Pregnancy with peritoneal dialysis- a challenge revisited

BackgroundPregnancy with kidney failure is challenging, even more so with peritoneal dialysis (PD). The pregnancy rate is 50% lower while on PD than on hemodialysis, and usually, patients transition to hemodialysis to support better outcomes. There are only a few reported cases of pregnancy carried beyond 32 weeks' gestation on PD alone.MethodsWe present a patient treated with PD for over two years at the time of natural conception. Higher clearance needs arose during pregnancy, but the patient did not transition to hemodialysis due to fear of hematological infections and need for new dialysis access. With the patient's consent and discussions with the pharmacy medical liaison, at 30 weeks, her PD regimen was modified to include Icodextrin to support adequacy and volume control. This adjustment aided in pregnancy reaching 32w4d when she delivered a viable infant. Though our patient underwent a cesarean section, she stayed on PD with appropriate modifications, not needing hemodialysis at any time.Results and ConclusionsWe present the challenges and report a successful outcome of such a pregnancy, along with the off-label use of Icodextrin as add-on therapy during the third trimester. We opine that Icodextrin did not adversely impact the course; it helped carry the pregnancy forward a few more critical weeks. This is also a unique case report of a pregnancy while on PD in a pacific islander and only one of five cases of Pregnancy on PD in women over 40.