Der Bedarf an Nierenersatztherapie (NET) in Deutschland wird vermutlich trotz wirksamer
Medikamente weiter ansteigen. Ob Nierentransplantation, Peritonealdialyse und Hämodialyse/Hämodiafiltration,
die Indikation und damit die richtige Auswahl der Patient*innen ist aus prognostischen,
aber auch ökonomischen und ökologischen Gründen entscheidend. Der Beitrag beleuchtet
die verschiedenen Verfahren im Vergleich und deren Möglichkeiten und Limitationen
bei uns in Deutschland.
Abstract
In Germany, around 80000 people are currently dependent on permanent renal replacement
therapy (RRT). Due to demographic developments and improvements in life expectancy,
the prevalence will continue to increase even if the effects of newer pharmacological
substances such as SGLT2 inhibitors and GLP1 agonists are promising in inhibiting
progression. There are basically three different methods of renal replacement therapy
and their variants: Kidney transplantation (KTX), peritoneal dialysis (PD), hemodialysis
(HD)/hemodiafiltration (HDF). The life expectancy of dialysis patients is reduced
by around 67% compared to the normal population, particularly due to cardiovascular
and infection-related complications. PD and HD are considered to be equivalent in
terms of mortality. Currently, HDF is increasingly coming back into focus after the
last randomized controlled trial (CONVINCE trial) proved its superiority over conventional
HD. Kidney transplantation is clearly superior to dialysis therapy in terms of life
expectancy; according to a meta-analysis, the risk of death is reduced by around 55%
in comparison.
Schlüsselwörter
Nierenersatzverfahren - Nierentransplantation - Hämodialyse - Hämodiafiltration -
Peritonealdialyse
Keywords
renal replacement therapy - kidney transplantation - hemodialysis - hemodiafiltration
- peritoneal dialysis
