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Kidney disease and reproductive health

Nature Reviews Nephrology volume 21, pages 127–143 (2025)Cite this article

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Abstract

Understanding the relationship between reproductive health and kidney function is important to provide holistic care for people living with kidney disease. Chronic kidney disease (CKD) has negative impacts on both male and female fertility owing to factors including inflammation, hormonal dysregulation, reduced ovarian reserve, reduced sperm quality and sexual dysfunction. However, pregnancy is achievable for most cisgender women with kidney disease, including kidney transplant recipients and patients on dialysis. CKD in pregnancy is associated with health risks to the mother and child, including increased risk of progression of kidney disease, hypertensive complications of pregnancy, and neonatal complications including fetal growth restriction, preterm birth and stillbirth. However, with appropriate pre-pregnancy counselling, fertility assessment and support, health optimization, and evidence-based antenatal care, the majority of patients will achieve a good outcome. Medication safety should be reviewed before and during pregnancy and lactation, weighing the risk of disease flare against potential adverse effects on the offspring. Important areas for further research include the optimal timing of delivery and the short- and long-term cardiovascular and renal impacts of pregnancy in patients with CKD, as well as long-term kidney and cardiovascular outcomes in their offspring.

Key points

  • Reproductive health care is an essential component of the management of chronic kidney disease (CKD).

  • In women, CKD is associated with hormonal dysregulation, menstrual irregularities, premature menopause, reduced ovarian reserve and reduced libido, which negatively impact fertility.

  • In men, CKD is associated with hormonal dysregulation, hypogonadism and reduced sperm quality with substantial negative impacts on fertility, libido and sexual function.

  • Pregnancy is possible for the majority of women with CKD but is associated with increased maternal and fetal health risks; pre-pregnancy counselling, optimization of blood pressure control and proteinuria, planned timing of pregnancy and specialist antenatal care can help to mitigate these risks and optimize pregnancy outcomes.

  • The offspring of patients with CKD, particularly those with preterm delivery or fetal growth restriction, might be at increased risk of kidney and cardiovascular disease in later life; increased health surveillance is required to enable early identification and management of these diseases.

  • Targeted research is needed to improve understanding of the impact of CKD on fertility and pregnancy outcomes as well as the long-term impact of CKD during pregnancy on the offspring with the aim of enabling advances in evidence-based care.

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Fig. 1: Mechanisms of reduced fertility in CKD.
Fig. 2: Reduced AMH concentrations in women with CKD.
Fig. 3: Proposed antenatal, peripartum and postpartum care pathway for patients with kidney disease.

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Authors and Affiliations

  1. Division of Women’s Health, King’s College London, London, UK

    Priscilla A. Smith, Ippokratis Sarris, Katherine Clark & Kate Bramham

  2. King’s Kidney Care, King’s College Hospital NHS Foundation Trust, London, UK

    Priscilla A. Smith, Katherine Clark & Kate Bramham

  3. King’s Fertility, London, UK

    Ippokratis Sarris

  4. Department of Women’s Health, Royal London Hospital, Barts Health NHS Trust, London, UK

    Kate Wiles

  5. Wolfson Institute of Population Health, Queen Mary, University of London, London, UK

    Kate Wiles

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  1. Priscilla A. Smith
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  2. Ippokratis Sarris
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  3. Katherine Clark
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  4. Kate Wiles
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  5. Kate Bramham
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Contributions

P.A.S., I.S. and K.B. researched data for the article. P.A.S., I.S., K.C. and K.B. wrote the article. All authors contributed substantially to discussion of the content and reviewed and/or edited the manuscript before submission.

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Correspondence to Kate Bramham.

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Nature Reviews Nephrology thanks Shilpanjali Jesudason, Giorgina Piccoli and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Smith, P.A., Sarris, I., Clark, K. et al. Kidney disease and reproductive health. Nat Rev Nephrol 21, 127–143 (2025). https://doi.org/10.1038/s41581-024-00901-6

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