Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology

Rossella Attini, Gianfranca Cabiddu, Benedetta Montersino, Linda Gammaro, Giuseppe Gernone, Gabriella Moroni, Domenico Santoro, Donatella Spotti, Bianca Masturzo, Isabella Bianca Gazzani, Guido Menato, Valentina Donvito, Anna Maria Paoletti, Giorgina Barbara Piccoli

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1343-1359
JournalJournal of Nephrology
Volume33
Issue number6
DOIs
Publication statusPublished - 2020

Keywords

  • Abortion
  • Barrier methods
  • Birth control
  • Chronic kidney disease
  • Contraception
  • Dialysis
  • Emergency contraception
  • Hormonal contraceptives
  • Intrauterine devices
  • Kidney transplantation

ASJC Scopus subject areas

  • Nephrology

Fingerprint

Dive into the research topics of 'Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology'. Together they form a unique fingerprint.

Cite this