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Dialyse aktuell 2018; 22(08): 345-349
DOI: 10.1055/a-0704-4791
Schwerpunkt | Dialyse
© Georg Thieme Verlag KG Stuttgart · New York

Die Rolle der Dialysatzusammensetzung und -temperatur

Worauf ist zu achten?
Dirk Bokemeyer
Klinik für Nieren- und Hochdruckerkrankungen, Dialyse, Augusta-Kranken-Anstalt Bochum
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Publication History

Publication Date:
29 October 2018 (online)

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Zusammenfassung

Die Wahl der Dialysatzusammensetzung ist für die Verträglichkeit und die Vermeidung von Komplikationen einer Hämodialyse von elementarer Bedeutung. Während der Dialyse ist die Salzbilanz für die kardiovaskuläre Stabilität und die Blutdruckkontrolle relevant. Die Natriumkonzentration im Dialysat sollte an den individuellen Sollwert für die extrazelluläre Osmolarität angepasst werden. Ziel der Festlegung des Dialysatkaliums ist die sichere Vermeidung von Hyperkaliämien. Darüber hinaus sollte während der Dialyse eine neutrale Kalziumbilanz angestrebt werden, dies wird bei den meisten Patienten bei einer Kalziumkonzentration des Dialysats von 1,25 mmol/l erreicht. Auch das Bikarbonat sollte bei jedem Patienten so gewählt werden, dass zur Mitte der Woche ein Serumbikarbonat von über 22 mmol/l erreicht wird. Letztendlich ist auch die Wahl der richtigen Dialysattemperatur zur Vermeidung intradialytischer Hypotonien wichtig. Zusammengefasst sollte zur Steigerung der Verträglichkeit der Dialyse und zur Vermeidung von Spätkomplikationen das Dialysat individuell verordnet werden.

 

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