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Langzeitüberleben bei chronischer Niereninsuffizienz

  • K.-H. SchulzEmail author
  • F. Thaiss
Leitthema

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.

Schlüsselwörter

Chronische Nierenerkrankung Dialyse Nierentransplantation Lebensqualität Bewegungstherapie 

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

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.

Keywords

Chronic kidney disease Dialysis Kidney transplantation Quality of life Exercise 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Parker T III, Hakim R, Nissenson AR et al (2011) Dialysis at a crossroads: 50 years later. Clin J Am Soc Nephrol 6:457–461PubMedCrossRefGoogle Scholar
  2. 2.
    Himmelfarb J, Ikizler TA (2010) Hemodialysis. N Engl J Med 363:1833–1845PubMedCrossRefGoogle Scholar
  3. 3.
    Lameire N, van Biesen W, Vanholder R (2009) Did 20 years of technological innovations in hemodialysis contribute to better patient outcomes? Clin J Am Soc Nephrol 4:30–40CrossRefGoogle Scholar
  4. 4.
    Galliford J, Game DS (2009) Modern renal transplantation: present challenges and future prospects. Postgrad Med J 85:91–101PubMedCrossRefGoogle Scholar
  5. 5.
    Inrig JK, Sun JL, Yang Q et al (2006) Mortality by dialysis modality among patients who have end-stage renal disease and are awaiting renal transplantation. Clin J Am Soc Nephrol 1:774–779PubMedCrossRefGoogle Scholar
  6. 6.
    Liem YS, Weimar W (2009) Early living-donor kidney transplantation: a review of the associated survival benefit. Transplantation 87:317–318PubMedCrossRefGoogle Scholar
  7. 7.
    Davis CL (2010) Preemptive transplantation and the transplant first initiative. Curr Opin Nephrol Hypertens 19:592–597PubMedCrossRefGoogle Scholar
  8. 8.
    McFarlane PA (2010) Should patients remain on intensive hemodialysis rather than choosing to receive a kidney transplant? Semin Dial 23(5):516–519PubMedCrossRefGoogle Scholar
  9. 9.
    Braam B, Verhaar MC, Blankestijn P et al (2007) Technology insight: innovative options for end-stage renal disease – from kidney refurbishment to artificial kidney. Nat Clin Pract Nephrol 3(10):564–572PubMedCrossRefGoogle Scholar
  10. 10.
    Turka LA, Lechler RI (2009) Towards the identification of biomarkers of transplantation tolerance. Nat Rev Immunol 9:521–526PubMedCrossRefGoogle Scholar
  11. 11.
    Weisbord SD, Fried LF, Arnold RM et al (2005) Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol 16:2487–2894PubMedCrossRefGoogle Scholar
  12. 12.
    Davison SN, Jhangri GS (2010) Impact of pain and symptom burden on the health-related quality of life of hemodialysis patients. J Pain Symptom Manage 39(3):477–485PubMedCrossRefGoogle Scholar
  13. 13.
    Solano JP, Gomes B, Higginson IJ (2006) A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 31(1):58–69PubMedCrossRefGoogle Scholar
  14. 14.
    Abdel-Kader K, Unruh ML, Weisbord SD (2009) Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol 4:1057–1064PubMedCrossRefGoogle Scholar
  15. 15.
    Kimmel PL, Peterson RA, Weihs KL et al (2000) Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int 57:2093–2098PubMedCrossRefGoogle Scholar
  16. 16.
    Hedayati SS, Minhajuddin AT, Toto RD et al (2009) Prevalence of major depressive episode in CKD. Am J Kidney Dis 54(3):424–432PubMedCrossRefGoogle Scholar
  17. 17.
    Hedayati SS, Bosworth HB, Briley LP et al (2008) Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression. Kidney Int 74:930–936PubMedCrossRefGoogle Scholar
  18. 18.
    Hedayati SS, Finkelstein FO (2009) Epidemiology, diagnosis, and management of depression in patients with CKD. Am J Kidney Dis 54(4):741–752PubMedCrossRefGoogle Scholar
  19. 19.
    Raison CL, Capuron L, Miller AH (2006) Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol 27:24–31PubMedCrossRefGoogle Scholar
  20. 20.
    Miller AH, Maletic V, Raison CL (2009) Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry 65:732–741PubMedCrossRefGoogle Scholar
  21. 21.
    Dowlati Y, Herrmann N, Swardfager W et al (2010) A meta-analysis of cytokines in major depression. Biol Psychiatry 67:446–457PubMedCrossRefGoogle Scholar
  22. 22.
    Capuron L, Miller AH (2004) Cytokines and psychopathology: lessons from interferon-alpha. Biol Psychiatry 56:819–824PubMedCrossRefGoogle Scholar
  23. 23.
    Tyring S, Gottlieb A, Papp K et al (2006) Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebo-controlled randomised phase III trial. Lancet 367(9504):29–35PubMedCrossRefGoogle Scholar
  24. 24.
    Chawla LS, Krishnan M (2009) Causes and consequences of inflammation on anemia management in hemodialysis patients. Hemodial Int 13(2):222–234PubMedCrossRefGoogle Scholar
  25. 25.
    Cowen PJ (2010) Not fade away: the HPA axis and depression. Psychol Med 40:1–4PubMedCrossRefGoogle Scholar
  26. 26.
    Troidle L, Watnick S, Wuerth DB et al (2003) Depression and its association with peritonitis in long-term peritoneal dialysis patients. Am J Kidney Dis 42:350–354PubMedCrossRefGoogle Scholar
  27. 27.
    Schulz K-H (2009) Zur Bedeutung chronischer Belastung und sozialer Unterstützung für die Entwicklung körperlicher Erkrankungen. In: Schumpelick V, Vogel B (Hrsg) Volkskrankheiten. Gesundheitliche Herausforderungen in der Wohlstandsgesellschaft. Herder, Freiburg, S 527–552Google Scholar
  28. 28.
    Spengler U (2010) Non Adherence-Non Response in der Transplantationsmedizin. Therapeutische Umschau 6:317–322CrossRefGoogle Scholar
  29. 29.
    Cukor D, Rosenthal DS, Jindal RM et al (2009) Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int 75(11):1223–1229PubMedCrossRefGoogle Scholar
  30. 30.
    Denhaerynck K, Manhaeve D, Dobbels F et al (2007) Prevalence and consequences of nonadherence to hemodialysis regimens. Am J Crit Care 16(3):222–235PubMedGoogle Scholar
  31. 31.
    Saran R, Bragg-Gresham JL, Rayner HC et al (2003) Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int 64:254–262PubMedCrossRefGoogle Scholar
  32. 32.
    Matteson ML, Russell C (2010) Interventions to improve hemodialysis adherence: a systematic review of randomized-controlled trials. Hemodial Int 14(4):370–382PubMedCrossRefGoogle Scholar
  33. 33.
    McDonald HP, Garg A, Haynes RB (2002) Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 288:2868–2879PubMedCrossRefGoogle Scholar
  34. 34.
    Haynes RB, Yao X, Degani A et al (2005) Interventions to enhance medication adherence [update of Cochrane Database Syst Rev 2002 (2):CD000011; PMID: 12076376]. Cochrane Database Syst Rev (4):CD000011Google Scholar
  35. 35.
    Dew MA, Switzer GE, Goycoolea JM et al (1997) Does transplantation produce quality of life benefits? A quantitative analysis of the literature. Transplantation 15, 64(9):1261–1273Google Scholar
  36. 36.
    Schulz K-H, Kraft S, Ewers H et al (2002) Lebensqualität nach Organtransplantation. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 45:782–794CrossRefGoogle Scholar
  37. 37.
    Cameron JI, Whiteside C, Katz J, Devins GM (2000) Differences in quality of life across renal replacement therapies: a meta-analytic comparison. Am J Kidney Dis 35(4):629–637PubMedCrossRefGoogle Scholar
  38. 38.
    Liem YS, Bosch JL, Arends LR et al (2007) Quality of life assessed with the Medical Outcomes Study Short Form 36-Item Health Survey of patients on renal replacement therapy: a systematic review and meta-analysis. Value Health 10(5):390–397PubMedCrossRefGoogle Scholar
  39. 39.
    Laupacis A, Keown P, Pus N et al (1996) A study of the quality of life and cost-utility of renal transplantation. Kidney Int 50:235–242PubMedCrossRefGoogle Scholar
  40. 40.
    Shield CF, McGrath MM, Goss TF (1997) Assessment of health-related quality of life in kidney transplant patients receiving tacrolimus (FK506)-based versus cyclosporine-based immunosuppression. FK506 Kidney Transplant Study Group. Transplantation 64:1738–1743PubMedCrossRefGoogle Scholar
  41. 41.
    Hathaway DK, Winsett RP, Johnson C et al (1998) Post kidney transplant quality of life prediction models. Clin Transplant 12:168–174PubMedGoogle Scholar
  42. 42.
    Jofre R, Lopez-Gomez JM, Moreno F et al (1998) Changes in quality of life after renal transplantation. Am J Kidney Dis 32:93–100PubMedCrossRefGoogle Scholar
  43. 43.
    Neipp M, Karavul B, Jackobs S et al (2006) Quality of life in adult transplant recipients more than 15 years after kidney transplantation. Transplantation 81(12):1640–1644PubMedCrossRefGoogle Scholar
  44. 44.
    Laupacis A, Pus N, Muirhead N et al (1993) Disease-specific questionnaire for patients with a renal transplant. Nephron 64:226–231PubMedCrossRefGoogle Scholar
  45. 45.
    Finkelstein FO, Wuerth D, Finkelstein SH (2009) Health related quality of life and the CKD patient: challenges for the nephrology community. Kidney Int 76(9):946–952PubMedCrossRefGoogle Scholar
  46. 46.
    Ouzouni S, Kouidi E, Sioulis A et al (2009) Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients. Clin Rehabil 23(1):53–63PubMedCrossRefGoogle Scholar
  47. 47.
    Brenner I (2009) Exercise performance by hemodialysis patients: a review of the literature. Phys Sportsmed 37(4):84–96PubMedCrossRefGoogle Scholar
  48. 48.
    Takhreem M (2008) The effectiveness of intradialytic exercise prescription on quality of life in patients with chronic kidney disease. Medscape J Med 10(10):226PubMedGoogle Scholar
  49. 49.
    Parsons TL, Toffelmire EB, King-VanVlack CE (2006) Exercise training during hemodialysis improves dialysis efficacy and physical performance. Arch Phys Med Rehabil 87:680–687PubMedCrossRefGoogle Scholar
  50. 50.
    Kong CH, Tattersall JE, Greenwood RN, Farrington K (1999) The effect of exercise during haemodialysis on solute removal. Nephrol Dial Transplant 14:2927–2931PubMedCrossRefGoogle Scholar
  51. 51.
    O’Hare AM, Tawney K, Bacchetti P et al (2003) Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2. Am J Kidney Dis 41:447–454CrossRefGoogle Scholar
  52. 52.
    Shlipak MG, Fried LF, Cushman M et al (2005) Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA 293:1737–1745PubMedCrossRefGoogle Scholar
  53. 53.
    Cheema BS, Singh MA (2005) Exercise training in patients receiving maintenance hemodialysis: a systematic review of clinical trials. Am J Nephrol 25(4):352–364PubMedCrossRefGoogle Scholar
  54. 54.
    Gordon EJ, Prohaska T, Siminoff LA et al (2005) Needed: tailored exercise regimens for kidney transplant recipients. Am J Kidney Dis 45(4):769–774PubMedCrossRefGoogle Scholar
  55. 55.
    Painter PL, Hector L, Ray K et al (2002) A randomized trial of exercise training after renal transplantation. Transplantation 74:42–48PubMedCrossRefGoogle Scholar
  56. 56.
    Macdonald JH, Kirkman D, Jibani M (2009) Kidney transplantation: a systematic review of interventional and observational studies of physical activity on intermediate outcomes. Adv Chronic Kidney Dis 16:482–500PubMedCrossRefGoogle Scholar
  57. 57.
    Gordon EJ, Prohaska TR, Gallant MP et al (2009) Longitudinal analysis of physical activity, fluid intake, and graft function among kidney transplant recipients. Transpl Int 22(10):990–998PubMedCrossRefGoogle Scholar
  58. 58.
    Groothoff JW, Grootenhuis M, Dommerholt A et al (2002) Impaired cognition and schooling in adults with end stage renal disease since childhood. Arch Dis Child 87:380–385PubMedCrossRefGoogle Scholar
  59. 59.
    Broyer M, Le BC, Charbit M et al (2004) Long-term social outcome of children after kidney transplantation. Transplantation 77:1033–1037PubMedCrossRefGoogle Scholar
  60. 60.
    Bawden HN, Acott P, Carter J et al (2004) Neuropsychological functioning in end-stage renal disease. Arch Dis Child 89(7):644–647PubMedCrossRefGoogle Scholar
  61. 61.
    Groothoff JW, Grootenhuis MA, Offringa M et al (2005) Social consequences in adult life of end-stage renal disease in childhood. J Pediatr 146(4):512–517PubMedCrossRefGoogle Scholar
  62. 62.
    Groothoff JW, Grootenhuis MA, Offringa M et al (2003) Quality of life in adults with end-stage renal disease since childhood is only partially impaired. Nephrol Dial Transplant 18(2):310–317PubMedCrossRefGoogle Scholar
  63. 63.
    Sundaram SS, Landgraf JM, Neighbors K et al (2007) Adolescent health-related quality of life following liver and kidney transplantation. Am J Transplant 7(4):982–989PubMedCrossRefGoogle Scholar
  64. 64.
    Bartosh S, Leverson G, Robillard D, Sollinger H (2003) Long-term outcomes in pediatric renal transplant recipients who survive into adulthood. Transplantation 76(8):1195–2000PubMedCrossRefGoogle Scholar
  65. 65.
    Qvist E, Närhi V, Apajasalo M et al (2004) Psychosocial adjustment and quality of life after renal transplantation in early childhood. Pediatr Transplant 8(2):120–125PubMedCrossRefGoogle Scholar
  66. 66.
    Kärrfelt HME, Berg UB (2008) Long-term psychosocial outcome after renal transplantation during childhood. Pediatr Transplant 12:557–562PubMedCrossRefGoogle Scholar
  67. 67.
    Grootenhuis MA, Stam H, Last BF, Groothoff JW (2006) The impact of delayed development on the quality of life of adults with end-stage renal disease since childhood. Pediatr Nephrol 21(4):538–544PubMedCrossRefGoogle Scholar
  68. 68.
    Brouhard BH, Donaldson LA, Lawry KW et al (2000) Cognitive functioning in children on dialysis and post-transplantation. Pediatr Transplant 4(4):261–267PubMedCrossRefGoogle Scholar
  69. 69.
    Davis ID (1999) Pediatric renal transplantation: back to school issues. Transplant Proc 31(4A):61–62CrossRefGoogle Scholar
  70. 70.
    Berney-Martinet S, Key F, Bell L et al (2009) Psychological profile of adolescents with a kidney transplant. Pediatr Transplant 13(6):701–710PubMedCrossRefGoogle Scholar
  71. 71.
    Anthony SJ, Hebert D, Todd L et al (2010) Child and parental perspectives of multidimensional quality of life outcomes after kidney transplantation. Pediatr Transplant 14:249–256PubMedCrossRefGoogle Scholar
  72. 72.
    Dobbels F, Decorte A, Roskams A, Van Damme-Lombaerts R (2010) Health-related quality of life, treatment adherence, symptom experience and depression in adolescent renal transplant patients. Pediatr Transplant 14(2):216–223PubMedCrossRefGoogle Scholar
  73. 73.
    Shemesh E, Annunziato RA, Shneider BL et al (2005) Parents and clinicians underestimate distress and depression in children who had a transplant. Pediatr Transplant 9:673–679PubMedCrossRefGoogle Scholar
  74. 74.
    Takemoto SK, Pinsky BW, Schnitzler MA et al (2007) A retrospective analysis of immunosuppression compliance, dose reduction and discontinuation in kidney transplant recipients. Am J Transplant 7:2704–2711PubMedCrossRefGoogle Scholar
  75. 75.
    Dobbels F, Ruppar T, De Geest S et al (2010) Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: a systematic review. Pediatr Transplant 14(5):603–613PubMedCrossRefGoogle Scholar
  76. 76.
    Dew MA, Dimartini AF, De Vito Dabbs A et al (2007) Rate and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation 83:858–873PubMedCrossRefGoogle Scholar
  77. 77.
    Magee JC, Krishnan SM, Benfield MR et al (2008) Pediatric transplantation in the United States, 1997–2006. Am J Transplant 8(4):935–945PubMedCrossRefGoogle Scholar
  78. 78.
    Horslen S, Barr ML, Christensen LL et al (2007) Pediatric transplantation in the United States, 1996–2005. Am J Transplant 7(5):1339–1358PubMedCrossRefGoogle Scholar
  79. 79.
    Rianthavorn P, Ettenger RB, Malekzadeh M et al (2004) Noncompliance with immunosuppressive medications in pediatric and adolescent patients receiving solid-organ transplants. Transplantation 77:778–782PubMedCrossRefGoogle Scholar
  80. 80.
    Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497PubMedCrossRefGoogle Scholar
  81. 81.
    Schäfer-Keller P, Steiger J, Bock A et al (2008) Diagnostic accuracy of measurement methods to assess non-adherence to immunosuppressive drugs in kidney transplant recipients. Am J Transplant 8:616–626PubMedCrossRefGoogle Scholar
  82. 82.
    Vlaminck H, Maes B, Evers G et al (2004) Prospective study on late consequences of subclinical non-compliance with immunosuppressive therapy in renal transplant patients. Am J Transplant 4:1509–1513PubMedCrossRefGoogle Scholar
  83. 83.
    Nevins TE, Kruse L, Skeans MA et al (2001) The natural history of azathioprine compliance after renal transplantation. Kidney Int 60:1565–1570PubMedCrossRefGoogle Scholar
  84. 84.
    Nevins TE, Thomas W (2009) Quantitative patterns of azathioprine adherence after renal transplantation. Transplantation 87:711–718PubMedCrossRefGoogle Scholar
  85. 85.
    De Bleser L, Matteson M, Dobbels F et al (2009) Interventions to improve medication adherence after transplantation: a systematic review. Transpl Int 22:780–797CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2012

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Hepatobiliäre Chirurgie und Transplantationschirurgie und Institut für Medizinische PsychologieUniversitätsklinikum EppendorfHamburgDeutschland
  2. 2.Institut für Medizinische PsychologieUniversitätsklinikum EppendorfHamburgDeutschland
  3. 3.III. Medizinische Klinik und PoliklinikUniversitätsklinikum EppendorfHamburgDeutschland

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