Dialysis and a plant-based diet to achieve physiologic urea levels for fetal benefit: Normal pregnancy outcome despite chronic kidney disease and hypertension

Abstract

Chronic kidney disease significantly increases the risk of adverse maternal and perinatal outcomes. A growing body of evidence suggests that intensive dialysis, achieving physiologic pre-dialysis blood urea, is associated with decreased morbidity. We report a case of a successful pregnancy outcome in a 32-year-old nulliparous woman with stage 4 chronic kidney disease who dialysed from 11 to 31 weeks, gestation for fetal benefit and concurrently trialled a plant-based diet. We hypothesise that her dietary changes assisted with urea reduction, enabling her to become dialysis independent. Although we must recognise that such pregnancies remain high risk, as demonstrated both in this case and more recent literature, advances in complex obstetric care and dialysis protocols may now give women with chronic kidney disease a realistic hope of a successful pregnancy.

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]…”

“…One study stressed that culturally appropriate diets should be prescribed, with the main objective of preventing malnutrition [98]. The authors of another publication prescribed their patient a plant-based diet at the commencement of HD as per the treating nephrologist's advice [148]. This diet made the patient's request to cease HD at 31 weeks gestation possible due to stability of renal function.…”