Hello Katinka,

You mentioned wanting to read more on breastfeeding during dialysis re: "The mother I am working with has dialysis 3x per week. She was told to discard breastmilk if she goes into the 3rd day, which will happen once a week due to contamination of the milk with waste products."

This 2015 study from Germany included a 39 y/o mother who had been undergoing chronic hemodialysis, comparing that mother's milk composition in a longitudinal manner with milk from low-risk control mothers:

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 [hemodialysis] 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.

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

In:  PLoS One 2015; 10(11): e0143340.  doi: 10.1371/journal.pone.0143340

Authors:  Michael S. Balzer, Mechthild M. Gross, Ralf Lichtinghagen, Hermann Haller, and Roland Schmitt.

Open access:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4646653/


This 2017 study from Canada looked at one mother's milk after acute kidney injury that required a period of hemodialysis, comparing her milk with one control sample, and concluding that "acute kidney injury results in changes in milk composition, but it does not significantly affect major macronutrients. We also determine that iodinated computer tomography contrast dye does not accumulate in milk in appreciable amounts."

Title:  Composition of human breast milk in acute kidney injury.  

In:  Obstetric Medicine 2017 June; 10(2): 79–82.  Published online 2017 Jan 29.  doi: 10.1177/1753495X16686276

Authors:  Adam Chruscicki, Alexander Ross Morton, Ayub Akbari, and Christine Anne White.

Open access:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480647/


I checked the indexes of the current editions of Lawrence & Lawrence's Breastfeeding:  A Guide for the Medical Profession and Wambach & Spencer's Breastfeeding and Human Lactation, but don't see any mention of renal disease or dialysis.  A search using the term "dialysis" on La Leche League International's website also yielded no results.   I briefly checked the Academy of Breastfeeding Medicine's protocols and found no mention of medical management in regard to dialysis and lactation.  

Staff at the Infant Risk Center (infantrisk.com) at Texas Tech University is currently operating from home via chat during this COVID-19 pandemic.  I've chatted with a member of their staff, who is going to check with Dr. Hale.  I will follow up when I hear back from them.  

Since the purpose of dialysis is to help the body remove waste and extra fluid during renal disease, human milk from a dialysis patient appears to be compatible with the infant per the above two studies.  Am puzzled in regard to why the mother's milk would need to be discarded only after the 3rd day of dialysis in a given week due to reported contamination of the milk with waste products.  This infers that the mother's milk is acceptable after the first two of 3 weekly dialysis sessions, but not after the 3rd weekly dialysis session per the medical management.  Am I understanding this correctly?  

To emphasize the above 2015 study's statement, "Significant variations in breast milk composition between pre- and post-HD [hemodialysis] samples suggest that breastfeeding might be preferably performed after dialysis treatment," the study authors did not caution against breastfeeding and human milk for the infant prior to each dialysis session.  

Improved pregnancy and neonatal outcomes have occurred with improvements in the management of chronic renal disease, including intensified hemodialysis regimens which occur far more often than 3 times a week.  This excerpt is from the 2015 study mentioned above:  

"Due to endocrine abnormalities and sexual dysfunction, fertility of chronic kidney disease (CKD) and end stage renal disease (ESRD) patients of childbearing age is generally reduced[1]. Accordingly, the incidence of pregnancies in women on chronic dialysis is very low but appears to be increasing from 0.9% in 1980[2] to about 1.0–7.0% in the 1990s[3–7]; still, the course of pregnancy remains challenging for both mother and child[8]. With intensified hemodialysis (HD) regimens[9], however, the prevalence of maternal complications and adverse fetal outcomes have decreased encouragingly and more term infants are born[10–13]. Overall rates of successful pregnancies, i.e. resulting in a live infant, reach up to 71–87%[11, 14], gestational age has increased considerably and maternal complications have decreased dramatically within the last few decades[11, 15, 16]."  

Would also be grateful to hear from an ABM physician on this topic.  

With kind regards,

Debbie

Debra Swank, RN BSN IBCLC
Program Director
MoreThanReflexes Education
Elkins, West Virginia USA
http://www.MoreThanReflexes.org

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