Hämodialyse vs. Peritonealdialyse

Hämodialyse (HD) und Peritonealdialyse (PD) sind 2 gleichwertige, aber unterschiedliche Verfahren. In den letzten 25 Jahren hat sich das Langzeitüberleben der Dialysepatienten trotz der Zunahme des Alters und der Komorbiditäten verbessert. Während die PD in den 1980er-Jahren im Vergleich zur HD eine deutlich höhere Mortalität aufwies, sind die Mortalitätsraten von HD und PD seit 2002 vergleichbar. Grund dafür ist, dass es bei der PD in den letzten Jahren in der Therapie mehr Veränderungen gab als bei der HD. Bei der PD entwickelte sich ein verstärktes Bewusstsein für eine Optimierung des Volumenmanagements. Dies wurde erleichtert durch eine differenziertere Therapie mit dem Einsatz von Cyclern bei High-Transportern und der Verwendung von Icodextrin. Während bei der HD die dialyseassoziierten Infektionen insbesondere auch durch eine höhere Rate an Vorhofkathetern gestiegen sind, hat sich die PD-assoziierte Infektionsrate kontinuierlich verbessert. Die Hospitalisierungsraten aufgrund von dialyseassoziierten Infektionen sind mittlerweile vergleichbar. Es besteht in den Studien ein Trend für ein etwas besseres Patientenüberleben in den ersten Jahren bei einem Dialysebeginn mit der PD. Entscheidend für die Auswahl des Verfahrens sollte jedoch die Lebensqualität des Patienten sein.

Hemodialysis (HD) and peritoneal dialysis (PD) are 2 equivalent, but different modalities. Despite of an increased age and more comorbidities, survival of both HD and PD patients has improved over the last 25 years. Whereas mortality of PD patients compared to HD patients was higher 30 years ago, survival rate is comparable between these 2 modalities since 2002. Substantial changes in the practice of PD occured in the last decades. Better fluid control was achieved by using APD und icodextrin, especially by patients with fast peritoneal transport. Whereas there was a continuous improvement of PD-associated infections, dialysis-associated infection rates by HD patients increased due to a higher rate of central venous catheter. Hospitalization due to dialysis-associated infections are meanwhile comparable. There is a trend for better survival on PD compared to HD during the first years after start of dialysis. A key criterion for choosing the modality should be quality of life.

Key words

hemodialysis - peritoneal dialysis - mortality - long-term survival

• Literatur

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