Reproductive Health in CKD and Kidney Failure: Core Curriculum 2026.

Chronic kidney disease (CKD) and kidney failure are associated with disruptions in the hypothalamic-pituitary-gonadal axis leading to alterations in sex-hormone homeostasis, sexual dysfunction, and impaired fertility in women and men. The incidence of CKD among younger adults has increased over the past few decades, with up to 6% of women of childbearing age affected by CKD. Women with CKD have a higher risk of adverse pregnancy outcomes, yet reproductive counseling remains underemphasized in nephrology. In addition, sexual dysfunction and impaired fertility are highly prevalent in men with CKD but often go unaddressed due to underreporting or lack of recognition of their association with CKD. This core curriculum reviews the epidemiology, pathophysiology, and management of reproductive health in both women and men across the spectrum of CKD, dialysis, and kidney transplantation. Embedding nuanced, stage-specific reproductive counseling into routine nephrology care is essential to reduce adverse maternal, fetal, and kidney outcomes and to address persistent knowledge gaps.