Nierenersatztherapie bei kritisch kranken Patienten mit akuter Nierenschädigung

Kernaussagen

• Die neue Definition der akuten Nierenschädigung beinhaltet eine vereinfachte Definition, die je nach Anstieg des Serum-Kreatininwerts und/oder Abfall der Urinproduktion eine Unterteilung in mehrere Schweregrade vorsieht.

• Diese neue klinische Einteilung ermöglicht eine bessere Risikobeurteilung und korreliert mit der Schwere der Nierenschädigung.

• Es gibt bislang noch keine prospektiven, randomisierten Studien, die zeigen, wann man in Abwesenheit „harter“ Indikationen bei kritisch kranken Patienten mit akuter Nierenschädigung mit einer Nierenersatztherapie beginnen sollte.

• Bei hämodynamisch instabilen Patienten und bei Patienten mit einem erhöhten intrakraniellen Druck ist eine kontinuierliche einer intermittierenden Nierenersatztherapie vorzuziehen.

• Die verfügbaren Daten sprechen für ein Austauschvolumen von mindestens 20 – 25 ml/kgKG/h bei kontinuierlichen Verfahren und eine Dialysedosis (Kt/V) von 3,9 pro Woche bei intermittierenden Verfahren.

• Literatur

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