Dialyse- und Ultrafiltrationsverfahren bei kardio-renalem Syndrom. Empfehlung der Arbeitsgemeinschaft „Herz – Niere“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. und der Deutschen Gesellschaft für Nephrologie e.V.^[*]

This paper is dedicated to our colleague and coauthor Prof. Dr. Bernd Krumme (4. Sept. 1961 - 7. Sept. 2013)

Zusammenfassung

Patienten mit fortgeschrittener Herzinsuffizienz weisen oftmals auch eine begleitende Niereninsuffizienz auf. Diese enge pathophysiologische Interaktion wird als kardio-renales 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. This complex pathophysiological interaction has been classified as cardio-renal syndrome. In these patients hydropic decompensation is the main cause of hospitalization. In patients with refractory heart failure, characterized by diuretic resistance and congestion due to volume overload, ultrafiltration has to be considered. In acute decompensated heart failure with worsening 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. Prerequisite for an optimized care of patients with cardio-renal syndrome is the close collaboration among intensive care doctors, cardiologists and nephrologists.

Schlüsselwörter

Kardio-renales Syndrom - Herzinsuffizienz - Niereninsuffizienz - Diuretikaresistenz - Ultrafiltration - Peritonealdialyse - peritoneale Ultrafiltration - Register Herz-Niere

Keywords

Cardio-renal syndrome - heart failure - renal failure - diuretic resistance - ultrafiltration - peritoneal dialysis - peritoneal ultrafiltration - heart-kidney registry

*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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