The good news is adults with chronic kidney disease (CKD) can and do have children. As a rule, fertility (the ability for a man to impregnate a woman or for a woman to become pregnant) tends to decline as kidney function is lost due to low levels of the hormones that control sperm and egg production. It is not uncommon for women to stop having menstrual periods in the setting of advanced kidney disease, representing the loss of ovulation and the onset of infertility.

Libido (sex drive) also tends to decline in the setting of kidney disease, due to multiple factors including low sex hormone levels, anemia and depression. The frequency with which women dialysis patients become pregnant and deliver normal babies appears to be increasing, perhaps due to improved dialysis adequacy and the beneficial effects of erythropoietin. It is estimated about one-two percent of women on dialysis in childbearing years will become pregnant. Of those who become pregnant and progress through the first trimester, about 50 percent will deliver viable infants.

If a pregnant woman develops kidney failure requiring dialysis after the onset of the pregnancy, the likelihood of delivering a viable infant is close to 80 percent. However, women on dialysis tend to deliver eight weeks prematurely with an average birth weight of three pounds, so many of these babies will need neonatal ICU care for several weeks before they can go home. Pregnant women on dialysis have a higher rate of miscarriage, hypertension, toxemia, fetal growth retardation and congenital malformations, so close follow-up by a high-risk obstetrical specialist during pregnancy is a must. An increased dose of dialysis during pregnancy appears to be beneficial in decreasing these complications, so it is common for dialysis to be prescribed five to six days per week. Increased doses of erythropoietin to maintain hemoglobin level closer to normal during pregnancy may also be beneficial, but there are no studies to prove this. Both men and women with CKD whom received a kidney transplant and whose kidney function returns to close to normal typically enjoy normal fertility and produce healthy babies.

Most kidney diseases in the United States are not hereditary, so CKD patients are not destined to produce children who develop CKD. The two most common causes of kidney disease in the U.S. are diabetes and high blood pressure, both of which tend to run in families, but are not hereditary in the strict sense of the word. Although the tendency to develop kidney disease from diabetes or high blood pressure also tends to run in families, the good news is the risk of kidney disease from both these diseases can be decreased with prompt diagnosis and effective management. So the children of patients with kidney failure due to diabetes or high blood pressure should be screened periodically for these diseases and treated promptly to decrease the risk of kidney damage.

The third most common cause of kidney disease in the U.S. is glomerulonephritis, which is not generally passed on to children with one notable but rare exception called Alport’s syndrome. The most common hereditary form of kidney disease is polycystic kidney disease (PKD), which is the cause of kidney failure for about 10 percent of patients on dialysis. There are several forms of PKD, but the most common form, autosomal dominant, has a 50 percent chance of passing from parent to child. There is no treatment for PKD, but early diagnosis is important for genetic counseling since the onset of kidney failure usually does not occur until after the childbearing years.

In summary, the likelihood that a patient with CKD will be able to have children decreases with the severity of the kidney disease, but men on dialysis have been able to father children and women on dialysis can become pregnant. Women with more severe kidney disease have a higher rate of pregnancy-related complications and fetal abnormalities which may respond to more intensive dialysis five or six days per week. With a few notable exceptions such as those with PKD, the children of patients with CKD may be at higher risk than the general population for developing CKD, but the kidney disease is not hereditary like blood type or eye color.

Jay Wish, MD, is Professor of Medicine in the Division of Nephrology at the University Hospital of Cleveland, Ohio. Dr. Wish is also a member of the AAKP Medical Advisory Board.

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