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Primäre Optionen der Nierenersatztherapie für Diabetiker

Renal replacement therapy for diabetics — primary options

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Zusammenfassung

Der Anteil von Diabetikern, die in ein Nierenersatzprogramm aufgenommen werden müssen, steigt kontinuierlich und hat in einzelnen Zentren 50% der Patienten erreicht, die neu in die Dialyse aufgenommen werden. Vorbereitung und Planung eines Nierenersatzverfahrens werden dadurch kompliziert, daß der Großteil der Diabetiker dem Nephrologen erst im Stadium des terminalen Nierenversagens vorgestellt wird. Unter den primären Behandlungsoptionen bilden Hämo- und Peritonealdialyse für einen mittelfristigen Zeitraum gleichwertige Therapieverfahren. Bei jüngeren Diabetikern kann eine Nieren- bzw. bei Typ-I-Diabetikern eine kombinierte Nieren-/Pankreastransplantation zu einer besseren Überlebensprognose beitragen. Alle Verfahren ergänzen sich und müssen individuell geplant und im Rahmen eines Langzeitkonzeptes eingesetzt werden. Der primäre Ausschluß älterer und polymorbider Diabetiker von der Dialyse ist in keinem Fall gerechtfertigt.

Summary

The proportion of diabetic patients commencing renal replacement therapy is continuously increasing and in some centers diabetes accounts for 50% of the new patients who enter the dialysis programme. Most of the diabetic patients are referred to the nephrologist at the beginning of end-stage renal failure which means delayed preparation and planning of dialysis therapy. Both, hemodialysis and peritoneal dialysis, offer equal therapeutic options in a medium-term period. Renal and combined renal-pancreatic transplantation in Type I diabetes may contribute to better survival in younger diabetics. All therapeutic options are complementary and have to be applied individually within a long-term treatment concept. The primary exclusion of older and polymorbid diabetic patients from dialysis treatment is not justified.

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  1. Humboldt-Krankenhaus, Innere Medizin III (Schwerpunkt Nieren- und Hochdruckkrankheiten) Berlin-Reinickendorf, Germany

    Wolfgang Pommer

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  1. Wolfgang Pommer
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Pommer, W. Primäre Optionen der Nierenersatztherapie für Diabetiker. Med. Klin. 92 (Suppl 1), 35–39 (1997). https://doi.org/10.1007/BF03041808

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