Automatisierte Peritonealdialyse (APD) - Heimdialysetherapie mit Zukunft

Zusammenfassung

Die automatisierte Peritonealdialyse (APD) ist ein modernes Nierenersatzverfahren, das den hohen Anforderungen an die Dialyseeffektivität selbst beim anurischem Dialysepatienten gerecht werden kann. Darüber hinaus verbessert das Verfahren bei optimierter Gerätetechnologie in Abhängigkeit der individuellen Bedürfnisse die Lebensqualität vor allem der berufstätigen Patienten, sodass der Anteil der APD-Patienten an der Peritonealdialyse als führendes Heimdialyseverfahren zunimmt. Die Kombination der automatisierten Peritonealdialyse mit alternativen Dialyselösungen, wie beispielsweise dem isoosmolaren Glukosepolymer Icodextrin, für die lange Verweilzeit tagsüber, verbessert zusätzlich die Ultrafiltrationsvolumina. Der Einsatz biokompatibler neutral gepufferter Dialysate in der automatisierten Peritonealdialyse könnte in der Zukunft die Peritonitisinzidenz weiter senken und gegebenenfalls den Langzeitproblemen der Peritonealdialyse wie der Entwicklung einer peritonealen Fibrose bzw. peritonealen Neoangiogenese mit entsprechend funktionellen Einschränkungen der peritonealen Membran mit konsekutivem Ultrafiltrationsverlust entgegenwirken.

Summary

Automated peritoneal dialysis (APD) is a modern kidney replacement option capable of meeting the high demands placed on the adequacy of dialysis even in anuric dialysis patients. Moreover, with optimised technology, the modality improves the individual requirements in terms of quality of life, in particular in working patients, with the result that among dialysis patients, the proportion of those receiving APD as the leading home dialysis technique is on the increase. The combination of automated peritoneal dialysis with alternative dialysis solutions such as the iso-osmolar glucose polymer icodextrin for long diurnal dwell times further improves ultrafiltration volumes. The use of biocompatible buffered dialysates in APD might in future further lower the incidence of peritonitis and possibly counteract the long-term problems associated with peritoneal dialysis, such as peritoneal fibrosis or neoangiogenesis with associated functional impairment of the peritoneal membrane resulting in ultrafiltration loss.

Key Words

automated peritoneal dialysis - quality of life - icodextrin - ultrafiltration volume - ultrafiltration loss

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Anschrift des Verfassers