Survey among nephrologists in Germany: current practice and management of pregnant women on dialysis

Duffner, Johannes; Schulte-Kemna, Lena; Reister, Barbara; Ludwig, Ulla; Keller, Frieder; Erp, R. van; Schröppel, Bernd

doi:10.5414/cn109032

Cited by 6 publications

(7 citation statements)

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“…Though we did not specifically email private practice individuals, this may signal nonresponse bias from those who did not fill out the survey possibly due to a lack of interest or knowledge in the topic. Within the CSN network, the response rate was 17%, which is comparable to a prior web-based survey of nephrologists regarding management of sex hormone status in women with CKD (21%) [13] and larger than a prior survey of German nephrologists (10%) [14]. To better contextualize our convenience sample, we compared the Canadian survey respondent characteristics to the Canadian Medical Association Nephrologist profile, which contains demographic data of every registered nephrologist in Canada and was updated in August 2018 [35].…”

Section: Discussionmentioning

confidence: 63%

“…Figure 1 presents a flowchart of the survey development and dissemination. Survey question construction was grounded in a comprehensive literature review of qualitative and quantitative studies of women’s health in CKD [9,10,11,12,13,14]. Three main themes arose: participant characteristics and fellowship training, current clinical practices, and confidence levels in counseling and managing women’s health.…”

Section: Methodsmentioning

confidence: 99%

“…A survey of nephrologists and allied health professionals in Canada, Australia, and New Zealand focusing on menstrual disorders in women with CKD showed a minority (35%) reported discussing fertility with their patients, and even fewer (15%) discussed menstrual irregularities [13]. In a survey of German nephrologists regarding pregnancy in women on dialysis, only 45% of respondents reported routinely educating their dialysis patients of child-bearing age about contraception [14]. Finally, a survey of women with CKD revealed that only half were offered contraception counseling, and less than a quarter were offered preconception counseling [11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Confidence in Women’s Health: A Cross Border Survey of Adult Nephrologists

Hendren

Reynolds

Mariani

et al. 2019

JCM

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A range of women’s health issues are intimately related to chronic kidney disease, yet nephrologists’ confidence in counseling or managing these issues has not been evaluated. The women’s health working group of Cure Glomerulonephropathy (CureGN), an international prospective cohort study of glomerular disease, sought to assess adult nephrologists’ training in, exposure to, and confidence in managing women’s health. A 25-item electronic questionnaire was disseminated in the United States (US) and Canada via CureGN and Canadian Society of Nephrology email networks and the American Society of Nephrology Kidney News. Response frequencies were summarized using descriptive statistics. Responses were compared across provider age, gender, country of practice, and years in practice using Pearson’s chi-squared test or Fisher’s exact test. Among 154 respondents, 53% were women, 58% practiced in the US, 77% practiced in an academic setting, and the median age was 41–45 years. Over 65% of respondents lacked confidence in women’s health issues, including menstrual disorders, preconception counseling, pregnancy management, and menopause. Most provided contraception or preconception counseling to less than one woman per month, on average. Only 12% had access to interdisciplinary pregnancy clinics. Finally, 89% felt that interdisciplinary guidelines and/or continuing education seminars would improve knowledge. Participants lacked confidence in both counseling and managing women’s health. Innovative approaches are warranted to improve the care of women with kidney disease and might include the expansion of interdisciplinary clinics, the development of case-based teaching materials, and interdisciplinary treatment guidelines focused on this patient group.

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Section: Discussionmentioning

confidence: 63%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Confidence in Women’s Health: A Cross Border Survey of Adult Nephrologists

Hendren

Reynolds

Mariani

et al. 2019

JCM

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“…The improvement in results recorded with daily, extended-hours dialysis not only allowed a more permissive attitude towards pregnancy in dialysis, but is also leading to a more positive attitude towards pregnancy in advanced CKD, often previously discouraged for the fear of needing to start dialysis during gestation [ 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 ].…”

Section: Dialysismentioning

confidence: 99%

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.

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“…[3] In a survey among nephrologists in Germany, about 45% of the doctors routinely provided contraception counseling and pregnancy guidance on the women undergoing MHD, 22% of them would suggest terminating pregnancy after the conception, whereas only 40% of all the respondents felt confident in dealing with pregnant women on dialysis. [4] Similarly, the survey in America indicated that 46% of nephrologists and their staffs offered contraception counseling, 37% stated they would recommend termination of pregnancy in dialyzed women, and 30% felt some uncomfortable to treat dialyzed pregnant women. [5] On the basis of these results, more attention should be paid in the diagnosis and treatment of pregnancy in women on dialysis.…”

Section: Discussionmentioning

confidence: 99%

Successful pregnancy and delivery in uremic patients with maintenance hemodialysis

Cao¹,

Zhang²,

Wang³

et al. 2018

Medicine

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Rationale:It is reported that successful pregnancies in dialyzed uremic women are rare. Over the past years, despite advances in clinical management and technology in dialysis for pregnancy in patients receiving maintenance hemodialysis, uremia remains a high risk factor for adverse outcomes in mother and fetus.Patient concerns:In this article, we present a case of pregnancy in a 34-year-old uremic woman on dialysis. After the pregnancy was diagnosed and confirmed, intensive dialysis and multidisciplinary care according to the recommendations in the available literatures were provided.Diagnoses:Single pregnancy of 31+4 GWs (gestational weeks), fetal growth restriction, polyhydramnios, and uremia.Outcomes:At 31 weeks’ gestation and 4 days, she was admitted to our hospital due to premature rupture of membranes and abdominal pain. Then a female baby weighed 1700 g was delivered successfully. After one year of follow-up, the mother feels well and the baby is healthy.Lessons:Intensive dialysis, detailed management and multidisciplinary approaches are necessary for optimal outcomes in uremic pregnant mother and fetus.

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Survey among nephrologists in Germany: current practice and management of pregnant women on dialysis

Abstract: Our survey demonstrates that the practice of nephrologists in treating pregnant women on dialysis differs significantly. These findings highlight the need for European guidelines to standardize the care of pregnant dialysis patients. .

Cited by 6 publications

References 0 publications

Confidence in Women’s Health: A Cross Border Survey of Adult Nephrologists

Confidence in Women’s Health: A Cross Border Survey of Adult Nephrologists

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Successful pregnancy and delivery in uremic patients with maintenance hemodialysis

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Survey among nephrologists in Germany: current practice and management of pregnant women on dialysis

Abstract: Our survey demonstrates that the practice of nephrologists in treating pregnant women on dialysis differs significantly. These findings highlight the need for European guidelines to standardize the care of pregnant dialysis patients. .

Cited by 6 publications

References 0 publications

Confidence in Women’s Health: A Cross Border Survey of Adult Nephrologists

Confidence in Women’s Health: A Cross Border Survey of Adult Nephrologists

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Successful pregnancy and delivery in uremic patients with maintenance hemodialysis

Contact Info

Product

Resources

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Abstract: Our survey demonstrates that the practice of nephrologists in treating pregnant women on dialysis differs significantly. These findings highlight the need for European guidelines to standardize the care of pregnant dialysis patients. .