Zusammenfassung
Ein neues Dialyseverfahren bei kritisch kranken Patienten mit akutem Nierenversagen stellt die „extended daily dialysis“ (EDD) oder „slow low-efficient daily dialysis“ (SLEDD) dar, ein sog. Hybridverfahren, das die Vorteile der intermittierenden Dialyse und die der kontinuierlichen Dialyseverfahren vereint. Das Volumen kann durch dieses Verfahren aufgrund der längeren Behandlungsdauer langsamer entzogen werden als bei der intermittierenden Dialyse. Auf diese Weise sollen eine bessere hämodynamische Stabilität und eine bessere Korrektur der Hypervolämie erreicht werden. Durch Wegfall des Wechsels der Dialysatbeutel, wie bei der konventionellen CRRT-Behandlung („continous renal replacement therapy“) erforderlich, kann der Arbeitsaufwand für das Personal auf der Intensivstation erheblich reduziert werden, und es können möglicherweise Kosten eingespart werden, abhängig von der jeweiligen Infrastruktur der Zentren. Bisherige Studien zeigen, dass unter SLEDD mit dem Genius-System die Antikoagulationsmenge niedriger ist, verglichen mit der CRRT. Die SLEDD vereint eine hohe Effektivität mit guter kardiovaskulärer Stabilität. Prospektive Studien, welche die SLEDD direkt mit der CRRT vergleichen, würden helfen, die exakte Rolle für die SLEDD in Bezug auf kritisch kranke Patienten mit akutem Nierenversagen zu definieren.
Abstract
For intensive care unit patients with acute renal failure, a new dialysis process called extended daily dialysis (EDD) or slow low-efficient daily dialysis (SLEDD), a so-called hybrid process, is an increasingly popular renal replacement treatment that combines the advantages of intermittent dialysis and continuous renal replacement therapy. In contrast to intermittent dialysis, the reduced rate of ultrafiltration results in better hemodynamic stability, while low-efficiency solute removal minimizes solute disequilibrium. Moreover, the daily costs can be reduced since dialysis fluid is less expensive with SLEDD than with application of ready-to-use fluid bags in CRRT. In the present studies, anticoagulation requirements were less for patients treated with SLEDD using the Genius system compared with CRRT. SLEDD combines high efficiency with good cardiovascular stability. Prospective studies directly comparing SLEDD to CRRT will help define the exact role for SLEDD in the critical care setting.
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Zierhut, S., Kammerl, M. Nierenersatztherapie mittels SLEDD. Intensivmed 46, 490–495 (2009). https://doi.org/10.1007/s00390-009-0062-z
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DOI: https://doi.org/10.1007/s00390-009-0062-z
Schlüsselwörter
- Akutes Nierenversagen
- Kritisch kranke Patienten
- Kontinuierliche Nierenersatztherapie
- Langsame verlängerte tägliche Dialyse
- Intermittierende Hämodialyse