SP381MODERATELY PROTEIN-RESTRICTED, PLANT-BASED SUPPLEMENTED DIETS IN PREGNANT CKD PATIENTS: EFFECT ON UTERO-PLACENTAL DOPPLER FLOWS

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INTRODUCTION AND AIMS: Pregnancy is increasingly common in patients with advanced or intensely proteinuric CKD, posing ethical and pragmatic problems. Previous experiences with plant based diets showed better stabilisation of kidney function and proteinuria and equal or better foetal growth at delivery as compared with patients on unrestricted diet. No data were so far available on fetal growth during pregnancy. Aim of the study was to analyse foetal growth and Doppler indexes (uterine and umbilical arteries) in pregnant CKD patients followed-up in the same settings, who did or did not follow the study diet in pregnancy. METHODS: From the database of the “kidney and pregnancy” Unit, prospectively updated since 2000, we selected all patients with at least one Doppler control in our Center (after 24 weeks; in case of more findings we considered the last one), and with CKD stage 3 and/or with proteinuria above 1 g at start of pregnancy or nephrotic at any time. The patients were stratified according to the diet followed: Plant-based supplemented moderately protein-restricted diets (the cases) (protein intake 0.6-0.8 g/Kg/day, 1-3 unrestricted meals per week, supplemented with alpha-ketoacids and aminoacids 1 tablet/8 Kg of body weight); CKD unrestricted diets (due to later referral, personal choice, milder disease) (the controls). Before 2011, only patients with stage 3b-5 CKD and nephrotic proteinuria were managed with the diet; after 2011 the diet was proposed to all patients with CKD stages 3-5 not on dialysis and with nephrotic or sub-nephrotic proteinuria. RESULTS: Overall, 41 patients followed the diet in pregnancy; 34 were selected for the study (3 twin pregnancies, 2 patients without ecographic data, 1 miscarriage and 1 voluntary termination were excluded); the control group consisted of 20 patients (5 miscarriages were excluded). The 2 groups were similar for age and BMI; proteinuria was non-significantly higher in on-diet patients, CKD stage and creatinine were non-significantly higher in the control group. No difference was found as for neonatal weight, gestational age at referral, caesarean section, birth weight centile. Prevalence of uterine Doppler flow impairment was non-significantly higher in control patients, while the difference in umbilical Doppler flow, better preserved in on-diet patients, was highly significant (p=0.009). The incidence of foetal growth restriction (FGR) was lower in on-diet patients (5.9%) than in control group (25%), but statistical significance was not reached (p=0.057) (Table). CONCLUSIONS: Protein-restricted diet, plant-based, supplemented diet in pregnant women may help preserving foetal growth in pregnancy, by favouring preservation of utero-placental flows. While these results suggest an anti-oxidant, vaso-protective effect at the placental level, further multicentre studies are needed to validate this hypothesis and confirm these results.

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