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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (4): 596-599    DOI: 10.31083/j.ceog.2020.04.5233
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Pregnancy in a peritoneal dialysis patient undergoing intermittent peritoneal dialysis during the third trimester of pregnancy: a case report and literature review
Z.Y. Chang1, R. Cao1, R.C. Xu1, Y. Cheng1, Q.J. Wan1, *()
1Department of Nephrology, Shenzhen Second People's Hospital and the First Affiliated Hospital of Shenzhen University, Shenzhen 518000, P.R. China
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Abstract  

For patients undergoing peritoneal dialysis (PD), the rate of successfully carrying a pregnancy to term is low. Herein, we describe the pregnancy course of a patient with end-stage renal disease on peritoneal dialysis. The information presented may make better undestanding in the knowledge and management of such high-risk pregnancies in this patient population. We report the successful completion of pregnancy in a patient who underwent continuous ambulatory peritoneal dialysis (CAPD) and then switched to intermittent peritoneal dialysis (IPD) during her third trimester. She became pregnant after undergoing CAPD for almost 1 year, using four 1.5 L exchanges of 1.5% bags per day. At 30 weeks of gestation, she switched from CAPD to IPD, using six 0.5 L exchanges of 1.5% bags per day with daily ultrafiltration of 100-300 mL. Her total Kt/V was 1.72 (dialysate 1.2, residual kidney 0.5) during her first and second trimesters and her total Kt/V decreased to 1.63 (dialysate 1.15, residual kidney 0.48) during her third trimester. She was admitted to our hospital at 35 weeks of gestation for a planned lower segment caesarian section. We report the successful completion of pregnancy in a patient on IPD. We have shown that rather than pursuing an adequate weekly default value of Kt/V, the most important criterion for the optimization of dialysis treatment for pregnant patients is their medical condition.
Key words:  Pregnancy      Intermittent peritoneal dialysis      Chronic kidney disease     
Submitted:  28 April 2019      Accepted:  20 June 2019      Published:  15 August 2020     
Fund: 201605008/Health and Family Planning Commission of Shenzhen Municipality
*Corresponding Author(s):  Q.J. Wan     E-mail:  cnzqdoc@126.com
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Z.Y. Chang, R. Cao, R.C. Xu, Y. Cheng, Q.J. Wan. Pregnancy in a peritoneal dialysis patient undergoing intermittent peritoneal dialysis during the third trimester of pregnancy: a case report and literature review. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 596-599.

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https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.04.5233     OR     https://ceog.imrpress.com/EN/Y2020/V47/I4/596

Table 1  — Pregnancy outcomes in end-stage renal disease patients treated with peritoneal dialysis.
Reference Year Pregnancies reported Infant
Survival(%)		 Gestational age at delivery(weeks) Delivery
type		 Infant
Weight(g)		 PD
complications
Tuncer et al. [7] 2000 1 100 38 Vaginal 1900 Peritonitis
Chang et al. [8] 2002 1 100 33 Vaginal 994 Drain pain
Smith et al. [9] 2005 1 100 33 Vaginal 1730 Hemoperitoneum
Chou et al. [10] 2006 1 0 19 c-section NR Hemoperitoneum
Tan et al. [11] 2006 1 100 33 Vaginal 2060 Post-tartum peritonitis
Lew [12] 2006 1 0 21 Vaginal NR Hemoperitoneum
Asgari et al. [13] 2007 1 100 36 c-section NR None reported
Altay et al. [14] 2007 1 100 39 Vaginal 2480 Hemoperitoneum
Gomez Vazquez et al. [15] 2007 2 100 36-38 Vaginal 1925-2700 None reported
Jefferys et al. [16] 2008 5 100 24-38 Vaginal(3)
c-section(2)		 478-2735 Catheter displacement
Chou et al. [17] 2008 3 33 22-35 NR 440-2388 None reported
Current paper 2017 1 100 35 c-section 2100 None reported
Table 2  — Maternal objectives of PD.
Parameter Objective Clinical/laboratory situation
Interdialytic weight gain ≤ 1 kg weight
Edema Minimal or absent
Blood pressure ≤ 140/90 mmHg
Central venous pressure 6-10 cm of water
Hemoglobin ≥ 8 g/dL or 10-11 g/dL
BUN ≤ 80 mg/dL or ≤ 50 mg/dL
Serum creatinine 5-7 mg/dL
Energy intake 35-40 kcal/kg weight/day
Protein intake 1 g/kg weight/day + 20 g protein/day to 1.8 g/kg weight/day
Medications (antihypertensives, diuretics, etc) Reduction of number and dosage
Transfusion Avoid or reduce its necessity
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