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Renale Rekompensation nach akuter Nierenschädigung bei chronisch kritisch kranken Patienten

Weaning from dialysis after acute kidney injury in chronically critically ill

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Zusammenfassung

Die Studie beschreibt den Verlauf der renalen Rekompensation nach Dialysepflicht für chronisch kritisch kranke Patienten in der Postakutphase. Die Studienergebnisse zeigen, dass erfolgreiche Dialyseauslassversuche auch Monate nach einer AKI in einer spezialisierten Einrichtung möglich sind. Bei 20 % der Patienten mit erfolgreichem Dialyseauslassversuch (welcher bei insgesamt 33 % aller Patienten in der Studie erfolgreich war) gelang die renale Rekompensation erst mehr als 3 Monate nach der Manifestation der dialysepflichtigen akuten Nierenschädigung (AKI). Die zeitliche Dauer der renalen Rekompensation unterscheidet sich zwischen den Patienten mit und ohne vorbestehende chronische Niereninsuffizienz (CKD) nicht. Die Ursache der Dialysebehandlung, wie z. B. eine Sepsis, ein chirurgischer Eingriff, eine Reanimation, sowie Risikofaktoren, wie z. B. Diabetes mellitus, arterielle Hypertonie, Atherosklerose, zeigten im multivariaten Hazard-Modell für die Entwöhnung der Patienten von der Dialyse keinen statistisch signifikanten Einfluss. Lediglich das Alter der Patienten beeinflusste die Entwöhnung von der Dialyse bei chronisch kritisch kranken Patienten statistisch signifikant.

Abstract

This study describes the course of renal recovery after dialysis in a specific population of chronically critically ill patients with a history of prolonged and complicated treatment in an intensive care unit. This study shows that, in a specialized center, patients can be successfully weaned from dialysis even months after acute kidney injury (AKI). Of the patients who could be recompensated (33%), approximately 20% achieved renal recovery more than 3 months after the start of dialysis. The duration of renal recovery after AKI did not differ between those patients with pre-existing chronic kidney disease (CKD) and those without. The reason for dialysis treatment such as sepsis, surgery, resuscitation, as well as the risk factors (e. g., diabetes mellitus, arterial hypertension, arteriosclerosis) did not reveal a difference in weaning in a hazard analysis. As a potential risk factor, only age significantly influenced weaning from dialysis in the multivariate hazard model.

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Authors and Affiliations

  1. Interdisziplinäre Intensivstation, Fachkrankenhaus der Klinik Bavaria in Kreischa, An der Wolfsschlucht 1–2, 01731, Kreischa, Deutschland

    M. Spacek MBA

  2. Abteilung Nephrologie/Dialyse, Klinik Bavaria in Kreischa, Kreischa, Deutschland

    K. Kunze

  3. Wissenschaftliches Institut, Klinik Bavaria in Kreischa, Kreischa, Deutschland

    J. Mehrholz

  4. Gesundheitswissenschaften/Public Health, Medizinische Fakultät, TU Dresden, Dresden, Deutschland

    J. Mehrholz

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  1. M. Spacek MBA
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  2. K. Kunze
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  3. J. Mehrholz
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Correspondence to M. Spacek MBA.

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Interessenkonflikt

M. Spacek, K. Kunze und J. Mehrholz geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Eine Einverständniserklärung der beteiligten Patienten war nicht notwendig.

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Spacek, M., Kunze, K. & Mehrholz, J. Renale Rekompensation nach akuter Nierenschädigung bei chronisch kritisch kranken Patienten. Med Klin Intensivmed Notfmed 114, 459–462 (2019). https://doi.org/10.1007/s00063-018-0488-9

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  • DOI: https://doi.org/10.1007/s00063-018-0488-9

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