Zusammenfassung
Eine akute oder chronische Herzinsuffizienz kann zu einer Verminderung der Nierenfunktion im Sinne eines kardiorenalen Syndroms (CRS) führen. Ein wesentliches klinisches Problem dieser Patienten ist eine Hypervolämie, zusammen mit sich verschlechternder Nierenfunktion. Die Behandlung besteht dabei zunächst in der Gabe von Diuretika. Allerdings stößt diese v. a. durch die Entwicklung einer Diuretikaresistenz häufig an ihre Grenzen. Ziel dieser Übersicht ist es, die Wirksamkeit der über die konservative medikamentöse Therapie hinausgehenden extrakorporalen Behandlungsmöglichkeiten im Sinne der Peritonealdialyse (PD), der Hämodialyse (HD) oder einer alleinigen maschinellen Ultrafiltration darzustellen. Die Bauchfelldialyse kann bei Patienten mit manifestem CRS die Lebensqualität und die Herzfunktion verbessern sowie die Zahl der Krankenhausaufenthalte vermindern. Auch die HD kann zur Behandlung eingesetzt werden. Allerdings sind damit ungünstige Effekte wie Hypotonien und der Verlust der Diurese verbunden. Eine alleinige maschinelle Ultrafiltration scheint im Gegensatz zu einer Diuretikabehandlung keine wesentlichen Vorteile zu haben.
Abstract
Acute or chronic heart failure can lead to a reduction in kidney function presenting as cardiorenal syndrome (CRS). A substantial clinical problem in such patients is hypervolemia in combination with deteriorating renal function. The treatment initially consists of diuretics at this clinical stage; however, development of resistance against diuretics often limits successful therapy. The aim of this overview is to provide an overview of extracorporeal treatment options, such as peritoneal dialysis (PD), hemodialysis (HD), and mechanical ultrafiltration alone. In patients with manifest CRS the use of PD can result in improvement in the quality of life and improve cardiac function as well as reduction in the number of hospital stays. The HD is also an option in the treatment of such patients; however, it is often related to unfavorable effects, such as hypotension and a reduction in diuresis. Mechanical ultrafiltration alone does not seem to provide any advantages as compared to diuretic treatment in patients with CRS.
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J. Lutz, A. Rieke und W. Bojara geben an, dass kein Interessenkonflikt besteht.
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U. Heemann, München
J. Lutz, Koblenz
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Lutz, J., Rieke, A. & Bojara, W. Diuretika und extrakorporale Verfahren zur Behandlung des kardiorenalen Syndroms. Nephrologe 13, 389–394 (2018). https://doi.org/10.1007/s11560-018-0282-y
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DOI: https://doi.org/10.1007/s11560-018-0282-y