Srialluri Nityasree, Thavarajah Sumeska
Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
BMC Nephrol. 2024 Dec 3;25(1):444. doi: 10.1186/s12882-024-03864-9.
Chronic Kidney Disease (CKD) affects millions globally, with a notable impact on biological females of reproductive age. This population faces specific issues such as fertility concerns, complex contraceptive decisions, and complications related to pregnancy that can exacerbate CKD. Given the increasing prevalence of CKD among young men and women owing to rising rates of hypertension, obesity, and diabetes, there is a need for early and tailored interventions among women of childbearing age. Current Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest nephrology referral primarily for advanced CKD stages or significant proteinuria. However, women at any CKD stage may face complex pregnancy-related decisions and increased risks that are not adequately addressed by these guidelines, warranting early specialty care. This review explores the distinct needs of women of reproductive age with CKD, identifies gaps in the existing management framework, and advocates for earlier and more comprehensive nephrology involvement. By focusing on preconception planning, risk factor management, adverse pregnancy outcomes, and existing disparities in care, this review seeks to improve understanding of the needs of women of reproductive age with CKD and calls for a shift towards more proactive, nephrology-driven care.
慢性肾脏病（CKD）在全球影响着数百万人，对育龄期生物学女性有显著影响。这一人群面临着诸如生育问题、复杂的避孕决策以及与妊娠相关的并发症等特定问题，而这些并发症会加重慢性肾脏病。鉴于高血压、肥胖症和糖尿病发病率上升，慢性肾脏病在年轻男性和女性中的患病率不断增加，因此需要对育龄期女性进行早期且针对性的干预。当前的改善全球肾脏病预后（KDIGO）指南建议主要在慢性肾脏病晚期或出现大量蛋白尿时转诊至肾脏病专科。然而，处于任何慢性肾脏病阶段的女性都可能面临与妊娠相关的复杂决策以及增加的风险，而这些指南并未充分解决这些问题，因此需要早期专科护理。本综述探讨了患有慢性肾脏病的育龄期女性的独特需求，找出了现有管理框架中的差距，并倡导肾脏病专科更早、更全面地参与其中。通过关注孕前规划、危险因素管理、不良妊娠结局以及现有的护理差异，本综述旨在增进对患有慢性肾脏病的育龄期女性需求的理解，并呼吁转向更积极主动、由肾脏病专科主导的护理。
