Urea and creatinine generation and removal in a pregnant patient receiving peritoneal dialysis.

Peritoneal dialysis is the preferred form of dialysis during pregnancy because it is continuous and lacks the wide variation in chemistries, weight and blood pressure, and avoids the use of anticoagulation necessary during hemodialysis. This is a case report of a successful vaginal delivery of a 35 week healthy baby boy to a patient with end stage renal disease receiving peritoneal dialysis. Approximately one year after starting peritoneal dialysis for end stage renal disease of unknown etiology, this patient was noted to be pregnant during a transplant evaluation. BUN and creatinine generation increased with pregnancy. In order to keep the plasma BUN less than 50 mg/dl and creatinine less than 5 mg/dl, BUN and creatinine removal were increased by increasing the liters of dialysate from 8 liters to 16 liters per day. The peritoneal volume decreased from an initial 2 liters to 0.8 liter per exchange. The frequency of exchange increased. This was accomplished at home with a cycler so the patient was able to continue self care and maintain a quality of life. Peritoneal equilibration test during pregnancy did not change.