Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience

Abstract

BackgroundPregnancy in women with advanced CKD becoming increasingly common. However, experience with low-protein diets in CKD patients in pregnancy is still limited.Aim of this study is to review the results obtained over the last 15 years with moderately restricted low-protein diets in pregnant CKD women (combining: CKD stages 3-5, proteinuria: nephrotic at any time, or > =1 g/24 at start or referral; nephrotic in previous pregnancy). CKD patients on unrestricted diets were employed for comparison.MethodsStudy period: January, 2000 to September, 2015: 36 on-diet pregnancies (31 singleton deliveries, 3 twin deliveries, 1 pregnancy termination, 1 miscarriage); 47 controls (42 singleton deliveries, 5 miscarriages). The diet is basically vegan; since occasional milk and yoghurt are allowed, we defined it vegan-vegetarian; protein intake (0.6–0.8 g/Kg/day), keto-acid supplementation, protein-unrestricted meals (1–3/week) are prescribed according to CKD stage and nutritional status. Statistical analysis was performed as implemented on SPSS.ResultsPatients and controls were similar (p: ns) at baseline with regard to age (33 vs 33.5), referral week (7 vs 9), kidney function (CKD 3-5: 48.4 % vs 64.3 %); prevalence of hypertension (51.6 % vs 40.5 %) and proteinuria >3 g/24 h (16.1 % vs 12.2 %). There were more diabetic nephropathies in on-diet patients (on diet: 31.0 % vs controls 5.3 %; p 0.007 (Fisher)) while lupus nephropathies were non-significantly higher in controls (on diet: 10.3 % vs controls 23.7 %; p 0.28 (Fisher)). The incidence of preterm delivery was similar (<37 weeks: on-diet singletons 77.4 %; controls: 71.4 %). The incidence of other adverse pregnancy related outcomes was non-significantly lower in on-diet patients (early preterm delivery: on diet: 32.3 % vs controls 35.7 %; birth-weight = <1.500 g: on diet: 9.7 % vs controls 23.8 %). None of the singletons in the on-diet series died, while two perinatal deaths occurred among the controls (p = 0.505).The incidence of small for gestational age (SGA <10th centile) and/or extremely preterm babies (<28th week) was significantly lower in singletons from on-diet mothers than in controls (on diet: 12.9 % vs controls: 33.3 %; p: 0.04 (Fisher)).ConclusionModerate protein restriction in the context of a vegan-vegetarian supplemented diet is confirmed as a safe option in the management of pregnant CKD patients.

Nutritional Challenges in Pregnant Women with Renal Diseases: Relevance to Fetal Outcomes

“…Even in this case, the experimental dietary regimen was tolerated and more interestingly the incidence of SGA babies was significantly lower in the diet group, while during the long-term follow-up, the children did not present health or socialization problems [33]. A subsequent analysis that compared 36 on diet CKD pregnancies vs. 47 CKD control cases on unrestricted diet in a follow-up of 15 years, confirmed that the incidence of SGA and/or extremely preterm babies (<28th week) was significantly lower in on-diet mothers than in the controls, suggesting again a possible positive effect of a plant-diet in CKD subjects [34]. The same group has more recently published a report focused on the same plant-based diet in three pregnant patients with focal segmental glomerulosclerosis.…”

Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe

“…Moreover, most of the children of the vegetarian women had normal intrauterine growth and developed normally between 1 month and 7.5 years from delivery [77]. The review of the results obtained during 15 years of treatment of pregnant CKD women on moderately restricted low-protein diets confirms that such a diet is a safe option in the management of pregnant CKD patients [78]. A trend towards better preserved fetal growth was observed.…”

Nutrition care for chronic kidney disease during pregnancy: an updated review

“…In advanced CKD stages and under dialysis, protein recommendations for adults with CKD may be used, while adding the extra needs of pregnancy. In stages 3-5, a moderate-protein-restricted plant-based diet (0.6-0.8 g/kg/ day of protein) plus keto-analogs (1 tablet/8-10 kg) showed a lower frequency of early preterm delivery, very low birth weight (LBW) (<1500 g) and SGA infants [20][21][22][23]. In different reported case series of pregnant women under HD, a protein intake of 1.2-1.5 g/kg of ideal body weight/day plus 6-10 g/day was related with optimal plasmatic nitrogen compounds levels, controlled blood pressure, reduced proteinuria, and improved plasmatic albumin and phosphorus [14,15,18].…”