Many kidney specialists may need more training and support when it comes to managing women’s health issues, according to a study presented last week at ASN Kidney Week 2018 by Dr. Monica Reynolds, a clinical instructor in the division of nephrology and UNC Gillings School of Global Public Health student pursuing a master of science in clinical research. The study gained the attention of ASN leaders. It was one of only a few selected from thousands, for special release during ASN Kidney Week, the premier US and international clinical and scientific meeting focused on kidney disease.
For a woman with chronic kidney disease (CKD), a broad range of women’s health issues including menstruation, fertility, pregnancy, menopause, and bone mineral disease may be negatively impacted by her disease or it’s treatment. Previous studies have shown that women with CKD receive low rates of disease-specific counseling but physician confidence levels have not been assessed as a possible etiology for poor counseling practices.
To investigate, Reynolds, along with University of Toronto’s Elizabeth Hendren, MD, created an electronic survey for nephrologists throughout the United States and Canada.
This study came about through discussions with physicians in the women’s health working group of Cure Glomerulonephritis, an international prospective study of glomerular disease. The group hypothesized that nephrologists lack confidence in certain aspects of women’s health and that by uncovering areas of low confidence, targeted strategies for improved care could be developed.
Of the 154 respondents, 58% were from the United States, 53% were women, and the median age was 41- 45 years. Most nephrologists counseled on contraception (65%) or pre-conception planning (76%) to an average of less than one woman per month. Interdisciplinary clinics for women planning pregnancy or already pregnant were available to 16% of nephrologists in Canada and 9% in the US.
The study found nephrologists lacked confidence managing many women’s health issues including menstrual disorders, contraception, osteoporosis, and menopause. While female providers were more confident in counseling about contraception (42% vs. 23%), there were no other significant differences in confidence level based on gender or country of practice. Within pregnancy, hypertension management was associated with the highest confidence levels but providers lacked confidence in preconception counseling and managing nephrotic syndrome or dialysis in pregnancy.
Nephrologists also reported inconsistent documentation of obstetric history even though diagnoses and outcomes in pregnancy can impact the quality of a provider’s risk assessment for future chronic diseases including diabetes, hypertension, and cardiovascular disease.
“It is our hope that by highlighting these gaps we can target future interventions to improve patient-centered care for women with chronic kidney disease,” said Dr. Reynolds. “Innovative approaches are needed to increase training didactics, identify best mechanisms to enhance physician confidence, and facilitate formation of interdisciplinary clinics.”
The study “Confidence in Women’s Health: An International Survey of Nephrologists” can be accessed here.