reduced fertility, but this simplistic assumption is probably true only for the last stages of the disease, or for some immunologic diseases, of which systemic lupus erythematosus (SLE) can be considered the prototype [1,2,3,4]. While several recent studies have been addressed to women with CKD and their desire, still too often frustrated, to give birth, contraception is not a part of the routine work-up for CKD patients, notwithstanding the fact that, albeit with lower rates, pregnancy is possible in all CKD stages, including transplantation and dialysis [1, 2, 8,9,10,11,12]. It is in particular in the late CKD stages that the widespread idea that fertility is sharply reduced may cause doctors to overlook counselling on contraception, with potentially devastating clinical and psychological effects.
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