#796 Obstetric nephrology in Europe: a survey of nephrologists’ self-reported experience and training
Authors: Cowhig Cliona , Redmond Andrew , Stoneman Sinead , O'donoghue Darragh , Mirenberg Hadas , Clarkson Michael , Plant Liam , Russell Nóirín , Moran Sarah 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) is estimated to affect 3% of pregnant women in high-income countries. The prevalence of CKD in pregnancy is predicted to rise due to advancing maternal age, obesity, and co-morbidities. There is a paucity of evidence regarding nephrologists’ experience in and exposure to women's health in Europe. North American literature reports two thirds of nephrologists self-reported a lack of confidence in women's health issues. This survey aimed to assess the confidence in and exposure to women's health among nephrologists in Europe.

Method
An anonymized online survey was conducted using the survey monkey platform from March to April 2023. A validated survey was utilised to ensure internal and external validity with minimal modifications made (Hendren, 2019). It was disseminated via email to Irish Nephrology Society membership, via link sharing on social media and messaging applications. Results were analysed using GraphPad prism.

Results
Demographics: A total of 75 participants responded, of those 52 identified as practising in Europe (22 Ireland and 30 other European countries). The results of respondents from Europe are detailed below. 63.46% (33) of respondents identified as female. 9.61% (5) were under 30 years of age, 42.3% (22) were aged from 30-40 years, 23.07% (12) were aged from 40-50 years, 23.07% (12) were aged from 50-60 years, and 1.92% (1) respondent over 60 years of age.
Service provision: Women with kidney disease who are planning pregnancy are seen by the following Physicians: General or Transplant Nephrologist 63.46% (33), Nephrologist who specializes in pregnancy 42.31% (22), High Risk Obstetrician or Maternal Foetal Medicine Specialist 38.42% (20), Specialized interdisciplinary kidney disease in pregnancy clinic (Obstetrician and Nephrologist) 26.92% (14),Primary care doctor/family doctor 15.38% (8), Obstetrical Internal Medicine specialist 7.69% (4). Women with kidney disease who are pregnant are seen by the following Physicians: Nephrologist who specializes in pregnancy 40.38% (21), Specialized interdisciplinary kidney disease in pregnancy clinic (Obstetrician and Nephrologist) 34.62% (18),High Risk Obstetrician or Maternal Foetal Medicine Specialist 50% (26), General or Transplant Nephrologist 50% (26), Primary care doctor/family doctor 11.54% (6), Obstetrical Internal Medicine specialist 7.69% (4). 17.42% (9) of respondents had cared for &lt;1 pregnant woman in the last year.
Education: 73.07% (38) of respondents noted receiving dedicated education in women's health while in specialty training. Resources that were identified as potentially be helpful for counselling and management of women of childbearing age with CKD included: Interdisciplinary guidelines established by Obstetrics and Nephrology 80.77% (42), continuing education seminars or case based materials 78.85% (41), referral to a nephrologist with special interest and/or training in women's health 53.85% (28), patient education pamphlets or videos with shared decision making tools 44.23% (23), and access to e-consultation in 21.15% (11).
Pregnancy counselling: 57.69% (30) of Nephrologists were confident/very confident in counselling on pregnancy outcomes by CKD stage. 48.08% (25) of Nephrologists were confident/very confident in counselling on foetal outcomes by CKD stage. 63.46% (33) of respondents offer pre-conception counselling to less than one women per month.

Conclusion
Nephrologists practising in Europe have varied exposure to and confidence in caring for women with kidney disease who are planning pregnancy or are pregnant. There is potential for improvement in training and expansion of combined obstetric and nephrology pre-conceptual counselling and pregnancy care. Further consultation with patient advocacy groups is required to plan future care delivery.