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Dialyse aktuell 2013; 17(6): 304-309
DOI: 10.1055/s-0033-1347111
Dialyse
© Georg Thieme Verlag Stuttgart · New York

Peritonealdialyse – Behandlung bei Herzinsuffizienz

Peritoneal dialysis – Treatment in case of refractory heart failure
Leonie Großekettler
1   Sektion Nephrologie, Medizinische Universitätsklinik Heidelberg (ärztlicher Leiter: Prof. Dr. Martin Zeier)
,
Vedat Schwenger
1   Sektion Nephrologie, Medizinische Universitätsklinik Heidelberg (ärztlicher Leiter: Prof. Dr. Martin Zeier)
› Author Affiliations
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Publication History

Publication Date:
22 July 2013 (online)

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Herzinsuffizienz hat eine steigende Inzidenz und Mortalität in den westlichen Industrienationen. Infolgedessen nimmt auch die Bedeutung des kardiorenalen Syndroms weiter zu. Die rezidivierenden Dekompensationen bei therapierefraktärer Herzinsuffizienz sind ein wachsendes klinisches und gesundheitsökonomisches Problem. Nach einer ausführlichen kardiologischen und nephrologischen Diagnostik und Ausreizung aller konservativen Therapieoptionen kann bei betroffenen Patienten, auch wenn formal noch keine terminale Niereninsuffizienz vorliegt, eine additive Nierenersatztherapie mit Peritonealdialyse eine zusätzliche therapeutische Option sein. Eine Peritonealdialyse bei therapierefraktärer Herzinsuffizienz hat den Vorteil einer vergleichsweise geringeren hämodynamischen Belastung und kann durch den intrakorporalen und kontinuierlichen Volumenentzug die Hypervolämie und die Anzahl der Krankenhausaufenthalte reduzieren sowie die NYHA-Stadien verbessern. Um mit diesem Therapieansatz jedoch nachhaltigen Erfolg zu erzielen, ist eine enge Kooperation zwischen Kardiologen und Nephrologen eine unabdingbare Voraussetzung.

Severe congestive heart failure (CHF) is one of the fastest growing morbidities and a major cause of mortality in western countries. Consequently, cardiorenal syndrome is of increasing importance. Recurrent volume overload in patients with severe CHF, refractory to conventional therapy, is still an unresolved clinical and health economical problem. After careful cardial and renal diagnostics and optimization of CHF therapy, an additional intracorporal ultrafiltration therapy using peritoneal dialysis might be an effective option, even if patients are not dialysis-dependent. Peritoneal dialysis has the advantage of less hemodynamical stress and can be beneficial in terms of volume control due to the continuous and intracorporal volume removal. Therefore, peritoneal dialysis is associated with a lower rate of rehospitalizations as well as an improvement of NYHA functional class. However, to achieve sustained success, a close cooperation between cardiologist and nephrologist is essential.

Key words

refractory heart failure - cardiorenal syndrome - renal replacement therapy - peritoneal dialysis
 

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