Contraception in patients with kidney disease

Abstract

Three per cent of women of childbearing age have chronic kidney disease, and although end-stage renal failure impacts on fertility, conception and high-risk pregnancy do occur. Following renal transplantation, the patient should understand the potential impact of a pregnancy on transplant function and vice versa. Surveys show that a large proportion of pregnancies in female renal patients are unplanned. The effectiveness of a particular contraceptive method is dependent upon acceptability to the patient and compliance. Contraceptive decision-making needs to balance acceptability and safety with the risk of an unplanned pregnancy. Oestrogen-containing contraceptive methods are considered unacceptable for many renal patients because of their association with increased blood pressure and thrombotic and vascular events. Progesterone-only methods have an advantageous safety profile. The progesterone-only pill (desogestrel preparations), intrauterine system (Mirena®), and implant (Nexplanon®) are safe and effective in women with CKD. Concerns regarding the intrauterine system (Mirena®) in women taking immunosuppression are unfounded and observational evidence does not demonstrate an increased risk of infection. Sterilization is effective and should be considered to be irreversible. The effectiveness of barrier methods is reduced when ‘typical use’ is compared to ‘perfect use’. Unplanned pregnancy rates are high with fertility awareness methods and reliance on lactational amenorrhoea is not advocated.Interactions between drugs which are commonly prescribed in the renal population and different contraceptive methods are outlined in this chapter.