Nutrition in the Pregnant Dialysis Patient

Successful pregnancy in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy

Frequency of pregnancy among childbearing age women with end-stage renal disease (ESRD) undergoing long-term periodic dialysis ranges from 1% to 7%. Although pregnancy in dialysis women with ESRD is considered a largely high-risk pregnancy, occurrence of successful pregnancy is not impossible with success rates approaching 70%. Rates of successful pregnancy are greatly impacted by early pregnancy diagnosis and preserved residual renal functions. Herein, to the best of our knowledge, we report the first case of successful pregnancy (despite late diagnosis at 14 weeks of gestation) in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy and no whatsoever preserved residual renal function. Moreover, a literature review on pregnancy in dialysis patients is presented.

Medical nutrition therapy in pregnancy and kidney disease

Pregnancy in the face of kidney disease poses a new dimension to medical nutrition therapy. Individualization for specific nutrient needs is paramount, whether the patient has renal insufficiency, requires hemodialysis or peritoneal dialysis, or has a renal transplant. Practice guidelines for pregnancy and kidney disease were first developed in 1986 and revised in 1992. These guidelines provided the foundation for present nutritional management of pregnant women with kidney disease. Based on the most current research and clinical case reviews, the following is a revision of these guidelines, incorporating medical nutrition therapy protocols and outcome parameters to improve assessing, tracking, and monitoring patient care in this unique population.