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.