Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Abstract

Background and objectives Women affected by CKD increasingly choose to get pregnant. Experience with lowprotein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets.Design, setting, participants, & measurements This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (.1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies-21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 proteinunrestricted meals allowed per week.Results Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P,0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups.Conclusion Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.

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

“…The two groups were comparable for age, referral, eGFR, and hypertension, while baseline proteinuria was higher in the intervention group. 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].…”

Effects of Long Non-Coding RNA LINC00963 on Renal Interstitial Fibrosis and Oxidative Stress of Rats with Chronic Renal Failure via the Foxo Signaling Pathway

“…Previous study has revealed that CRF is characterized by slowly progressive chronic renal interstitial fibrosis (RIF) and accompanied with increased oxidative stress (OS) that is already found in the early stage of renal disease [5]. Although a low protein diets is the effective treatment regimen for CRF, the side effects of this strategy cannot be ignored, such as a probable occurrence of proteinuria and functional impairment [6]. The underlying mechanisms and more effective therapies for CRF are still unknown.…”

Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?

“…Pregnant patients, who are also prescribed an adapted LPD, as elsewhere described, are not included in the present analysis [27]. …”