Zusammenfassung
Multimorbide, ältere Dialysepatienten vertragen Hämodialysebehandlungen oft schlechter als jüngere. Typische Komplikationen sind intradialytische Hypotonie, Krämpfe, Vorhofflimmern und Abgeschlagenheit nach der Dialyse, die zu einem beschleunigten Verlust der Selbständigkeit in dieser Patientengruppe führen. Ätiologisch spielt eine verminderte Toleranzbreite gegenüber intradialytischen Schwankungen des Intravasalvolumens eine bedeutende Rolle. Diese ist bedingt durch eine Einschränkung physiologischer hämodynamischer Anpassungsmechanismen in Kombination mit einer urämischen und/oder diabetischen autonomen Neuropathie. Die daraus resultierenden relevanten Einschränkungen der Organperfusion in Darm, Leber, Nieren, Herz und Hirn tragen direkt zur Entstehung von Inflammation, Malnutrition, Herzinsuffizienz, Gebrechlichkeit, Depression und Demenz bei. Um diese fatalen Komplikationen bei älteren Dialysepatienten zu vermeiden, muss die Hämodialyseverordnung in zahlreichen Facetten an die Empfindlichkeit der multimorbiden älteren Patienten individuell angepasst werden.
Abstract
Elderly dialysis patients with multiple comorbidities often have poorer tolerance to hemodialysis treatment than younger patients. Typical complications, such as intradialytic hypotension, cramps, atrial fibrillation and post-dialysis fatigue contribute to a rapid loss of independence in this vulnerable patient population. The underlying etiology is a reduced tolerance to intravascular volume changes during dialysis, which is caused by impaired cardiovascular hemodynamic responses in combination with uremic and/or diabetic autonomous neuropathy. Significant reduction in organ perfusion occurring in the intestines, liver, kidneys, heart and brain contribute to the development of inflammation, malnutrition, heart failure, frailty, depression and dementia. To protect vulnerable elderly dialysis patients from these fatal complications of intradialytic tissue hypoxia, the prescription of hemodialysis needs to be individually adjusted in numerous aspects to the sensitivities of multimorbid elderly patients.
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F. Aregger und M.K. Kuhlmann geben an, dass kein Interessenkonflikt besteht.
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C. Erley, Berlin
W. Kleophas, Düsseldorf
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Aregger, F., Kuhlmann, M.K. Hämodialyse bei Älteren. Nephrologe 11, 320–327 (2016). https://doi.org/10.1007/s11560-016-0084-z
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DOI: https://doi.org/10.1007/s11560-016-0084-z