Pregnancy on Peritoneal Dialysis with Systemic Lupus Erythematosus and Chronic Renal Failure

Multidisciplinary Follow-up of an Exceptional Case.

Abstract

Introduction: Pregnancy in women undergoing peritoneal dialysis (PD) represents an exceptional and highly complex clinical scenario. The coexistence of Systemic Lupus Erythematosus (SLE) and chronic kidney disease (CKD) significantly worsens the maternal-fetal prognosis. Peritoneal dialysis during pregnancy offers advantages over hemodialysis by avoiding abrupt hemodynamic fluctuations and providing continuous solute clearance.

Case Report: A 20-year-old Ecuadorian woman with SLE (diagnosed in 2021), arterial hypertension, and stage 5 CKD—on automated PD since September 2023—was diagnosed with a 14-week pregnancy in April 2024. Dialysis was intensified to the "Tidal" modality with a total volume of 4,000 mL/day. Follow-up was multidisciplinary (nephrology, PD nursing, obstetrics, rheumatology, nutrition, and psychology). The SLE remained serologically inactive. Biochemical parameters stayed within acceptable ranges throughout the pregnancy. The patient progressed favorably, resulting in a successful delivery and a return to conventional PD postpartum.

Results: A female infant weighing 1,480 g, measuring 50 cm in length, with a head circumference of 29 cm, was delivered via lower-segment cesarean section at 32 weeks and 5 days of gestation. The patient’s clinical course was generally favorable throughout the pregnancy, with the exception of blood pressure elevations three days prior to delivery; however, there were no events related to active immune disease.

Conclusions: This case demonstrates that pregnancy in patients with PD and SLE can be successfully managed through early dialysis intensification and strict multidisciplinary follow-up. Key elements include: early initiation of intensive monitoring upon pregnancy diagnosis, intensification of PD, SLE in serological remission, continuous nutritional and psychological support, and a multidisciplinary team approach (nephrology, PD nursing, obstetrics, rheumatology, nutrition, and psychology). The published experience is limited to a series of cases and isolated reports; this represents a significant contribution to the scarce published evidence regarding pregnancy in patients with SLE and CKD undergoing peritoneal dialysis.