Zitratantikoagulation – Hintergründe zur Behandlung von Nierenkranken

Patienten mit akutem oder chronischem Nierenversagen weisen gegenüber Nierengesunden ein erhöhtes Blutungsrisiko auf. Soll eine Nierenersatzbehandlung erfolgen, wird das Blutungsrisiko durch Heparin nochmals gesteigert. Liegen bereits Blutungen vor oder ist das Blutungsrisiko sehr hoch, liegt es nahe, auf Heparin nach Möglichkeit zu verzichten. Bereits in den 1960er-Jahren wurde das erste Mal über die regionale Antikoagulation mit Zitrat zur Aufrechterhaltung eines extrakorporalen Kreislaufs geschrieben. Diese Form der Antikoagulation hat sich in den letzten Jahren vor allem im intensivmedizinischen Bereich etabliert. Aber auch die intermittierende Hämodialyse kann mit gutem Erfolg langfristig mit Zitrat durchgeführt werden. Die technische Umsetzung wird von den kommerziellen Anbietern zunehmend besser gelöst und vereinfacht. Trotzdem sind intensive Personalschulungen insbesondere bei der Einführung der regionalen Zitratantikoagulation notwendig, um für die möglichen Komplikationen und deren Behandlung zu sensibilisieren. In erster Linie sind Störungen im Kalzium- und Säure-Basen-Haushalt zu erwarten. Diese sind bei adäquater Umsetzung der Behandlungsprotokolle aber selten und behandelbar.

Patients with acute or chronic renal failure have a higher bleeding risk compared to patients with normal renal function. Administration of heparin during renal replacement therapy even more increases the risk. Thus, in patients with actual bleeding or very high bleeding risk it should be considered to avoid heparin. Regional citrate anticoagulation for renal replacement therapy, first described in 1961, has evolved into a standard procedure in the last years, especially for continuous renal replacement therapy in intensive care units. Although serious complications are rare, personnel training is needed, especially during implementation phase. The most common complications are disturbances of calcium and acid-base balance which can be detected and managed reliably when treatment protocols are followed.

Key words

regional citrate anticoagulation - renal replacement therapy - haemodialysis

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