<i>In utero</i> growth restriction environment among end-stage kidney disease: Pre-term low-weight baby

An in utero favorable environment is of paramount importance to the growing fetus. Pregnancy is less probable to occur in women undergoing dialysis, and they have a higher risk of experiencing a problematic pregnancy compared to those with normal renal function. Among women on peritoneal dialysis (PD), the probability of becoming pregnant is low, and the pregnancy rate is even lower compared to those on hemodialysis. The present patient’s pregnancy is thought to be high risk since she has end-stage kidney disease (ESKD) with advanced maternal age for pregnancy. End-stage kidney disease may interfere with the proper nutrition and adequate homeostasis for the growing fetus. We present a successful case of pregnancy in a 36-year-old patient, on continuous ambulatory peritoneal dialysis (CAPD) and classified as an elderly multigravida. We discovered the pregnancy early, and the patient was carefully supervised by her nephrologists and gynecologists. She had been on her usual prescription for PD till the 13 th gestational week when she could not tolerate the fill volume. As a result, she was shifted to Continuous Cycler PD for the remainder of the pregnancy, with the fluid removal of 1000-1500mls/day. Her blood pressure remained well controlled with antihypertensive medications. The patient’s dialysis adequacy (Kt/V) ranged from 2.4 to 3.2. The lab investigations were steady throughout the entire pregnancy, and she was hospitalized at 33 weeks of gestation for a successful low-segment caesarean section (LSCS) delivery. The present case shows that a successful pregnancy was achieved in a patient undergoing PD with thorough counseling, close monitoring, and adequate dialysis clearance. Therefore, these women should not be discouraged from getting pregnant even if they reach an older age for pregnancy with ESKD and on dialysis.