Use of kidney-preserving medications in breastfeeding

Breastfeeding has recognized health benefits for all mother-infant dyads, which are particularly important for women with chronic kidney disease (CKD) and their children. There is growing evidence to suggest breastfeeding positively impacts maternal vascular health by lowering blood pressure, assisting with weight loss, improving lipid profiles, and preventing type 2 diabetes. Similarly, breastfed infants have demonstrated decreased risks of developing obesity, hypertension, and diabetes, improving their long-term vascular health. Postpartum women with CKD often require different therapies to manage their disease and improve long-term outcomes, but there is a lack of robust lactation safety data for many drugs used in the treatment of CKD. As a result, postpartum women with CKD may be deprived of nephroprotective therapies that impact long-term renal survival or the vascular protective effects associated with breastfeeding for themselves and their children. In this review, we summarize the importance of breastfeeding for women with CKD and their children, and existing data on the safety of drugs used for the treatment of CKD in lactation. We also review available methods for assessing drug safety and describe emerging pharmacometric modeling techniques that may be particularly useful for informing safety in lactation for drugs with little human data, helping to overcome some of the ethical and practical issues associated with conducting research on postpartum women and their infants.