Abstract
Fluids play an important role in clinical nephrology.
1) Temperature of dialysate fluid has recently re-attracted a lot of attention. Individualized
cooling of the dialysate (0.5 °C below predialysis ear temperature) has been shown
to not only prevent intradialytic hypotension but also to improve myocardial contractility
and to prevent white matter changes in CKD5D.
2) Access fluid in AKI is associated with an increased mortality. While Furosemide
has no place in treating AKI the Furosemide stress test can help to identify patients
with AKI that will eventually need renal replacement therapy.
3) Components of replacement fluid for therapeutic plasma exchange (albumin or fresh
frozen plasma) are high in demand. Especially the cost for albumin increases year
by year. Alternative solutions such as immunoadsorption should be studied and employed
for those indications where replenishment of plasma components is not necessary. Further,
a seperate reimbursement of repalcement fluid seems necessary to avoid a decline in
treatment quality.
Schlüsselwörter
Chronische Hämodialyse - Dialysebeginn - Akute Nierenschädigung - Nierenersatztherapie
- Plasmapherese
Keywords
Chronic hemodialysis - start of hemodialysis - acute kidney injury - renal replacement
therapy - plasma exchange
