Das akute Nierenversagen bei älteren Patienten – entscheidend für die Gesamtmortalität?

Zusammenfassung

Das akute Nierenversagen (ANV) im fortgeschrittenen Lebensalter erhöht nicht nur das Risiko für eine chronische Nierenkrankheit (CKD), sondern auch die Krankenhausmortalität und Gesamtsterblichkeit. Durch altersspezifische renale Funktionseinschränkungen und Komorbiditäten (Hypertonie, kardiovaskuläre Folgeerkrankungen, Diabetes mellitus) besteht ein erhöhtes Risiko für akute Nierenschäden. Auslöser im ambulanten Bereich sind häufig eine inadäquate Pharmakotherapie und Selbstmedikation. Grund für ein stationäres ANV sind meist schwere Infektionen, kardiovaskuläre Interventionen mit Kontrastmittel und große operative Eingriffe. Jeder vierte Patient erleidet ein Rezidiv des ANV mit einem hohen Risiko für ein fortgeschrittenes CKD-Stadium und eine Nierenersatztherapie. Die Indikation zur Dialyse sollte bei Hochaltrigen mit hoher Komorbidität in einem Prozess der gemeinsamen Entscheidungsfindung erfolgen. Eine palliative Betreuung ist in vielen Fällen angemessen.

Abstract

Acute kidney injury (AKI) in the elderly is associated with high risks of chronic kidney disease (CKD), hospital- and all-cause mortality. Based on the decreased renal function in older age groups and age-specific co-morbidity as hypertension, cardiovascular complications, and diabetes mellitus, the risk for AKI is increased. In outpatients inadequate pharmacotherapy and self-medication contribute to increased risk of AKI while in hospital settings severe infection, cardiovascular interventions with contrast media and major surgery may result in higher rates of AKI. Every fourth case is on risk for recurrent AKI followed by advanced CKD and renal replacement therapy. In the oldest old with high co-morbidity condition indication of renal replacement in AKI should be processed by shared-decision making. In many cases palliative care in this setting may be appropriate.

Schlüsselwörter

akutes Nierenversagen - chronische Nierenkrankheit - Hochaltrigkeit - Mortalität

Key Words

acute kidney injury - chronic kidney disease - elderly - mortality

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