Abstract
The fetal and neonatal mortality rate is higher in hemodialysis patients than in healthy patients. According to the diagnosis and treatment guidelines of the Japanese Society of Nephrology, concerning patients with renal disease, pregnancy is not recommended for hemodialysis patients. From 2009 to 2012, we conducted prenatal nutritional management case experiments on three hemodialysis patients. In addition to the basic diet during the dialysis period, they were given an additional amount of water-soluble vitamins, minerals, and amino acids commonly administered to healthy pregnant women. By modifying their diet, we were able to secure the necessary amount of nutrition. Case 1 gave birth by caesarean section at 27 weeks of gestation : neonatal weight 443 g and APGAR score 9 (after 5 minutes), but death about 1 month later. Case 2 gave birth by caesarean section at 35 weeks of gestation : neonatal weight 1,652 g and APGAR score 9 (after 5 minutes). Case 3 gave birth by caesarean section at 34 weeks of gestation : neonatal weight 1,783 g and APGAR score 9 (after 5 minutes). The neonatal development of cases 2 and 3 was good. These three case experiments suggest that individual nutritional management is necessary during pregnancy of hemodialysis patients.
