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Peritonealdialyse

Mehr Unabhängigkeit für Dialysepatienten mit Diabetes

Peritoneal dialysis

More autonomy for chronic dialysis patients with diabetes

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Der Diabetologe Aims and scope

Zusammenfassung

Die PD ist ein modernes Heimdialyseverfahren, das sich bei adäquater Dialysequalität durch hohe Lebensqualität bei erhaltener Patientenautonomie auszeichnet. Die Lebenserwartung ist bei der HD und PD vergleichbar, wobei in einzelnen Studien sogar eine geringere Mortalität in den ersten Jahren der Nierenersatztherapie mit der PD beobachtet wurde. Insbesondere für Diabetiker bietet die PD neben hoher Lebensqualität eine Vielzahl von Vorteilen, die insbesondere in der länger erhaltenen Nierenrestfunktion, den geringeren Elektrolytschwankungen, den fehlenden Problemen einer Shuntanlage und der höheren Blutdruckstabilität begründet sind. Die höhere peritoneale Glukoseresorption kann beim Diabetiker durch eine entsprechende Insulintherapie bei adäquater Blutzuckerkontrolle ausgeglichen werden und muss dem individuellen PD-Regime angepasst werden. Es sollte für den Diabetiker ein stabiles Regime angestrebt werden, wobei sich der Einsatz moderner, glukosefreier Dialysate als vorteilhaft erwiesen hat. Orale Antidiabetika kommen ohne Insulingabe nur bedingt zum Einsatz. Standardtherapie ist die subkutane intensivierte Insulintherapie und nur selten die intraperitoneale Applikationsform.

Abstract

Peritoneal dialysis (PD) is a modern kidney replacement option capable of meeting the high demands placed on the desired quality of life in a home therapy setting. Survival probability is comparable between hemodialysis (HD) and PD and some retrospective analyses have even proven lower mortality in the first years of PD. Especially diabetics benefit from PD as the initial dialysis treatment because it offers a better quality of life, better preservation of residual renal function, less electrolyte disorders, no complications due to fistulas for HD and less hypotensive periods. Higher peritoneal glucose absorption needs to be treated with equivalent insulin therapy according to the specific regimen to achieve adequate blood sugar control. It is recommended to treat diabetics with a stable PD regimen and especially in case of diabetes patients may benefit from modern glucose-free PD solutions. Oral antidiabetics play a minor role due to renal elimination and the risk of hyoglycemia. Standard therapy for diabetics is subcutaneous insulin rather than intraperitoneal administration.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor ist als Referent für die Firmen Baxter Healthcare, Fresenius Medical Care und Gambro tätig und wurde von Baxter Healthcare und Gambro bei klinisch, wissenschaftlichen Studien unterstützt.

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Correspondence to A. Fußhöller.

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Fußhöller, A., Rump, L. Peritonealdialyse. Diabetologe 5, 549–556 (2009). https://doi.org/10.1007/s11428-009-0484-z

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  • DOI: https://doi.org/10.1007/s11428-009-0484-z

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