Got Milk? Breastfeeding and Milk Analysis of a Mother on Chronic Hemodialysis

Abstract

Purpose: Women on dialysis rarely become pregnant. However, the overall rate of successful pregnancies is increasing in this patient population and breastfeeding becomes an option for mothers on dialysis. In this study we performed a systematic breast milk composition analysis of a mother on chronic hemodialysis (HD).

Methods: Specimens of breast milk and blood were collected in regular intervals before and after HD from a 39-year old woman starting on day 10 postpartum. Samples were analyzed for electrolytes, retention solutes, nutrients and other laboratory measurements. Breast milk samples from low-risk mothers matched for postpartum age were used as controls.

Results: Significantly higher levels of creatinine and urea were found in pre-HD breast milk when compared to post-HD. A similar post-dialytic decrease was only found for uric acid but not for any other investigated parameter. Conversely, sodium and chloride were significantly increased in post-HD samples. Compared to controls creatinine and urea were significantly higher in pre-HD samples while the difference remained only significant for post-HD creatinine. Phosphate was significantly lower in pre- and post-HD breast milk when compared to controls, whereas calcium showed no significant differences. In terms of nutrient components glucose levels showed a strong trend for a decrease, whereas protein, triglycerides and cholesterol did not differ. Similarly, no significant differences were found in iron, potassium and magnesium content.

Conclusion: To the best of our knowledge this is the first report on a breastfeeding mother on chronic dialysis. Although we found differences in creatinine, urea, sodium, chloride and phosphate, our general analysis showed high similarity of our patient's breast milk to samples from low-risk control mothers. Significant variations in breast milk composition between pre- and post-HD samples suggest that breastfeeding might be preferably performed after dialysis treatment. In summary, our findings indicate that breastfeeding can be considered a viable option for newborns of mothers on dialysis.

Fig 1. Longitudinal development of urea, hemoglobin and stdKt/V during gestation and postpartum.

Note the increase of stdKt/V with intensified HD regimen during pregnancy.

Fig 2. Retention solutes concentrations in breast milk.

A, B. Breast milk retention solutes of our mother on dialysis were significantly elevated prior to HD (pre-HD) when compared to healthy controls (Co), as shown for urea and creatinine. HD treatment significantly reduced breast milk creatinine concentration and even normalized urea to control level (post-HD). C. Similarly, pre-HD elevated uric acid concentrations normalized post-HD. D. A strong relationship of breast milk retention solute concentration with HD treatments could be seen and is visualized in a longitudinal fashion.

Fig 3. Electrolyte and phosphate concentrations in breast milk.

A-D. Electrolyte composition of breast milk showed only minor changes pre- and post-HD, but HD treatment lead to a significant increase of sodium and chloride concentrations of breast milk when compared to Co, which–in the case of sodium–was still present prior to HD. E-F. Phosphate levels were similar pre- and post-HD but were significantly lower than in Co, whereas calcium levels did not differ significantly.

Fig 4. Nutrient components in breast milk.

A. Compared to Co, breast milk glucose levels were generally lower in our patient. HD did not influence post-HD levels compared to pre-HD levels. B-D. In contrast, total protein, triglycerides and cholesterol did not differ significantly when compared to controls. Again, HD did not influence post-HD levels compared to pre-HD levels.