Der Kardiologe

, Volume 8, Issue 1, pp 26–35 | Cite as

Dialyse- und Ultrafiltrationsverfahren bei kardiorenalem Syndrom

Empfehlung der Arbeitsgemeinschaft „Herz – Niere“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. und der Deutschen Gesellschaft für Nephrologie e.V.
  • V. Schwenger
  • B.A. Remppis
  • R. Westenfeld
  • T. Weinreich
  • R. Brunkhorst
  • G. Schieren
  • B. Krumme †
  • H. Haller
  • R. Schmieder
  • G. Schlieper
  • B. Frye
  • U.C. Hoppe
  • J. Hoyer
  • T. Keller
  • M. Blumenstein
  • H. Schunkert
  • F. Mahfoud
  • L.C. Rump
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  • 397 Downloads

Zusammenfassung

Patienten mit fortgeschrittener Herzinsuffizienz weisen oftmals auch eine begleitende Niereninsuffizienz auf. Diese enge pathophysiologische Interaktion wird als kardiorenales Syndrom (KRS) bezeichnet. Die hydropische Dekompensation ist bei diesen Patienten einer der häufigsten Hospitalisierungsgründe. Wenn trotz Optimierung der Therapie eine hydropische Dekompensation bzw. eine Diuretikaresistenz eintritt, kann eine Ultrafiltrationstherapie notwendig sein. In der akuten Dekompensation wird bei den oftmals intensivstationspflichtigen Patienten eine extrakorporale Nierenersatztherapie bevorzugt durchgeführt. Bei der chronischen Dekompensation, insbesondere wenn diese mit Aszitesbildung einhergeht, bietet eine peritoneale Ultrafiltration verfahrensspezifische Vorteile. Eine enge Kooperation zwischen Intensivmedizinern, Kardiologen und Nephrologen ist Voraussetzung für die optimale Behandlung des Patienten mit KRS.

Schlüsselwörter

Herzinsuffizienz Niereninsuffizienz Diuretikaresistenz Ultrafiltration Peritonealdialyse 

Dialysis and ultrafiltration therapy in patients with cardio-renal syndrome

Recommendations of the working group “heart-kidney” of the German Cardiac Society and the German Society of Nephrology

Abstract

Renal failure is common in patients with severe heart failure and this complex pathophysiological interaction is classified as cardiorenal syndrome. In these patients hydropic decompensation is the main reason for hospitalization. In patients with refractory heart failure characterized by diuretic resistance and congestion due to volume overload, ultrafiltration has to be considered. In cases of acute decompensated heart failure with deterioration of renal function, extracorporeal ultrafiltration is the preferred treatment modality. On the other hand, patients suffering from chronic decompensated heart failure, particularly patients with ascites, will profit from the treatment-specific advantages of peritoneal ultrafiltration. A prerequisite for an optimized care of patients with cardiorenal syndrome is the close collaboration between intensive care physicians, cardiologists and nephrologists.

Keywords

Heart failure Renal failure Diuretic resistance Ultrafiltration Peritoneal dialysis 

Notes

Widmung

This paper is dedicated to our colleague and coauthor Prof. Dr. Bernd Krumme (04.09.1961–07.09.2013).

Einhaltung ethischer Richtlinien

Interessenkonflikt. V. Schwenger, B.A. Remppis, R. Westenfeld, T. Weinreich, R. Brunkhorst, R. Schmieder, G. Schlieper, B. Frye, U.C. Hoppe, J. Hoyer, T. Keller, M. Blumenstein, H. Schunkert, F. Mahfoud, L.C. Rump, G. Schieren, B. Krumme und H. Haller geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • V. Schwenger
    • 1
  • B.A. Remppis
    • 2
  • R. Westenfeld
    • 3
  • T. Weinreich
    • 4
  • R. Brunkhorst
    • 5
  • G. Schieren
    • 6
  • B. Krumme †
    • 7
  • H. Haller
    • 8
  • R. Schmieder
    • 9
  • G. Schlieper
    • 10
  • B. Frye
    • 11
  • U.C. Hoppe
    • 12
  • J. Hoyer
    • 13
  • T. Keller
    • 14
  • M. Blumenstein
    • 15
  • H. Schunkert
    • 16
  • F. Mahfoud
    • 17
  • L.C. Rump
    • 6
  1. 1.Nierenzentrum HeidelbergMedizinische Universitätsklinik HeidelbergHeidelbergDeutschland
  2. 2.Klinik für KardiologieHerz- und Gefäßzentrum Bad BevensenBad BevensenDeutschland
  3. 3.Klinik für Kardiologie, Pneumologie und AngiologieUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  4. 4.Nephrologisches Zentrum Villingen-SchwenningenSchwenningenDeutschland
  5. 5.Klinik für Nieren-, Hochdruck- und Gefäßkrankheiten, Medizinische Klinik IKRH Klinikum Oststadt-HeidehausHannoverDeutschland
  6. 6.Klinik für NephrologieUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  7. 7.Deutsche Klinik für Diagnostik, KfH Nierenzentrum WiesbadenWiesbadenDeutschland
  8. 8.Klinik für Nieren- und HochdruckerkrankungenMedizinische Hochschule HannoverHannoverDeutschland
  9. 9.Forschungsstation CRC Nephrologie und HypertensiologieUniversitätsklinikum ErlangenErlangenDeutschland
  10. 10.Klinik für Nieren- und Hochdruckkrankheiten, rheumatologische und immunologische Erkrankungen (Medizinische Klinik II)Universitätsklinik RWTH AachenAachenDeutschland
  11. 11.Zentrum für Nieren- und Hochdruckerkrankungen MünsterMünsterDeutschland
  12. 12.Universitätsklinik für Innere Med. II, Kardiologie u. intern. IntensivmedizinPMU SalzburgSalzburgÖsterreich
  13. 13.Klinik für Innere Medizin, Schwerpunkt Nephrologie am Standort MarburgUniversitätsklinikum GießenMarburgDeutschland
  14. 14.Medizinische Klinik III, KardiologieUniversitätsklinikum, Goethe-Universität FrankfurtFrankfurtDeutschland
  15. 15.Innere Medizin – KardiologieKlinikum Augustinum MünchenMünchenDeutschland
  16. 16.Klinik für Herz- und Kreislauferkrankungen im ErwachsenenalterDeutsches Herzzentrum MünchenMünchenDeutschland
  17. 17.Klinik für Innere Medizin III, Kardiologie und AngiologieUniversitätsklinikum des SaarlandesHomburg/SaarDeutschland

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