Zusammenfassung
Über 65-jährige Patienten mit mehreren Begleiterkrankungen stellen die am schnellsten wachsende Altersgruppe in der deutschen Dialysepopulation dar. Im Gegensatz zu 80- und 90-Jährigen mit nur geringer Komorbidität, bei denen durch die Dialyse durchaus eine signifikante Lebensverlängerung erreicht werden kann, profitieren stark multimorbide ältere Patienten mit eingeschränkter körperlicher Funktionalität oft gar nicht oder nur sehr wenig von einer Dialyseeinleitung. Bei dieser Patientengruppe und auch bei Patienten, die sich in einer Patientenverfügung gegen eine Dialyse ausgesprochen haben, stellt ein intensives konservatives Management eine durchaus adäquate Alternative zur Dialyseeinleitung dar. Das Spektrum des konservativen Managements sollte neben der notwendigen medikamentösen Therapie einschließlich Erythropoetin zur Behandlung der renalen Anämie immer auch physiotherapeutische und ernährungsmedizinische Aspekte beinhalten.
Abstract
Patients aged 65 years and older with multiple comorbidities represent the most rapidly growing group of dialysis patients in Germany. In contrast to octo- and nonagenarians with little comorbidity and whose life expectancy clearly benefits from dialysis treatment, those elderly patients with complex comorbidity and impaired physical function show little or no benefit from dialysis. Such patients and those who refuse dialysis treatment benefit from intensive conservative management as a valid alternative. Besides the specific medications required to manage advanced chronic kidney disease, including erythropoietin, the course of conservative management should always include nutritional and physiotherapeutic aspects.
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Kuhlmann, M. Der ältere multimorbide Patient mit präterminaler Niereninsuffizienz. Nephrologe 5, 202–211 (2010). https://doi.org/10.1007/s11560-009-0367-8
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DOI: https://doi.org/10.1007/s11560-009-0367-8