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Data about peritoneal dialysis are very scarce and limited to a low number of patients. The incidence of pregnancies in these patients is even lower than the rates for HD patients probably because the presence of hypertonic solutions in the peritoneum, previous episodes of peritonitis or physical factors that could interfere with fetal implantation. Most of the authors do not recommend changing the dialysis technique after conception [35, 36]. Data from the register of pregnant patients on dialysis and several reports showed no differences in the maternal and fetal results between HD and peritoneal [http://www.selleckchem.com/products/JNJ-26481585.html Quisinostat concentration] dialysis [9, 22, 37]. Peritoneal dialysis has the advantage of not inducing sudden metabolic changes, and allows for a gradual control of fluids, thus avoiding episodes of hypotension. The main disadvantage would be difficulty in maintaining proper nutrition [2]. Adjustment of medications and diet Attention to nutritional considerations is essential for a successful pregnancy because malnutrition is common in pregnancies of ESRD patients [19]. For this reason, it is mandatory to avoid proteins restriction [http://www.selleckchem.com/GSK-3.html selleck chemicals llc] g/kg of body weight/day in HD and 1.4 g/kg of body weight/day in peritoneal dialysis. Moreover, it is important to add 20 g/day of proteins to daily maternal needs for the correct fetal growth [2, 38] (http://www.nephromeet.com/web/procedure/documenti.cfm?p=lg_2edizione#). Some authors a suggest protein intake of 1.8 g/kg of body weight/day [17]. The caloric intake in this clinical setting should be of 35 kcal/kg of body weight/day in HD and 25 kcal/kg of body weight/day in peritoneal dialysis and folate supplementation with 1 mg/day should be administered starting from the first trimester (http://www.nephromeet.com/web/procedure/documenti.cfm?p=lg_2edizione#). Since the requirements for vitamins increase due to the fact that intensive dialysis promotes their elimination, these [http://en.wikipedia.org/wiki/Ankyrin ankyrin] molecules should be administered throughout the pregnancy [39]. The main vitamins to be supplemented are vitamin C, thiamine, riboflavin, niacin and vitamin B6 [35]. Occurrence of hypocalcaemia should be avoided by giving 1.5�C2 g of supplementary calcium daily that are necessary for a normal fetal growth in a woman with a normal dietary calcium intake of 800 mg/day. However, it is important to check weekly for serum calcium because both the calcium provided by the dialysate (1.5 mmol/L daily) and calcium intake of chelating agents might induce maternal hypercalcaemia and secondary fetal hypocalcaemia and hyperphosphataemia with impaired skeletal development [20]. The placenta converts calcidiol into calcitriol, thus 25-OH vitamin D must be measured every trimester, administering supplements if levels are low [2]. Although primary hyperparathyroidism is known to increase the frequency of pre-term births by 10�C20%, the effects of hyperparathyroidism on the fetus are unknown.