Abstract: SA-PO1053
Pregnancy, Peritoneal Dialysis, and a Dive into Some Unchartered Territories
Session Information
- Women's Health and Kidney Diseases
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Rainwater, Randall Reece, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Valiani, Salima, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Singh, Manisha, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Introduction
Pregnancy with end-stage-kidney disease (ESKD) is challenging at all levels, even more so with peritoneal dialysis (PD). The pregnancy rate on peritoneal dialysis is about half that of patients on hemodialysis, and usually, all such patients are transitioned to hemodialysis to support better outcomes. There are only a few reported cases of pregnancy that were carried beyond 32 weeks' gestation on PD alone. We report such a case in a 41 yo Pacific islander woman with spontaneous conception and continuation on PD through pregnancy and postpartum, using Icodextrin when needed.
Case Description
We present a case of a 41-year-old pacific islander woman with ESKD secondary to ureteral reflux with multiple infections who had been on PD for over two years at the time of natural conception. As the pregnancy progressed, the need for better clearances arose, but the patient was adamant not to transition to hemodialysis due to her fear of blood infections and tunnel catheters. The patient is in the medical profession and would read up on her options. She was aware of the risks and benefits of the alternatives discussed, thus enabling us to carry out a genuinely patient-centered and patient-led plan. With the patient's consent and multiple discussions with our team, division, and the pharmacy medical liaison, at 30 weeks of pregnancy, her PD regimen was modified to include a 1.5-liter Icodextrin to support her adequacy and volume control. This adjustment aided in her pregnancy reaching a higher gestation age of 32w4d when she delivered a viable 1630g female infant with Apgar scores of 1 and 8 at 1 and 5 minutes after birth. Though our patient underwent a cesarean section, she stayed on PD by modifications as appropriate, given her residual renal function, diuretic use, and renal diet, not needing hemodialysis at any time.
Discussion
We present the challenges and report a successful outcome of such a pregnancy, along with the first off-label use of icodextrin in pregnancy. We opine that Icodextrin did not adversely impact the course; it helped carry the pregnancy forward a few more critical weeks. As far as we are aware, this is also the first case report of a pacific islander and only one of two cases of pregnancy on PD in women aged 40 and over.