title: Fertility preservation in paediatric nephrology: results of a physician survey.
abstract: OBJECTIVE
  Fertility preservation (FP) is a widespread practice in paediatric oncology when gonadotoxic medications such as cyclophosphamide (CPO) are used. FP practice outside of oncology has not been studied, although nephrologists regularly use CPO. This is the first study to explore FP practice by paediatric nephrologists when CPO is used.
  
  
  METHODS
  Survey study. Descriptive statistics and chi-squared analyses were employed to analyse the data.
  
  
  METHODS
  US paediatric nephrologists were sent a survey via email. The survey queried participants about FP practice behaviours, FP attitudes and barriers to practice.
  
  
  METHODS
  Of 579 nephrologists invited, 32% responded to the survey.
  
  
  RESULTS
  CPO was dosed in mg/kg by 23% of physicians, g/m(2) by 40% and both by 37%. About 80% agreed that pubertal females should be offered a fertility referral, while 58% report that they actually refer. Factors negatively associated with referral include lack of training, lack of referral network and adherence to gonadotoxic dose limits. Results were similar for male patients.
  
  
  CONCLUSIONS
  The survey showed that FP practice in the United States is widespread among nephrologists. Lack of referral networks is a notable barrier for nephrologists. Perceived adherence to dose limits may be problematic given the variable dosing regimens utilised. This is due to the risk of unintended overdose in large adolescents dosed in mg/kg whose cumulative dose exceeds gonadotoxic limits in g/m(2) . This paper has implications for nephrology care providers and other specialists who utilise CPO, generalists who care for these patients and oncologists with extant FP referral networks.
authors: Department of Paediatrics, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Steven D
authors: SD
authors: Miller
authors: Yimei
authors: Y
authors: Li
authors: Kevin E C
authors: KE
authors: Meyers
authors: Arthur
authors: A
authors: Caplan
authors: Victoria A
authors: VA
authors: Miller
authors: Jill P
authors: JP
authors: Ginsberg
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D003299:Cooperative Behavior; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced* / Q000451:nursing* / Q000517:prevention & control; D007248:Infertility, Male / Q000139:chemically induced* / Q000451:nursing* / Q000517:prevention & control; D033183:Interdisciplinary Communication; D008297:Male; D009398:Nephrology; D010372:Pediatrics; D012017:Referral and Consultation; D013074:Sperm Banks; D014481:United States
chemical_list: D003520:Cyclophosphamide
keywords: Cyclophosphamide; Fertility; Infertility; Nephrology; Paediatric; Survey