Pregnancy in a woman undergoing peritoneal dialysis: Management and dialysis options

Abstract

Pregnancy in patients with end-stage renal disease on maintenance dialysis is uncommon, with annual incidences reported at 0.3 – 2.7%. Peritoneal dialysis usage in pregnancy has been less reported than hemodialysis, although outcomes are similar. Nowadays, there are insufficient data to establish a generalizable dialysis strategy in pregnant women with end-stage renal disease. As such, decisions should be individualized, depending on clinical factors, residual renal function, and, whenever possible, choice of the patient. We report the case of a 22-year-old patient receiving peritoneal dialysis who delivered a full-term, normal weight, healthy baby with increased dialysis dose achieved by supplementary hemodialysis during pregnancy, thus enabling peritoneal dialysis to be continued until the third trimester and minimizing hemodialysis requirements.

Pregnancy and pre-term delivery in a peritoneal dialysis patient in a public hospital in Peru. Case report

“…Prescribing PD can be challenging, especially in the advanced stages of pregnancy, as it requires reduced infusion volume along with multiple exchanges to maintain adequate clearance 12 . The lack of evidence and experience in the management of PD during pregnancy often leads most physicians to temporarily switch to HD.…”

“…The lack of evidence and experience in the management of PD during pregnancy often leads most physicians to temporarily switch to HD. However, there are reports of three patients only the past 10 years who remained on PD even after childbirth 3,10,13 (Table 1) 3,7,10,[12][13][14][15] . In this case, the stable clinical parameters of both the patient and the fetus allowed for the continuation of PD without having to change the therapy, even after childbirth.…”

Embarazo y parto pretérmino en paciente de diálisis peritoneal en un hospital público de Perú. Reporte de caso

“…La prescripción de DP puede resultar desafiante especialmente en etapas avanzadas del embarazo, ya que se requiere reducción del volumen de infusión, combinado con múltiples intercambios para mantener una depuración adecuada 12 . La falta de evidencia y experiencia en el manejo de la DP durante el embarazo lleva a la mayoría de los médicos al cambio temporal a HD, solo se encontró reportes de tres pacientes en los últimos 10 años, que se mantuvieron en DP incluso después del parto 3,10,13 (Tabla 1) 3,7,10,[12][13][14][15] . En este caso, los parámetros clínicos estables tanto de la paciente como del feto permitieron que se mantenga en DP sin necesidad de cambio de terapia incluido después del parto.…”