Case report: Applicability of breastfeeding the child of a patient with kidney failure with replacement therapy

Abstract

This case report highlights the benefit or harm of breastfeeding in a patient with Kidney Failure with Replacement Therapy (KFRT) undergoing program hemodialysis. This is a unique clinical case, as pregnancy and successful delivery are rare in this group of females. With a favorable outcome, the possibility of breastfeeding is especially relevant for doctors and the mother. The patient was a 31-year-old female who was diagnosed in 2017 with end-stage renal disease associated with chronic glomerulonephritis. Against the background of hemodialysis, pregnancy, accompanied by polyhydramnios, anemia, and secondary arterial hypertension, occurred in 2021. At 37 weeks, a healthy, full-term baby girl was born, and breastfeeding was started. In this study, we conducted a detailed analysis of toxic substances and immunologically significant proteins using high-tech analysis methods. In addition, we studied different portions of milk before and after hemodialysis at different time intervals. After a wide range of experiments, our study did not reveal an optimal time interval for breastfeeding a baby. Despite the decrease in the level of the major uremic toxins 4 h after the hemodialysis procedure, their level remained high. In addition, the content of nutrients did not reach acceptable limits and the immune status was characterized as pro-inflammatory. In our opinion, breastfeeding is not advisable for this group of patients since the concentration of nutrients is low, and the content of toxic substances exceeds the permissible limits. In this clinical case, the patient decided to stop breastfeeding one month after delivery due to insufficient breast milk and the inability to express it in a certain period of time.

Keywords: Kidney Failure with Replacement Therapy (KFRT); biochemistry; breastfeeding; case report; immunology; molecular physics.

FIGURE 1

(A) Dynamics of uremic toxins (creatinine and urea) and (B) nutrients (total protein, albumin, and glucose) concentrations in the breast milk of the patient undergoing renal replacement therapy by program hemodialysis. The horizontal axis presents time relative to the hemodialysis procedure: before HD, immediately after HD (0 h), 4, 7, and 13 h after hemodialysis. The vertical axis shows the concentration of analytes. Dashed lines indicate the average concentration of each analyte in the control sample (breast milk of healthy females with the same lactation period).

FIGURE 2

Dynamics of the concentration of immunoglobulins of IgA, IgM, and sIgA subclasses in the breast milk of the patient undergoing renal replacement therapy by program hemodialysis. The horizontal axis presents time relative to the hemodialysis procedure: before HD, immediately after HD (0 h), 4, 7, and 13 h after hemodialysis. The vertical axis shows the concentration of analytes. Dashed lines indicate the average concentration of each analyte in the control sample (breast milk of healthy females with the same lactation period).

FIGURE 3

(A) Dynamics of pro-inflammatory and (B) anti-inflammatory cytokine concentrations in the breast milk of the patient undergoing renal replacement therapy by program hemodialysis. The horizontal axis presents time relative to the hemodialysis procedure: before HD, immediately after HD (0 h), 4, 7, and 13 h after hemodialysis. The vertical axis shows the concentration of analytes. Dashed lines indicate the average concentration of each analyte in the control sample (breast milk of healthy females with the same lactation period).

FIGURE 4

(A) Distribution (intensity weighted) of hydrodynamic particle diameters obtained by MADLS in milk samples from the patient with KFRT at various time intervals (before HD, immediately after HD (0 h), 4, 7, and 13 h after HD) and in control samples (milk of healthy females with the same lactation period); (B) fluorescence spectra of breast milk samples. Milk samples from a patient with KFRT have higher fluorescent activity compared with control samples.