Kidney health management during pregnancy: a dialogue between patients and healthcare professionals

Pregnancy in patients with chronic kidney disease (CKD) represents a significant challenge for nephrologists and healthcare professionals involved in the care pathway, especially in advanced stages of the disease and during dialysis. From an epidemiological standpoint, the exact percentage of women with CKD who become pregnant is unknown. It is estimated that stages 1 and 2 of kidney disease (where kidney function is still preserved or mildly impaired with persistent albuminuria) affect up to 3% of women of childbearing age (20-39 years), while stages 3-5 (glomerular filtration rate <60 ml/min) affect about 1 in 150 women of childbearing age. However, due to reduced fertility, these women often experience spontaneous miscarriages in the early months of pregnancy, and 1 in 750 face complications in their offspring. As a result, managing pregnancy in CKD patients requires special attention, considering various clinical aspects including the reciprocal influence between the disease and pregnancy, the need to adjust therapies, the modification of treatments, and the high risk of maternal and fetal complications. An appropriate nutritional approach is also a crucial phase in this process, as nutritional status significantly influences maternal and fetal health. In this article, developed through questions posed to physicians and the case manager during routine care, we do not intend to address the entire complex issue linking kidney disease to pregnancy outcomes. Instead, we aim to provide updated answers to various topics of interest for the multidisciplinary team to safeguard the health of both mother and child.