Nierenersatztherapie auf Intensivstation

ZUSAMMENFASSUNG

Bei intensivstationär behandelten Patient*innen kommt es regelmäßig zu akuten Nierenfunktionseinschränkungen (AKI), die oft auch den Einsatz apparativer Nierenersatzverfahren nötig machen. Der vorliegende Artikel soll ein verständliches und umfassendes Kompendium des aktuellen Therapiestandards für Nierenersatzverfahren im intensivstationären Kontext mit der Erläuterung der jeweiligen Evidenz darstellen: So werden die verschiedenen verfügbaren Modalitäten (kontinuierliche versus intermittierende Hämodialyseverfahren sowie Peritonealdialyse) vorgestellt und ihre jeweiligen Vor- und Nachteile diskutiert. Dabei wird auch auf die richtigen Bedingungen für eine etwaige Umstellung von kontinuierlichen auf diskontinuierliche Verfahren eingegangen und der damit in Zusammenhang stehenden Problematik der hämodynamischen Instabilität unter einer Nierenersatztherapie. Weiterhin wird die viel diskutierte Frage nach dem richtigen Zeitpunkt des Beginns von Nierenersatzverfahren im Licht der vorhandenen Evidenz kritisch beleuchtet, genauso wie die Frage nach den Voraussetzungen für eine erfolgreiche Beendigung der Nierenersatztherapie. Verschiedene Antikoagulationsstrategien werden vorgestellt, mit besonderem Augenmerk auf die regionale Antikoagulation mit Zitrat, die mittlerweile die bevorzugte Option insbesondere für kontinuierliche Verfahren darstellt. Ebenso wird auf die Bestimmung der adäquaten Dosen je nach Modalität für den/die einzelne/n Patient*in eingegangen. Auch den spezifischen Aspekten von chronischen Dialysepatient*innen auf Intensivstation wird Rechnung getragen.

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