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Stellenwert, Indikationen und Grenzen der Peritonealdialyse

Relevance of peritoneal dialysis, indications for it and its limitations

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Peritoneal- und Hämodialyse werden als unterschiedliche, aber gleichwertige Dialyseverfahren angesehen. Für die meisten Patienten sind aus medizinischer Sicht beide Verfahren gleichermaßen geeignet. Wichtig für die Auswahl ist der Wunsch des umfassend informierten Patienten. Die durch die Peritonealdialyse erreichten Möglichkeiten der Berufsausübung, Freizeitgestaltung, Reiseplanung und Unabhängigkeit haben für viele Patienten einen hohen Stellenwert. Die Peritonealdialyse ist für Kinder und für Patienten mit Problemen mit der Hämodialyse zu bevorzugen und kontraindiziert bei aktiver oder intermittierender Divertikulitis. Erschwerte Bedingungen für die Peritonealdialyse sind Erkrankungen mit erhöhtem Peritonitisrisiko, Hernien, schwere obstruktive Lungenerkrankung, ausgeprägter Eiweißmangel und schwere Psychose. Fälschlich angenommene Kontraindikationen sind Multimorbidität, fortgeschrittenes Lebensalter, kardiovaskuläre Erkrankungen, Transplantatversagen, Zystennieren und Anurie.

Abstract

Peritoneal dialysis and haemodialysis are regarded as different, but equally good, treatment modalities for the end-stage renal failure. From a medical perspective both dialysis modalities are equally suitable for most patients. It is important that the modality selected is influenced by patient preference and that patients are well informed. Peritoneal dialysis offers the options of going out to work, arranging free time, planning trips and being independent, all of which are high priorities for many patients. Peritoneal dialysis is preferable to haemodialysis for children and for patients who have experienced problems with haemodialysis, while active and intermittent diverticulitis are contraindications. Peritoneal dialysis can be problematic in the presence of diseases involving an elevated risk of peritonitis, hernias, severe obstructive lung disease, severe protein deficiency malnutrition, and severe psychosis. Multimorbidity, advanced age, cardiovascular disease, failed kidney transplant, polycystic kidney disease and anuria have been wrongly regarded as contraindications.

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Mögliche Interessenkonflikte bestehen durch Beratungstätigkeit, Vorträge, Studien, wissenschaftliche Projekte bei Baxter Deutschland GmbH, Fresenius Medical Care Deutschland GmbH, Gambro Hospal GmbH.

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Kribben, A., Nebel, M., Herget-Rosenthal, S. et al. Stellenwert, Indikationen und Grenzen der Peritonealdialyse. Nephrologe 2, 74–81 (2007). https://doi.org/10.1007/s11560-007-0072-4

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