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Langzeitüberleben bei chronischer Niereninsuffizienz

Long-term outcome with end-stage renal disease – survival is not enough: does dialysis or kidney transplantation matter?

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Im Endstadium der chronischen Niereninsuffizienz ist eine Nierenersatztherapie durch Dialysebehandlung oder Nierentransplantation notwendig. Das Überleben und die Lebensqualität (LQ) der Patienten mit terminaler Niereninsuffizienz sind nach erfolgreicher Nierentransplantation besser als unter einer chronischen Dialysebehandlung. Je früher die Nierentransplantation durchgeführt werden kann, desto besser ist das Patienten- und Transplantatüberleben. Die präemptive Lebendspende-Nierentransplantation ist daher die beste medizinische Versorgung für diese Patienten. Patienten mit terminaler Nierenerkrankung leiden unter einer Vielzahl körperlicher und psychischer Beschwerden. Die Prävalenz depressiver Störungen wird in dieser Population auf 20–25% geschätzt. Studien bei nierentransplantierten Kindern zeigen eine eingeschränkte LQ im körperlichen, aber eine insgesamt gute LQ im psychischen Bereich. Ein alarmierendes Ergebnis ist jedoch die hohe Non-Adhärenz-Rate in der Gruppe der Jugendlichen. Speziell für bewegungstherapeutische Interventionen während der Dialysebehandlung und nach der Transplantation zeigen vorliegende Studien ermutigende Ergebnisse. Wie sich neue Therapieformen der Immunsuppression auf die LQ auswirken, müssen zukünftige Studien zeigen.

Abstract

Patients with end-stage renal disease require renal replacement therapy with either dialysis or kidney transplantation. Survival and quality of life (QoL) after transplantation are superior to chronic dialysis. Early living donor kidney transplantation is best for patient and graft survival. Preemptive living-related kidney transplantation therefore is the best medical treatment option for these patients. Patients with end-stage renal disease suffer from multiple physical and psychological complaints. The prevalence of depressive disorders is 20–25% in this population. Studies on QoL in children after kidney transplantation show a reduced physical QoL, but an overall good psychological QoL. Alarming results of numerous studies are the high non-adherence rates in adolescents. Especially exercise interventions during dialysis and after kidney transplantation show promising results. Whether QoL of patients will improve with new approaches to immunosuppressive therapy remains to be evaluated in future studies.

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  1. Klinik und Poliklinik für Hepatobiliäre Chirurgie und Transplantationschirurgie und Institut für Medizinische Psychologie, Universitätsklinikum Eppendorf, Martinistr. 52, W26, 20241, Hamburg, Deutschland

    K.-H. Schulz

  2. Institut für Medizinische Psychologie, Universitätsklinikum Eppendorf, Hamburg, Deutschland

    K.-H. Schulz

  3. III. Medizinische Klinik und Poliklinik, Universitätsklinikum Eppendorf, Hamburg, Deutschland

    F. Thaiss

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Schulz, KH., Thaiss, F. Langzeitüberleben bei chronischer Niereninsuffizienz. Bundesgesundheitsbl. 55, 543–551 (2012). https://doi.org/10.1007/s00103-012-1450-2

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