Peritonealdialyse – Eine Behandlung für fast alle Dialysepatienten?

Trotz der Vorteile der Peritonealdialyse (PD) gerade zu Dialysebeginn ist die PD insbesondere in Deutschland unterrepräsentiert. Es gibt nur wenige Kontraindikationen für die PD. Es konnte gezeigt werden, dass die PD bei Zystennieren mit guten Ergebnissen durchgeführt werden kann. Aszites ist keine Kontraindikation, sondern eine medizinische Indikation für die PD. Auch bei Transplantatversagen und Immunsuppression kann die PD ohne größere Komplikationen durchgeführt werden. PEG-Anlagen sind keine Kontraindikation für die PD. Verschiedene Studien konnten zeigen, dass eine PD bei hohem Body-Mass-Index möglich ist. Die PD hat bei älteren Patienten viele Vorteile. Problematisch ist jedoch, dass viele ältere Patienten eine Assistenz benötigen. Assistenz durch Pflegepersonal ist in einigen Ländern etabliert. In Deutschland laufen einige Pilotprojekte. Bei ungeplantem Dialysestart wird in der Regel die Hämodialyse (HD) gewählt. Mit entsprechender Infrastruktur kann auch hier mit der PD begonnen werden.

Despite several advantages of peritoneal dialysis (PD) particularly at the start of dialysis, especially in Germany PD is still underutilized. There are only a few contraindications for PD. Good clinical results are observed with PD in patients with polycystic kidney disease. Ascites should not longer be considered as contraindication for PD, but as medical indication for PD. Failure of kidney transplantation and immunosuppression are no contraindication for PD. Peritoneal dialysis is possible for patients with high body mass index. Peritoneal dialysis has many advantages in elderly patients. The main barrier for PD in these patients is that many patients need some assistance. In some countries, assisted PD is well established. In Germany, there are several pilot projects. Hemodialysis is regularly chosen in the case of unplanned start of dialysis. With appropriate structures, unplanned dialysis could also be started with PD.

Key words

peritoneal dialysis - ascites - polycystic kidney disease - elderly patient - assisted peritoneal dialysis - unplanned dialysis start

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