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Intensivmedizin up2date 2014; 10(02): 105-116
DOI: 10.1055/s-0034-1365161
Allgemeine Prinzipien der Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Nierenersatztherapie bei kritisch kranken Patienten mit akuter Nierenschädigung

Alexander Zarbock
,
Philipp Kümpers
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Publication Date:
20 March 2014 (online)

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Kernaussagen

  • Die neue Definition der akuten Nierenschädigung beinhaltet eine vereinfachte Definition, die je nach Anstieg des Serum-Kreatininwerts und/oder Abfall der Urinproduktion eine Unterteilung in mehrere Schweregrade vorsieht.

  • Diese neue klinische Einteilung ermöglicht eine bessere Risikobeurteilung und korreliert mit der Schwere der Nierenschädigung.

  • Es gibt bislang noch keine prospektiven, randomisierten Studien, die zeigen, wann man in Abwesenheit „harter“ Indikationen bei kritisch kranken Patienten mit akuter Nierenschädigung mit einer Nierenersatztherapie beginnen sollte.

  • Bei hämodynamisch instabilen Patienten und bei Patienten mit einem erhöhten intrakraniellen Druck ist eine kontinuierliche einer intermittierenden Nierenersatztherapie vorzuziehen.

  • Die verfügbaren Daten sprechen für ein Austauschvolumen von mindestens 20 – 25 ml/kgKG/h bei kontinuierlichen Verfahren und eine Dialysedosis (Kt/V) von 3,9 pro Woche bei intermittierenden Verfahren.

 

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