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Nierenersatztherapie bei schwerer Herzinsuffizienz

Renal replacement therapy in cardiac insufficiency

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Zunehmende Salz- und Wasserretention, Diuretikaresistenz und progrediente Nierenfunktionsverschlechterung markieren oft das Endstadium einer schweren Herzinsuffizienz. Nierenersatzverfahren finden in dieser Situation zunehmend Anwendung. Zur Verfügung stehen extrakorporale (Ultrafiltration, Hämofiltration, „slow low efficient dialysis“ (SLED), intermittierende Hämodialyse) und intrakorporale Verfahren (Peritonealdialyse), die eine intermittierende oder kontinuierliche Therapie ermöglichen. Für alle Verfahren ist eine Besserung der hämodynamischen sowie der klinischen Situation beschrieben. Es gibt jedoch keine Studien, die verschiedene Verfahren vergleichen oder die einen Einfluss auf die Mortalität der Patienten nachweisen. Die Wahl des Verfahrens erfolgt demnach je nach klinischen Begleitumständen und Patientenwunsch.

Da die Anämie bei herzinsuffizienten Patienten ein unabhängiger Mortalitätsprädiktor ist, wird auch der Ersatz der endokrinen Nierenfunktion als Erythropoese-regulierendes Organ diskutiert. Schließlich wird der Einsatz antikörperdepletierender Verfahren bei dilatativer Kardiomyopathie beschrieben.

Abstract

Salt and water retention, diuretic resistance, and progressive loss of renal function often mark the final stages of chronic heart failure. Renal replacement therapy is increasingly used in this situation. Extracorporeal (ultrafiltration, hemofiltration, slow low-efficient dialysis, hemodialysis) or intracorporeal (peritoneal dialysis) methods are used to provide either continuous or intermittent therapy. All treatment modalities can lead to hemodynamic and clinical improvement, but no study has compared different methods, and no effect on patient mortality has been described so far. The choice of treatment modality has to be based on clinical circumstances and patient preference.

Anemia is an independent predictor of mortality in congestive heart failure. Replacement of endocrine kidney function in the regulation of erythropoiesis is discussed, and antibody-depleting techniques in patients with dilated cardiomyopathy are described.

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  1. Medizinische Klinik V, Nephrologie, Angiologie, Rheumatologie, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95444, Bayreuth, Deutschland

    H.D. Rupprecht

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Rupprecht, H. Nierenersatztherapie bei schwerer Herzinsuffizienz. Nephrologe 5, 212–224 (2010). https://doi.org/10.1007/s11560-009-0333-5

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