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Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience.
BMC Nephrol. 2016 09 20; 17(1):132.BN

Abstract

BACKGROUND

Pregnancy 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.

STUDY 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.

RESULTS

Patients 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)).

CONCLUSION

Moderate protein restriction in the context of a vegan-vegetarian supplemented diet is confirmed as a safe option in the management of pregnant CKD patients.

Authors+Show Affiliations

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableSS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy.SCD Nephrology, Brotzu Hospital, Cagliari, Italy.SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy.SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy.No affiliation info availableSCD Nephrology, Brotzu Hospital, Cagliari, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableSS Epidemiology, University of Torino, Torino, Italy. SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.No affiliation info availableSS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino, 10100, Italy. Nèphrologie, CH du Mans, Le Mans, France.SCD Nephrology, Brotzu Hospital, Cagliari, Italy.SCD Nephrology, Brotzu Hospital, Cagliari, Italy.No affiliation info availableSS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino, 10100, Italy. gbpiccoli@yahoo.it. Nèphrologie, CH du Mans, Le Mans, France. gbpiccoli@yahoo.it.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27649693

Citation

Attini, Rossella, et al. "Vegan-vegetarian Low-protein Supplemented Diets in Pregnant CKD Patients: Fifteen Years of Experience." BMC Nephrology, vol. 17, no. 1, 2016, p. 132.
Attini R, Leone F, Parisi S, et al. Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience. BMC Nephrol. 2016;17(1):132.
Attini, R., Leone, F., Parisi, S., Fassio, F., Capizzi, I., Loi, V., Colla, L., Rossetti, M., Gerbino, M., Maxia, S., Alemanno, M. G., Minelli, F., Piccoli, E., Versino, E., Biolcati, M., Avagnina, P., Pani, A., Cabiddu, G., Todros, T., & Piccoli, G. B. (2016). Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience. BMC Nephrology, 17(1), 132. https://doi.org/10.1186/s12882-016-0339-y
Attini R, et al. Vegan-vegetarian Low-protein Supplemented Diets in Pregnant CKD Patients: Fifteen Years of Experience. BMC Nephrol. 2016 09 20;17(1):132. PubMed PMID: 27649693.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience. AU - Attini,Rossella, AU - Leone,Filomena, AU - Parisi,Silvia, AU - Fassio,Federica, AU - Capizzi,Irene, AU - Loi,Valentina, AU - Colla,Loredana, AU - Rossetti,Maura, AU - Gerbino,Martina, AU - Maxia,Stefania, AU - Alemanno,Maria Grazia, AU - Minelli,Fosca, AU - Piccoli,Ettore, AU - Versino,Elisabetta, AU - Biolcati,Marilisa, AU - Avagnina,Paolo, AU - Pani,Antonello, AU - Cabiddu,Gianfranca, AU - Todros,Tullia, AU - Piccoli,Giorgina B, Y1 - 2016/09/20/ PY - 2016/02/02/received PY - 2016/08/29/accepted PY - 2016/9/22/entrez PY - 2016/9/22/pubmed PY - 2017/11/7/medline KW - CKD KW - Low-protein diets KW - Maternal-foetal outcomes KW - Pregnancy KW - Preterm delivery KW - Small for gestational age baby KW - Supplemented diets SP - 132 EP - 132 JF - BMC nephrology JO - BMC Nephrol VL - 17 IS - 1 N2 - BACKGROUND: Pregnancy 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. STUDY 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. RESULTS: Patients 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)). CONCLUSION: Moderate protein restriction in the context of a vegan-vegetarian supplemented diet is confirmed as a safe option in the management of pregnant CKD patients. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/27649693/Vegan_vegetarian_low_protein_supplemented_diets_in_pregnant_CKD_patients:_fifteen_years_of_experience_ L2 - https://www.biomedcentral.com/1471-2369/17/132 DB - PRIME DP - Unbound Medicine ER -