title: Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience.
abstract: 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.
  
  
  
  
  
  
  
  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.
  
  
  
  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)).
  
  
  
  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.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.forename: Filomena
authors.initials: F
authors.lastname: Leone
authors.forename: Silvia
authors.initials: S
authors.lastname: Parisi
authors.forename: Federica
authors.initials: F
authors.lastname: Fassio
authors.affiliation: SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Capizzi
authors.affiliation: SCD Nephrology, Brotzu Hospital, Cagliari, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Loi
authors.affiliation: SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Colla
authors.affiliation: SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Rossetti
authors.forename: Martina
authors.initials: M
authors.lastname: Gerbino
authors.affiliation: SCD Nephrology, Brotzu Hospital, Cagliari, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maxia
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Alemanno
authors.forename: Fosca
authors.initials: F
authors.lastname: Minelli
authors.forename: Ettore
authors.initials: E
authors.lastname: Piccoli
authors.affiliation: SS Epidemiology, University of Torino, Torino, Italy.|SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Versino
authors.forename: Marilisa
authors.initials: M
authors.lastname: Biolcati
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino, 10100, Italy.|Nèphrologie, CH du Mans, Le Mans, France.
authors.forename: Paolo
authors.initials: P
authors.lastname: Avagnina
authors.affiliation: SCD Nephrology, Brotzu Hospital, Cagliari, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.affiliation: SCD Nephrology, Brotzu Hospital, Cagliari, Italy.
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Cabiddu
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
authors.affiliation: SS 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.
authors.forename: Giorgina B
authors.initials: GB
authors.lastname: Piccoli
mesh_terms: D000328:Adult; D018753:Diet, Protein-Restricted / Q000009:adverse effects / Q000639:trends*; D000067269:Diet, Vegan / Q000009:adverse effects / Q000639:trends; D014676:Diet, Vegetarian / Q000009:adverse effects / Q000639:trends*; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000178:diet therapy* / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy* / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: CKD; Low-protein diets; Maternal-foetal outcomes; Pregnancy; Preterm delivery; Small for gestational age baby; Supplemented diets