Kidney health management during pregnancy: a dialogue between patients and healthcare professionals

Anna Laura Fantuzzi; Elisa Berri; Lida Tartaglione; Marcora Mandreoli; Rossella Giannini; Sara Dominjanni; Silvia Porreca

doi:10.33393/gcnd.2024.3180

Authors

Anna Laura Fantuzzi Dietista già Coordinatore Nutrizione e Dietetica Aziendale, AUSL Modena, Comitato Scientifico ASAND (Associazione Scientifica Alimentazione Nutrizione e Dietetica), Modena - Italy
Elisa Berri Dietista, Dipartimento di Cure Primarie, AUSL-IRCCS di Reggio Emilia - Italy https://orcid.org/0000-0003-1431-6551
Lida Tartaglione Dirigente Medico, UOC Nefrologia, AOU Policlinico Umberto I di Roma - Italy
Marcora Mandreoli MD, Comitato Tecnico Scientifico Progetto regionale PIRP (Prevenzione Insufficienza Renale Progressiva) - Italy https://orcid.org/0000-0003-0117-4857
Rossella Giannini Dietista, SSD Malattie del Metabolismo e Nutrizione Clinica Azienda Ospedaliero-Universitaria Policlinico di Modena - Italy
Sara Dominjanni Dirigente Medico, UOC Nefrologia e Dialisi Ospedale Sant’Eugenio, ASL Roma 2, Roma - Italy
Silvia Porreca Dirigente Medico, UOC Nefrologia e Dialisi, P.O. “Di Venere”, Bari, ASL BA, Bari - Italy https://orcid.org/0000-0002-5636-1361

DOI:

https://doi.org/10.33393/gcnd.2024.3180

Keywords:

Chronic kidney disease, Nutrition, Peritoneal dialysis, Pregnancy, Renal transplant

Abstract

Pregnancy in patients with chronic kidney disease (CKD) represents a significant challenge for nephrologists and healthcare professionals involved in the care pathway, especially in advanced stages of the disease and during dialysis. From an epidemiological standpoint, the exact percentage of women with CKD who become pregnant is unknown. It is estimated that stages 1 and 2 of kidney disease (where kidney function is still preserved or mildly impaired with persistent albuminuria) affect up to 3% of women of childbearing age (20-39 years), while stages 3-5 (glomerular filtration rate < 60 mL/min) affect about 1 out of 150 women of childbearing age. However, due to reduced fertility, these women often experience spontaneous miscarriages in the early months of pregnancy, and 1 out of 750 faces complications in her offspring.

As a result, managing pregnancy in CKD patients requires special attention, considering various clinical aspects including the reciprocal influence between the disease and pregnancy, the need to adjust therapies, the modification of treatments, and the high risk of maternal and fetal complications. An appropriate nutritional approach is also a crucial phase in this process, as nutritional status significantly influences maternal and fetal health. In this article, developed through questions posed to physicians and the case manager during routine care, we do not intend to address the entire complex issue linking kidney disease to pregnancy outcomes. Instead, we aim to provide updated answers to various topics of interest for the multidisciplinary team to safeguard the health of both mother and child.

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