Dr Shilpa Jesudason is helping women with kidney disease start a family.
For young women and men living with kidney disease, the decision to start a family can be a difficult one. What are their risks if they do decide to have children, and when is the right time?
Kidney Specialist Dr Shilpa Jesudason based at the Royal Adelaide Hospital (RAH) has set forth to answer these questions with the support of Kidney, Transplant and Diabetes Research Australia (KTDRA).
“For those younger people who are looking forward to big life decisions, such as having children, living with kidney disease can leave them feeling overwhelmed,” Dr Jesudason said.
To support these patient’s Dr Jesudason wanted to first understand the experiences and emotions of women currently living with kidney disease and kidney failure, dialysis or a kidney transplant. With her research collaborators, she undertook a study interviewing patients from the RAH and St George Hospital in Sydney.
“I really wanted to find out from these women what their experiences around pregnancy have been and what we can do as clinicians to improve their experiences and make it better for others,” she said.
“Most of the women said they found issues around motherhood very confronting. They found the decisions they were being asked to make incredibly challenging.
“There was a lot of grief when they couldn’t have children because of the risk to their health, and guilt from those who received a kidney from a donor who felt they were gambling with that very special gift.”
Touched by the responses of these women Dr Jesudason and her team published a paper ‘Perspectives on Pregnancy in Women with Chronic Kidney Disease: A Semistructured Interview Study’.
Now, Dr Jesudason is using this to develop an improved process of counselling which she is implementing in her monthly pregnancy counselling clinics.
“In this clinic I look after women with kidney disease who want to get pregnant, are already pregnant or who have developed kidney problems during their pregnancy.
“We’ve now developed a strategy for talking about the risks, taking into account what they are going through, their perspectives and the things we learned from the interview study in order to navigate shared decision making.”
Dr Jesudason is preparing to launch a national study looking at kidney disease in pregnancy across 300 maternity hospitals in Australia.
“Nationwide, we are trying to find all women with significant kidney disease in pregnancy, those who need dialysis or who have had a kidney transplant in pregnancy. These are the highest risk patients and we want to be able to identify and follow these women and their babies through the pregnancy,” she said.
“This will be really important because it’s going to help develop a health policy so we can deliver the best health care to these women.”
Pursuing both studies has given Dr Jesudason and Kidney Specialists like her the opportunity to provide patients with the best possible care as they n