Salz- und Wasser-Zufuhr bei Dialysepatienten

ZUSAMMENFASSUNG

Die Regulation von Na⁺ und Aldosteron ist komplex und eng mit dem Renin-Angiotensin-II-Aldosteron-System (RAAS) verknüpft. Die Aldosteron-Renin-Relation wird in physiologischen und pathophysiologischen Situationen, z. B. durch eine Hämodialysebehandlung, entkoppelt. Zudem ist die Angiotensin-I-Aktivierung durch das Angiontensin I Converting Enzyme (ACE) gesteigert. Komplizierend ist Na⁺ mit unterschiedlichen Wirkungen kompartimentalisiert: extrazellulär volumenwirksam, ossär zum langsamen Austausch gespeichert und wasserfrei im Gewebe tonizitätsassoziiert metabolisch aktiv. Eine spezifisch Na⁺-arme Diät ist nicht sinnvoll, da sie mit einer höheren Mortalität assoziiert ist. Jedoch scheint bei sonst gutem Ernährungszustand eine Kochsalz-Zufuhr von unter 6–7 g/d und eine geringe interdialytische Gewichtszunahme vorteilhaft für das Überleben zu sein. Studien zum Dialysat-Na⁺ sind von mäßiger Qualität und zeigen, dass ein tieferes Dialysat-Na⁺ zu einer geringeren interdialytischen Gewichtszunahme, zu einem niedrigeren prädialytischen Blutdruck und zu einem reduzierten Einsatz von Antihypertensiva führt. Krämpfe und intradialytische Blutdruckabfälle nehmen zu. Einige potenzielle Forschungsfragestellungen werden beschrieben.

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