Metabolische Konsequenzen der Peritonealdialyse

Zusammenfassung

Zur Behandlung der terminalen Niereninsuffizienz kann alternativ zur Hämodialyse auch die Peritonealdialyse eingesetzt werden. Hierbei wird die Bauchhöhle mit 2 – 3 l Dialyseflüssigkeit gefüllt, die in regelmäßigen Abständen gewechselt wird. Um einen osmotischen Gradienten aufzubauen und dem Körper Flüssigkeit entziehen zu können, wird der Dialyseflüssigkeit Glukose zugesetzt. Ein Teil dieser Glukose wird während der Behandlung resorbiert und beeinflusst den Kohlenhydratstoffwechsel des Patienten. Dies ist vor allem bei Diabetikern bedeutsam, die aber bei geeigneter Steuerung durchaus mit Peritonealdialyse behandelt werden können.

Patienten weisen unterschiedliche Glukosetransportcharakteristika auf. Die jeweilige Dialyseverordnung muss die Transportcharakteristik berücksichtigen und hat Einfluss auf die Glukoseresorption. Zur Verringerung der Glukoseaufnahme kann auch die Polyglukose Icodextrin als osmotisches Agens eingesetzt werden. Es gibt Hinweise, dass dies zu einer besseren Stoffwechselführung bei Diabetikern beitragen kann. Allerdings sind diagnostische Besonderheiten zu beachten, da Icodextrin das Glukosemonitoring des Diabetikers beeinflussen kann.

Abstract

Peritoneal dialysis is a feasible alternative for hemodialysis in the treatment of end-stage renal failure. Treatment is done by filling the peritoneum with 2 – 3 l of dialysis fluid which is exchanged several times a day. Dialysis fluid is enriched with glucose to build up an osmotic gradient. This is needed to remove fluid from the patient. Glucose which can be resorbed from the peritoneum influences the carbohydrate metabolism of the patient. Although this is particularly relevant to the patient with diabetes, this comorbidity is not a contraindication to peritoneal dialysis.

Patients have different peritoneal transport characteristics leading to different amounts of glucose being resorbed in a defined time. This transport characteristic has to be considered when designing a peritoneal dialysis prescription. The polyglucose Icodextrin can be used to reduce the glucose load to the patient. It has similar osmotic effects while hardly being resorbed. The literature gives hints that the use of Icodextrin improves metabolic adjustment in patients with diabetes. Some diagnostic aspects have to be considered when treating patients with diabetes by Icodextrin since the substance can influence glucose monitoring.

Schlüsselwörter

Peritonealdialyse - Niereninsuffizienz - Glukosemonitoring

Keywords

peritoneal dialysis - chronic kidney failure - glucose monitoring

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