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Grundlagen der Peritonealdialyse

Basic principles of peritoneal dialysis

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Zusammenfassung

Hintergrund

Neben der Hämodialyse und der Nierentransplantation ist die Peritonealdialyse ein weiteres Nierenersatzverfahren, das aktuell in unseren Breitengraden zu selten angewandt wird.

Ziel der Arbeit

Die Gefäßchirurgen sollen mit den Modalitäten dieser Methode als mögliche Alternative zu einem Hämodialyseshunt vertraut werden.

Methode

Der Artikel gibt einen Überblick über die verfügbaren Techniken zur Peritonealdialyse.

Resultate

Der durch Diffusion, Konvektion und Ultrafiltration bewerkstelligte Austausch von harnpflichtigen Substanzen unter Verwendung von heute meist glukosehaltigem Dialysat in verschiedenen Konzentrationen kann manuell oder automatisch, kontinuierlich oder intermittierend, am Tag oder während der Nacht erfolgen. Es gibt die offene, die laparoskopische oder kombinierte Katheterimplantation neben interventionellen Verfahren mit ihren jeweiligen Vor- und Nachteilen. Es stehen auch eine breite Palette von Kathetermodellen zur Verfügung, angefangen vom klassischen Tenckhoff®-Katheter bis hin zu sich selbst lokalisierenden Wolfram-Kathetern. Katheterdislokationen und -infekte sind die häufigsten Komplikationen bei diesem Verfahren.

Schlussfolgerungen

Die Peritonealdialyse ist bezüglich Mortalität und Morbidität einer Hämodialyse ebenbürtig, bietet aber für den Patienten dank kontinuierlicher Dialyse einen großen Komfort und erlaubt eine ortsungebundenere Bewegungsfreiheit.

Abstract

Background

In addition to hemodialysis and renal transplantation, peritoneal dialysis (PD) is an alternative renal replacement therapy that should receive more attention in Europe.

Aim of the work

A vascular surgeon should be familiar with this method as an alternative to hemodialysis.

Method

This article gives a review of the techniques available for peritoneal dialysis.

Results

Peritoneal dialysis can be performed manually or automatically, continuously or intermittently, during the day or even at night using diffusion, convection and ultrafiltration to exchange renal toxins by administration of solutions containing different concentrations of dextrose. Catheter implantation includes open, laparoscopic or a combination of both techniques, besides the interventional guided placement with their respective advantages and disadvantages. Different catheters ranging from the classical Tenckhoff® model to self-locating models with tungsten are available. Catheter dislocation and infections are the main complications of peritoneal dialysis.

Conclusions

The mortality and morbidity associated with peritoneal dialysis is similar to that of hemodialysis. The patients benefit from this method as the continuous dialysis offers more comfort and a greater freedom of movement.

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Danksagung

Wir danken Prof. Dr. med. D.E. Uehlinger, Universitätsklinik für Nerphrologie, Hypertonie und klinische Pharmakologie, Universitätsspital Bern für die kritische Durchsicht des Manuskriptes.

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Authors and Affiliations

  1. Universitätsklinik für Herz- und Gefässchirurgie, Universität Bern, 3010, Bern, Schweiz

    C. Geppert &  M.K. Widmer

  2. Southwestern Medical Center, University of Texas, Dallas, Texas USA

    R. Saxena

  3. Nephrology, School of Medicine, University of Milano, Milano, Italien

    M. Gallieni

Authors
  1. C. Geppert
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  2. M.K. Widmer
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  3. R. Saxena
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  4. M. Gallieni
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Corresponding author

Correspondence to M.K. Widmer.

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Interessenkonflikt

C. Geppert, M.K. Widmer, R. Saxena und M. Gallieni geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Geppert, C., Widmer, M., Saxena, R. et al. Grundlagen der Peritonealdialyse. Gefässchirurgie 20, 564–570 (2015). https://doi.org/10.1007/s00772-015-0093-7

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  • DOI: https://doi.org/10.1007/s00772-015-0093-7

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