Extrakorporale Nierenersatztherapie bei akuter Nierenschädigung

Empfehlungen der Sektionen „Niere“ der DGIIN, ÖGIAIN und DIVI

Extracorporeal renal replacement therapy in acute kidney injury

Recommendations from the renal section of the DGIIN, ÖGIAIN and DIVI

Zusammenfassung

Hintergrund

Eine akute Nierenschädigung ist bei Intensivpatienten mit bis zu über 50 % eine häufige Komplikation, die mit hoher Morbidität, Mortalität und schlechter Langzeitprognose assoziiert ist. Bei 5–25 % dieser Patienten mit akuter Nierenschädigung auf der Intensivstation ist eine Nierenersatztherapie notwendig. Es stehen hierfür unterschiedliche Nierenersatzverfahren zur Verfügung.

Ziel der Arbeit

Um Indikation, Zeitpunkt, Auswahl und Anwendung der Nierenersatztherapie beim Erwachsenen zu erleichtern, werden aktuelle Empfehlungen der Sektionen Niere der Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), der Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin (ÖGIAIN) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI) dargestellt.

Material und Methoden

Die Empfehlungen dieser Arbeit basieren auf den aktuellen KDIGO(Kidney Disease: Improving Global Outcomes)-Leitlinien, den Empfehlungen der 17th Acute Disease Quality Initiative (ADQI)/Consensus Group der Französischen Intensivmedizinischen Fachgesellschaften (SRLF, SFAR) und der Expertenmeinung und klinischer Erfahrung der Autoren.

Ergebnisse

Kontinuierliche Verfahren unterscheiden sich hinsichtlich der Mortalität nicht von intermittierenden oder verlängerten Dialyseverfahren, weisen aber Unterschiede in der Handhabung und Ökonomie auf. Eine individualisierte Risikostratifizierung bezüglich des Behandlungsbeginns und der Verfahrenswahl sollte erfolgen.

Abstract

Background

Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients. The incidence of AKI in ICU patients exceeds 50% and the associated morbidity and mortality rates increase with severity of AKI. In addition, long-term consequences of AKI are underestimated and several studies show impaired long-term outcome after AKI. In about 5–25% of ICU patients with AKI renal replacement therapy (RRT) is required.

Objectives

To assist in indication, timing, modality and application of renal replacement therapy of adult patients, current recommendations from the renal sections of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated.

Materials and methods

The recommendations stated in this paper are based on the current KDIGO (Kidney Disease: Improving Global Outcomes) guidelines, recommendations from the 17th Acute Disease Quality Initiative (ADQI) Consensus Group, the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) and the expert knowledge and clinical experience of the authors.

Results

Today, different treatment modalities for RRT are available. Although continuous RRT and intermittent dialysis therapy as well as continuous dialysis therapy have comparable outcomes, differences exist with respect to practical application as well as health–economic aspects. Individualized risk stratification might be helpful to choose the right time to start and the right treatment modality for patients.

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Correspondence to Prof. Dr. V. Schwenger.

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Interessenkonflikt

D. Kindgen-Milles, C. Willam, A. Jörres, W. Druml, D. Czock, S.J. Klein, M. Oppert und M. Schmitz geben an, dass kein Interessenkonflikt besteht. V. Schwenger erhielt Vortragshonorare von den Firmen Fresenius Medical Care und Baxter. J. T. Kielstein erhielt Vortragshonorare von den Firmen Fresenius Medical Care, Baxter und Terumo BCT sowie Forschungsunterstützung durch die Firma ExThera Medical. A. Zarbock erhielt finanzielle Unterstützung von den Firmen Astute Medical und Fresenius. M. Joannidis erhielt Vortrags‑/Beraterhonorare von den Firmen Baxter Healthcare Corp, CSL Behring, Fresenius, Astute Medical sowie Forschungsunterstützung von der Firma Fresenius. S. John erhielt Studienunterstützung und Vortragshonorare von der Firma Baxter.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Joannidis, Innsbruck

S. John, Nürnberg

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Schwenger, V., Kindgen-Milles, D., Willam, C. et al. Extrakorporale Nierenersatztherapie bei akuter Nierenschädigung. Med Klin Intensivmed Notfmed 113, 370–376 (2018). https://doi.org/10.1007/s00063-018-0418-x

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Schlüsselwörter

  • Akutes Nierenversagen
  • Dialyse
  • Hämodialyse
  • Hämofiltration
  • AKI

Keywords

  • Acute kidney injury
  • Dialysis
  • Hemodialysis
  • Hemofiltration
  • AKI