Case report: nutritional intervention supplemented with ketoanalogues in chronic kidney disease during pregnancy

Chronic kidney disease (CKD) is expected to be present in 4% of women of reproductive age. Nutritional interventions that include supplementation with ketoanalogues (KAs) and essential aminoacids in pregnancy have been described in a limited number of cases. We report on a 26-year-old patient, with stage 4 CKD since 3 years, with unidentified cause, who received a very low protein diet and a KA (ketosteryl 1 tablet/5 kg ideal weight) as part of her nutritional therapy. At the sixth month of therapy, she was diagnosed to be 8 gestational weeks pregnant with a single embryo. Considering KA safety, under -adequate nutritional assistance, it was decided to modify this treatment during pregnancy, increasing protein intake to 0.6 g/Kg/day and modifying the dose of the KA to 1 tablet/10 kg ideal weight. At 20 gestational weeks, caloric intake was increased to 35 kcal/kg of ideal weight, complemented by 200 kcals, and protein intake was maintained at 0.6 g/kg/day. At 34 + 4 gestational weeks, a cesarean section was performed, delivering a male newborn weighing 2.5 kg and 44 cm in length, in good -general condition and actively breastfeeding, which was maintained exclusively for one month. This case illustrates that timely nutritional management, including strict monitoring of protein intake, supplemented with KAs, may be an option to optimize the maternal-fetal prognosis in advanced-stage CKD.