Zusammenfassung
Der Beginn einer chronischen Nierenersatztherapie ist für Patienten sehr häufig eine erhebliche Belastung und geht mit einer weitgehenden Änderung der Lebensführung und Autonomie einher. Gleichzeitig sind die medizinischen Risiken bei Erreichen des Stadium V der chronischen Niereninsuffizienz deutlich erhöht. Eine intensive nephrologische Betreuung kann die Häufigkeit von Komplikationen und die Zahl der Hospitalisierungen in dieser Phase nachweislich senken. Die Aufgabe des Nephrologen beinhaltet sowohl konkrete therapeutische Maßnahmen als auch die Schaffung eines Vertrauensverhältnisses, das notwendig ist, um den Patienten vom zeitgerechten Beginn einer Nierenersatztherapie zu überzeugen. Der Beitrag fasst die verschiedenen Aspekte zusammen, die bei der Vorbereitung von Patienten auf eine Dialysebehandlung beachtet werden sollten.
Abstract
For patients with advanced renal failure the start of renal replacement therapy has a high impact on the social as well as the medical well-being. It was shown that early referral to a nephrologist is of significance to reach lower morbidity and hospitalization rates when patients reach stage V of chronic kidney disease. Potential benefits of early referral include management of several dialysis-related and nondialysis issues. The manuscript summarizes the main aspects that should be paid attention to when patients are prepared for chronic renal replacement therapy.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Chan MR, Dall AT, Fletcher KE et al (2007) Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. Am J Med 120(12):1063–1070
Hasegawa T, Bragg-Gresham JL, Yamazaki S et al (2009) Greater first-year survival on hemodialysis in facilities in which patients are provided earlier and more frequent pre-nephrology visits. Clin J Am Soc Nephrol 4(3):595–602
Bonomini V, Feletti C, Scolari MP, Stefoni S (1985) Benefits of early initiation of dialysis. Kidney Int Suppl 17:S57–S59
Korevaar JC, Jansen MA, Dekker FW et al (2001) Netherlands Cooperative Study on the Adequacy of Dialysis Study Group When to initiate dialysis: effect of proposed US guidelines on survival. Lancet 358(9287):1046–1050
Traynor JP, Simpson K, Geddes CC et al (2002) Early initiation of dialysis fails to prolong survival in patients with end-stage renal failure. J Am Soc Nephrol 13(8):2125–2132
Kazmi WH, Gilbertson DT, Obrador GT et al (2005) Effect of comorbidity on the increased mortality associated with early initiation of dialysis. Am J Kidney Dis 46(5):887–896
Cooper BA, Branley P, Bulfone L et al (2004) IDEAL Study Steering Committee The Initiating Dialysis Early and Late (IDEAL) study: study rationale and design. Perit Dial Int 24(2):176–181
(n a) (2006) K/DOQI Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates Hemodialysis adequacy Peritoneal Dialysis Adequacy Vascular Access Am J Kidney Dis 48(Suppl 1):S1
(n a) (2005) EBPG: European Best Practice Guidelines for peritoneal dialysis. Nephrol Dial Transplant 20(Suppl 9):3
Ethier J, Mendelssohn DC, Elder SJ et al (2008) Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant (10):3219–3226
Tordoir J, Canaud B, Haage P et al (2007) EBPG on vascular access. Nephrol Dial Transplant 22 Suppl 2:ii88– ii117
Allon M, Lockhart ME, Lilly RZ et al (2001) Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 60(5):2013–2020
Dalman RL, Harris EJ Jr, Victor BJ, Coogan SM (2002) Transition to all-autogenous hemodialysis access: the role of preoperative vein mapping. Ann Vasc Surg 16(5):624–630
Flu H, Breslau PJ, Krol-van Straaten JM et al (2008) The effect of implementation of an optimized care protocol on the outcome of arteriovenous hemodialysis access surgery. J Vasc Surg 48(3):659–668
Fouque D, Laville M, Boissel JP (2006) Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev (2):CD001892
(n a) (2006) Dialysestandard Mitt. Klin Nephrologie XXXV/2006
Ikizler TA, Greene JH, Wingard RL et al (1995) Spontaneous dietary protein intake during progression of chronic renal failure. J Am Soc Nephrol 6(5):1386–1391
Mehrotra R, Berman N, Alistwani A, Kopple JD (2002) Improvement of nutritional status after initiation of maintenance hemodialysis. Am J Kidney Dis 40(1):133–142
Bond WW, Favero MS, Petersen NJ et al (1981) Survival of hepatitis B virus after drying and storage for one week. Lancet 1(8219):550–551
Girndt M (2008) Viral hepatitis in elderly haemodialysis patients: current prevention and management strategies. Drugs Aging 25(10):823–840
Fabrizi F, Andrulli S, Bacchini G (1997) Intradermal versus intramuscular hepatitis b re-vaccination in non-responsive chronic dialysis patients: a prospective randomized study with cost-effectiveness evaluation. Nephrol Dial Transplant 12(6):1204–1211
Barraclough KA, Wiggins KJ, Hawley CM et al (2009) Intradermal versus intramuscular hepatitis B vaccination in hemodialysis patients: a prospective open-label randomized controlled trial in nonresponders to primary vaccination. Am J Kidney Dis 54(1):95–103
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hetzel, G. Vorbereitung zur Nierenersatztherapie. Nephrologe 5, 184–191 (2010). https://doi.org/10.1007/s11560-009-0330-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11560-009-0330-8