Nutrition in the Pregnant Dialysis Patient

Abstract

■ Objective: To review reports of pregnancy in patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis to determine appropriate nutritional recommendations. ■ Data sources: Relevant English-language articles were identified through MEDLINE (1966 to 1992), the Registry of Pregnancy in Dialysis Patients (USA), the European Dialysis and Transplant Association Registry, and unpublished case study reports. ■ Study selection: All articles obtained were reviewed. Twenty cases were analyzed in detail in which either dietary recommendations or pregnancy weight gains were reported. ■ Data extraction: Data collected included dialysis protocol, pregnancy weight gain, outcome, and dietary intake for protein, sodium, potassium, calories, fluid, and other nutrients as reported. Data were not reported in all categories for all patients. ■ Data synthesis: Fifteen of the 20 reported pregnancies resulted in infant survival longer than 2 days; little or no information was given on long-term outcome of infants. Heterogeneous nutritional management, dialysis protocol, and weight gain gave clear direction for treatment recommendations. ■ Conclusions: Successful pregnancies were more likely to be reported than unsuccessful pregnancies, resulting in literature bias. Little data exist on nutritional management of pregnant patients receiving dialysis therapy; the later in pregnancy dialysis is initiated, the greater the likelihood of a successful outcome. Recommendations given are based on merged nutritional requirements of pregnant nondialysis patients with those of nonpregnant dialysis patients as supported by sporadic case report data. ■ Objective: To review reports of pregnancy in patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis to determine appropriate nutritional recommendations. ■ Data sources: Relevant English-language articles were identified through MEDLINE (1966 to 1992), the Registry of Pregnancy in Dialysis Patients (USA), the European Dialysis and Transplant Association Registry, and unpublished case study reports. ■ Study selection: All articles obtained were reviewed. Twenty cases were analyzed in detail in which either dietary recommendations or pregnancy weight gains were reported. ■ Data extraction: Data collected included dialysis protocol, pregnancy weight gain, outcome, and dietary intake for protein, sodium, potassium, calories, fluid, and other nutrients as reported. Data were not reported in all categories for all patients. ■ Data synthesis: Fifteen of the 20 reported pregnancies resulted in infant survival longer than 2 days; little or no information was given on long-term outcome of infants. Heterogeneous nutritional management, dialysis protocol, and weight gain gave clear direction for treatment recommendations. ■ Conclusions: Successful pregnancies were more likely to be reported than unsuccessful pregnancies, resulting in literature bias. Little data exist on nutritional management of pregnant patients receiving dialysis therapy; the later in pregnancy dialysis is initiated, the greater the likelihood of a successful outcome. Recommendations given are based on merged nutritional requirements of pregnant nondialysis patients with those of nonpregnant dialysis patients as supported by sporadic case report data.