Patients with chronic kidney disease (CKD) or kidney failure requiring treatment with dialysis or a kidney transplant interact with the health care system frequently and experience various transitions throughout their care journey. These transitions may include the process of initiating dialysis, transitioning between kidney replacement therapy modalities, engaging with multiple health care providers including primary care teams and subspecialists as well as emergency room visits and hospitalizations for acute illnesses. As people with CKD navigate complex and often siloed health systems, they may face barriers to accessing timely and quality care; these barriers may include limited health literacy, limited self-management skills, poor access to transportation, and living in rural and remote settings. A patient navigator may serve as a bridge between patients and the health care system, assisting patients with accessing services, navigating services, and addressing barriers in their care. 

They are used in a variety of chronic diseases such as cancer care, diabetes, and HIV/AIDS.Achieving parenthood can be an important priority for women and men with kidney failure. In recent decades, the paradigm has shifted toward greater support of parenthood, with advances in our understanding of risks related to pregnancy and improvements in obstetrical and perinatal care. This review, codesigned by people with personal experience of kidney disease, provides guidance for nephrologists on how to answer the questions most asked by patients when planning for parenthood. We focus on important issues that arise in preconception counseling for women receiving dialysis and postkidney transplant. We summarize recent studies reflecting pregnancy outcomes in the modern era of nephrology, obstetrical, and perinatal care in developed countries. We present visual aids to help clinicians and women navigate pregnancy planning and risk assessment. Key principles of pregnancy management are outlined. Finally, we explore outcomes of fatherhood in males with kidney failure.

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Regards
Mishita
Jornal co-ordinator
Journal of Clinical & Experimental Nephrology