Zusammenfassung
Die chronische Niereninsuffizienz wird in 5 Stadien eingeteilt; bei einer glomerulären Filtrationsrate (GFR) von 15 ml/min liegt das Stadium 5 vor. Diabetes und Hochdruck stellen zu über 50% die Ursache für Dialysepflicht dar. Dialysepflicht besteht in der Regel bei einer GFR von unter 10 ml/min, wobei das entscheidende Kriterium für die Dialyseeinleitung die klinische Symptomatik ist. Zu diesem Zeitpunkt sollte der Patient über die Möglichkeiten der Hämodialyse, der Peritonealdialyse und der Nierentransplantation inklusive der Lebendspende aufgeklärt werden. Die Vorteile von Dialysemodalitäten wie „High-flux“-Membranen, höhere Dialysefrequenz wie z. B. 6-mal pro Woche und nächtliche Dialyse sind Gegenstand aktueller Diskussion. Der Gefäßzugang ist ein entscheidener Faktor für eine effektive Dialyse und die Prognose des Patienten. Der rechtzeitigen Anlage von arteriovenösen Fisteln sollte der Vorzug vor Prothesen-Shunts gegeben werden. Falls sich Katheter nicht vermeiden lassen, sollten getunnelte Katheter mit Infektprophylaxe durch Locklösungen favorisiert werden.
Abstract
Chronic renal failure is categorized into five stages and stage 5 is defined as a glomerular filtration rate (GFR) below 15 ml/min. Diabetes and hypertensive nephropathy are the cause of dialysis dependency in more than 50% of patients and dialysis should be considered when the GFR falls below 10 ml/min but clinical symptoms should be the main indication for dialysis initiation. At this stage all patients should be informed about the options of hemodialysis, peritoneal dialysis and renal transplantation including living donation. The advantage of dialysis modalities, such as high-flux membranes, higher frequency, such as 6 times per week or nocturnal dialysis are currently being discussed. The vascular access is of utmost importance for efficient dialysis and the prognosis of patients. The timely creation of an arteriovenous fistula should be preferred to graft access. If a catheter is unavoidable a tunneled catheter plus infection prophylaxis with locking solutions should be preferred.
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Schindler, R. Was der Shunt-Chirurg von der Dialyse wissen muss. Gefässchirurgie 17, 779–787 (2012). https://doi.org/10.1007/s00772-012-1082-8
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DOI: https://doi.org/10.1007/s00772-012-1082-8