Nierenersatzverfahren und Plasmapherese

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

• Literatur

• 1 Bergstrom J. Ultrafiltration without simultaneous dialysis for removal of excess fluid. Proc Eur Dial Transplant Assoc 1978; 15: 260-270
• 2 Selby NM, Burton JO, Chesterton LJ, McIntyre CW. Dialysis-induced regional left ventricular dysfunction is ameliorated by cooling the dialysate. Clin J Am Soc Nephrol 2006; 1: 1216-1225
• 3 Reising A, Sambale S, Donnerstag F et al. Effect of isovolemic, isothermic hemodialysis on cerebral perfusion and vascular stiffness using contrast computed tomography and pulse wave velocity. PLoS One 2013; 8: e56396
• 4 Eldehni MT, Odudu A, McIntyre CW. Randomized clinical trial of dialysate cooling and effects on brain white matter. J Am Soc Nephrol 2015; 26: 957-965
• 5 Muthalagappan S, Johansson L, Kong WM, Brown EA. Dialysis or conservative care for frail older patients: ethics of shared decision-making. Nephrol Dial Transplant 2013; 28: 2717-2722
• 6 Kielstein R, Sass HM. From wooden limbs to biomaterial organs: the ethics of organ replacement and artificial organs. Artif Organs 1995; 19: 475-480
• 7 Alfaadhel TA, Soroka SD, Kiberd BA et al. Frailty and Mortality in Dialysis: Evaluation of a Clinical Frailty Scale. Clin J Am Soc Nephrol 2015; 10: 832-840
• 8 Koyner JL, Davison DL, Brasha-Mitchell E et al. Furosemide Stress Test and Biomarkers for the Prediction of AKI Severity. J Am Soc Nephrol 2015;
• 9 Zhang L, Yang J, Eastwood GM et al. Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis. Am J Kidney Dis 2015;
• 10 Prowle JR, Kirwan CJ, Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol 2014; 10: 37-47
• 11 Schmidt JJ, Beutel G, Kielstein JT. Diagnostik und Pathophysiologie der aktuen Nierenschädigung / des akuten Nierenversagens – Prävention möglich?. Dtsch Med Wochenschr 2015; 140: 245-249
• 12 Pickering JW, James MT, Palmer SC. Acute kidney injury and prognosis after cardiopulmonary bypass: a meta-analysis of cohort studies. Am J Kidney Dis 2015; 65: 283-293
• 13 Harel Z, Wald R, Bargman JM et al. Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. Kidney Int 2013; 83: 901-908
• 14 Ius F, Sommer W, Tudorache I et al. Preemptive treatment with therapeutic plasma exchange and rituximab for early donor-specific antibodies after lung transplantation. J Heart Lung Transplant 2015; 34: 50-58
• 15 Hadem J, Hafer C, Schneider AS et al. Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single-centre study of 23 patients. BMC Anesthesiol 2014; 14: 24
• 16 Winters JL. American Society for Apheresis guidelines on the use of apheresis in clinical practice: practical, concise, evidence-based recommendations for the apheresis practitioner. J Clin Apher 2014; 29: 191-193
• 17 Schwartz J, Winters JL, Padmanabhan A. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013; 28: 145-284