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Dialyse- und Ultrafiltrationsverfahren bei kardiorenalem Syndrom

Empfehlung der Arbeitsgemeinschaft „Herz – Niere“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. und der Deutschen Gesellschaft für Nephrologie e.V.

Dialysis and ultrafiltration therapy in patients with cardio-renal syndrome

Recommendations of the working group “heart-kidney” of the German Cardiac Society and the German Society of Nephrology

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Zusammenfassung

Patienten mit fortgeschrittener Herzinsuffizienz weisen oftmals auch eine begleitende Niereninsuffizienz auf. Diese enge pathophysiologische Interaktion wird als kardiorenales Syndrom (KRS) bezeichnet. Die hydropische Dekompensation ist bei diesen Patienten einer der häufigsten Hospitalisierungsgründe. Wenn trotz Optimierung der Therapie eine hydropische Dekompensation bzw. eine Diuretikaresistenz eintritt, kann eine Ultrafiltrationstherapie notwendig sein. In der akuten Dekompensation wird bei den oftmals intensivstationspflichtigen Patienten eine extrakorporale Nierenersatztherapie bevorzugt durchgeführt. Bei der chronischen Dekompensation, insbesondere wenn diese mit Aszitesbildung einhergeht, bietet eine peritoneale Ultrafiltration verfahrensspezifische Vorteile. Eine enge Kooperation zwischen Intensivmedizinern, Kardiologen und Nephrologen ist Voraussetzung für die optimale Behandlung des Patienten mit KRS.

Abstract

Renal failure is common in patients with severe heart failure and this complex pathophysiological interaction is classified as cardiorenal syndrome. In these patients hydropic decompensation is the main reason for hospitalization. In patients with refractory heart failure characterized by diuretic resistance and congestion due to volume overload, ultrafiltration has to be considered. In cases of acute decompensated heart failure with deterioration of renal function, extracorporeal ultrafiltration is the preferred treatment modality. On the other hand, patients suffering from chronic decompensated heart failure, particularly patients with ascites, will profit from the treatment-specific advantages of peritoneal ultrafiltration. A prerequisite for an optimized care of patients with cardiorenal syndrome is the close collaboration between intensive care physicians, cardiologists and nephrologists.

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Widmung

This paper is dedicated to our colleague and coauthor Prof. Dr. Bernd Krumme (04.09.1961–07.09.2013).

Einhaltung ethischer Richtlinien

Interessenkonflikt. V. Schwenger, B.A. Remppis, R. Westenfeld, T. Weinreich, R. Brunkhorst, R. Schmieder, G. Schlieper, B. Frye, U.C. Hoppe, J. Hoyer, T. Keller, M. Blumenstein, H. Schunkert, F. Mahfoud, L.C. Rump, G. Schieren, B. Krumme und H. Haller geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Nierenzentrum Heidelberg, Medizinische Universitätsklinik Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Deutschland

    V. Schwenger

  2. Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland

    B.A. Remppis

  3. Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    R. Westenfeld

  4. Nephrologisches Zentrum Villingen-Schwenningen, Schwenningen, Deutschland

    T. Weinreich

  5. Klinik für Nieren-, Hochdruck- und Gefäßkrankheiten, Medizinische Klinik I, KRH Klinikum Oststadt-Heidehaus, Hannover, Deutschland

    R. Brunkhorst

  6. Klinik für Nephrologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    G. Schieren & L.C. Rump

  7. Deutsche Klinik für Diagnostik, KfH Nierenzentrum Wiesbaden, Wiesbaden, Deutschland

    B. Krumme †

  8. Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Hannover, Deutschland

    H. Haller

  9. Forschungsstation CRC Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland

    R. Schmieder

  10. Klinik für Nieren- und Hochdruckkrankheiten, rheumatologische und immunologische Erkrankungen (Medizinische Klinik II), Universitätsklinik RWTH Aachen, Aachen, Deutschland

    G. Schlieper

  11. Zentrum für Nieren- und Hochdruckerkrankungen Münster, Münster, Deutschland

    B. Frye

  12. Universitätsklinik für Innere Med. II, Kardiologie u. intern. Intensivmedizin, PMU Salzburg, Salzburg, Österreich

    U.C. Hoppe

  13. Klinik für Innere Medizin, Schwerpunkt Nephrologie am Standort Marburg, Universitätsklinikum Gießen, Marburg, Deutschland

    J. Hoyer

  14. Medizinische Klinik III, Kardiologie, Universitätsklinikum, Goethe-Universität Frankfurt, Frankfurt, Deutschland

    T. Keller

  15. Innere Medizin – Kardiologie, Klinikum Augustinum München, München, Deutschland

    M. Blumenstein

  16. Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter, Deutsches Herzzentrum München, München, Deutschland

    H. Schunkert

  17. Klinik für Innere Medizin III, Kardiologie und Angiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland

    F. Mahfoud

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  1. V. Schwenger
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  2. B.A. Remppis
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  3. R. Westenfeld
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  4. T. Weinreich
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  5. R. Brunkhorst
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  6. G. Schieren
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  7. B. Krumme †
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  8. H. Haller
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  9. R. Schmieder
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  10. G. Schlieper
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  11. B. Frye
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  13. J. Hoyer
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  14. T. Keller
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  15. M. Blumenstein
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  16. H. Schunkert
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  17. F. Mahfoud
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  18. L.C. Rump
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Correspondence to V. Schwenger.

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Dieser Artikel wurde in den Zeitschriften Der Kardiologe (DOI: 10.1007/s12181-013-0549-5) und Deutsche Medizinische Wochenschrift DMW (DOI: 10.1055/s-0033-1360037) zeitgleich publiziert.

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Schwenger, V., Remppis, B., Westenfeld, R. et al. Dialyse- und Ultrafiltrationsverfahren bei kardiorenalem Syndrom. Kardiologe 8, 26–35 (2014). https://doi.org/10.1007/s12181-013-0549-5

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