Case report: Applicability of breastfeeding the child of a patient with kidney failure with replacement therapy

Abstract

This case report highlights the benefit or harm of breastfeeding in a patient with Kidney Failure with Replacement Therapy (KFRT) undergoing program hemodialysis. This is a unique clinical case, as pregnancy and successful delivery are rare in this group of females. With a favorable outcome, the possibility of breastfeeding is especially relevant for doctors and the mother. The patient was a 31-year-old female who was diagnosed in 2017 with end-stage renal disease associated with chronic glomerulonephritis. Against the background of hemodialysis, pregnancy, accompanied by polyhydramnios, anemia, and secondary arterial hypertension, occurred in 2021. At 37 weeks, a healthy, full-term baby girl was born, and breastfeeding was started. In this study, we conducted a detailed analysis of toxic substances and immunologically significant proteins using high-tech analysis methods. In addition, we studied different portions of milk before and after hemodialysis at different time intervals. After a wide range of experiments, our study did not reveal an optimal time interval for breastfeeding a baby. Despite the decrease in the level of the major uremic toxins 4 h after the hemodialysis procedure, their level remained high. In addition, the content of nutrients did not reach acceptable limits and the immune status was characterized as pro-inflammatory. In our opinion, breastfeeding is not advisable for this group of patients since the concentration of nutrients is low, and the content of toxic substances exceeds the permissible limits. In this clinical case, the patient decided to stop breastfeeding one month after delivery due to insufficient breast milk and the inability to express it in a certain period of time.

Nutritional Recommendations for Pregnant Women Receiving Dialysis: A Scoping Review

“…A total of 23 (10.8%) additional macronutrient recommendations were also charted [1,5,41,48,56,68,86,94,101,[104][105][106]112,121,124,128,133,139,141,169,177,182,183], which included general commentary as well as recommendations from studies other than the ones made or prescribed by those charted in this review. Of the 136 included papers, 29 did not make any macronutrient recommendations [3,9,14,45,66,70,78,83,88,[91][92][93][95][96][97][98]111,118,119,123,130,148,152,[154][155]…”

“…Four studies emphasized that a review of all medications is necessary to determine their compatibility with breastfeeding [45,52,70,164]. Seven articles warned that the urea content of breastmilk may be higher in renal patients which can cause diuresis in infants [46,93,143,174,177,179,182]. Of these publications, four suggested giving water with breastmilk feedings to mitigate this issue [46,177,179,182], whilst one also recommended supplementing breastmilk feedings with formula so that the nutrient needs of infants can be met.…”

“…Of these publications, four suggested giving water with breastmilk feedings to mitigate this issue [46,177,179,182], whilst one also recommended supplementing breastmilk feedings with formula so that the nutrient needs of infants can be met. One publication advised against breastfeeding in dialysing patients due to the low concentration of nutrients and high levels of toxic substances such as pro-inflammatory cytokines and urea in breastmilk samples [93].…”