Dr Melanie Wyld1,2,3, Dr Erandi Hewawasam3, Prof Allison Jaure1,4, Prof Shilpa Jesudason3,5
1Department of Renal Medicine, Westmead Hospital, Westmead, Australia, 2Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 3Pregnancy and Kidney Research Australia, Central and Northern Adelaide Renal and Transplantation Service, Adelaide, Australia, 4 Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia, 5Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
Biography:
Melanie Wyld (B.Econ(Hons) MBBS MBA MPH PhD FRACP) is a nephrologist at Westmead Hospital and senior lecturer in clinical epidemiology at the University of Sydney. She is a clinical researcher with research interests in obstetric nephrology, living donor kidney transplantation, and equity of access to care. She is a member of the ANZDATA Parenthood Working Group, Chair of Equity Diversity and Inclusion Committee of ANZSN, Chair of TSANZ’s Living Donor Transplantation Working Group.
Aim:
To describe the perspectives of nephrologists on addressing and managing conception and pregnancy in women with chronic kidney disease (CKD).
Background:
Successful pregnancies are achievable in women with all stages of CKD including dialysis and post-transplant, but carry increased maternal and foetal risks. As more women with CKD consider pregnancy, the demand for informed and supportive reproductive counselling grows. Despite this, the preparedness of nephrologists to provide such care is uncertain.
Methods:
Semi-structured videoconference interviews were conducted with Australian nephrologists(Aug-2021 to Jun-2023). Participants were purposively sampled for diversity in obstetric nephrology experience, career stage, gender, and state. Transcripts were analysed thematically.
Results:
Twenty nephrologists were interviewed (55% male) from all six states in Australia with a mean 15.7±9.8 years in practice. We identified five themes: knowledge, training, and confidence gaps (inadequate and ad hoc training, absence of formal education, low exposure impairing confidence), lack of reliable resources (absence of guidelines, personal networks as a substitute for formal support), deprioritised and difficult to discuss (not seen as core nephrology, oversight amid competing demands, gendered assumptions and clinical discomfort), risk aversion (avoiding disastrous consequences, pregnancy discouraged until post-transplant) and navigating patient autonomy and shared decision making (preference for patients to initiate discussions, need for patient support resources, shared decision making as a care principle).
Conclusion:
Nephrologists in Australia face considerable barriers in delivering reproductive care. Despite expressing support for patient autonomy, many clinicians defer or avoid reproductive discussions, especially in women with advanced CKD, limiting informed decision-making. Addressing these barriers through structured training, clear guidelines, and systematic integration of reproductive care into routine nephrology practice is essential to ensuring that women with kidney disease receive timely, consistent, and patient-centred reproductive care.