Peritonealdialyse bei diabetischer Nephropathie – Ein Überblick

Der Typ-2-Diabetes nimmt weltweit zu und damit auch die diabetischen Nephropathien. In ca. 15 % kann ein Nierenersatz notwendig werden. Kommt eine primäre, präemptive Nierentransplantation nicht in Betracht, muss eine Dialyse eingeleitet werden. Neuere Leitlinien empfehlen die Peritonealdialyse (PD) als Dialyseverfahren der Wahl für Diabetiker. Dies ist begründbar durch ein besseres Überleben in den ersten Jahren der Behandlung, einen besseren Erhalt der Restnierenfunktion, und weitere Faktoren wie Lebensqualität, Mobilität etc., die aber nicht Gegenstand der Übersicht sind. Es ist erstaunlich, dass die Peritonealdialyse in Deutschland nur einen Anteil unter 5 % hat. Bei aufgeklärten Patienten und freier Verfahrenswahl beträgt der PD-Anteil 30–50 %. Dies sollte angestrebt werden.

The diabetes typ 2 has increasing numbers worldwide. In a percentage of 15 % this is leading to the urge of renal replacement therapy. Major goal is a preemptive kidney transplantation. However, if that is not feasible, dialysis is indicated. New german guidelines recommend the peritonealdialysis as the modality of choice for diabetic ESRD-patients. The arguments are better survival in the first years of treatment, better preservation of residual renal function, and other factors as live quality, mobility and more. The latter will not be discussed in the review. For some people it is astonishing that the numbers of PD in Germany are below 5 %. If patients have the chance for an informed consent, the numbers should be around 30–50 % and this should be the goal for the future.

Key words

Diabetes - dialysis - peritonealdialysis - mortality - glucose - advanced glycation endproducts - glucose degradation products

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