Skip to main content
SpringerLink
Log in

Nierenersatztherapie auf der Intensivstation

Renal replacement therapy in the intensive care unit

  • CME Weiterbildung • Zertifizierte Fortbildung
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Das akute Nierenversagen beim kritisch kranken Patienten auf der Intensivstation stellt eine schwerwiegende Komplikation dar, die unabhängig von der zugrunde liegenden Ursache eine erhebliche Morbidität und Letalität aufweist. Trotz modernster intensivmedizinischer Maßnahmen und Fortschritten in der Nierenersatztherapie ist die Letalität bei Patienten mit akutem Nierenversagen gegenüber Patienten ohne Nierenfunktionseinschränkung deutlich erhöht. Im folgenden Beitrag werden Inzidenz und Letalität des akuten Nierenversagens beleuchtet. Zudem werden der Zeitpunkt des Beginns der Nierenersatztherapie sowie die Auswahl des geeigneten Nierenersatzverfahrens und der geeigneten Therapiedosis diskutiert.

Abstract

Acute renal failure in critically ill patients in the intensive care unit is associated with high morbidity and mortality which is independent of the underlying etiology. Despite improvements in intensive care medicine and renal replacement therapy, patients with acute renal failure have much higher morbidity and mortality rates than patients without acute renal failure in the intensive care unit. In this overview, we summarize the literature on the incidence and mortality of patients with acute renal failure in the intensive care unit. Furthermore, we discuss timing of the initiation of renal replacement therapy, patient outcome with different renal replacement therapies and the adequate dialysis dose to be delivered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3a–c
Abb. 4
Abb. 5

Literatur

  1. Augustine JJ, Sandy D, Seifert TH, Paganini EP (2004) A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 44: 1000–1007

    Article  PubMed  Google Scholar 

  2. Chauveau P, Nguyen H, Combe C et al. (2005) Dialyzer membrane permeability and survival in hemodialysis patients. Am J Kidney Dis 45: 565–571

    Article  PubMed  Google Scholar 

  3. Chertow GM, Levy EM, Hammermeister KE et al. (1998) Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 104: 343–348

    Article  PubMed  Google Scholar 

  4. Clermont G, Acker CG, Angus DC et al. (2002) Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int 62: 986–996

    Article  PubMed  Google Scholar 

  5. Dhondt AW, Vanholder RC, De Smet RV et al. (2003) Studies on dialysate mixing in the Genius single-pass batch system for hemodialysis therapy. Kidney Int 63: 1540–1547

    Article  PubMed  Google Scholar 

  6. Druml W (2004) Acute renal failure is not a „cute“ renal failure! Intensive Care Med 30: 1886–1890

    Google Scholar 

  7. Esson ML, Schrier RW (2002) Diagnosis and treatment of acute tubular necrosis. Ann Intern Med 137: 744–752

    PubMed  Google Scholar 

  8. Fliser D, Kielstein JT (2004) A single-pass batch dialysis system: an ideal dialysis method for the patient in intensive care with acute renal failure. Curr Opin Crit Care 10: 483–488

    Article  PubMed  Google Scholar 

  9. Gettings LG, Reynolds HN, Scalea T (1999) Outcome in post-traumatic acute renal failure when continuous renal replacement therapy is applied early vs. late. Intensive Care Med 25: 805–813

    Article  PubMed  Google Scholar 

  10. Guerin C, Girard R, Selli JM, Ayzac L (2002) Intermittent versus continuous renal replacement therapy for acute renal failure in intensive care units: results from a multicenter prospective epidemiological survey. Intensive Care Med 28: 1411–1418

    Article  PubMed  Google Scholar 

  11. Jaber BL, Lau J, Schmid CH et al. (2002) Effect of biocompatibility of hemodialysis membranes on mortality in acute renal failure: a meta-analysis. Clin Nephrol 57: 274–282

    PubMed  Google Scholar 

  12. Kellum JA, Angus DC, Johnson JP et al. (2002) Continuous versus intermittent renal replacement therapy: a meta-analysis. Intensive Care Med 28: 29–37

    Article  PubMed  Google Scholar 

  13. Kielstein JT, Kretschmer U, Ernst T et al. (2004) Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J Kidney Dis 43: 342–349

    Article  PubMed  Google Scholar 

  14. Kumar VA, Craig M, Depner TA, Yeun JY (2000) Extended daily dialysis: a new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 36: 294–300

    PubMed  Google Scholar 

  15. Lameire N, Van Biesen W, Vanholder R (2005) Acute renal failure. Lancet 365: 417–430

    PubMed  Google Scholar 

  16. Leblanc M, Kellum JA, Gibney RT et al. (2005) Risk factors for acute renal failure: inherent and modifiable risks. Curr Opin Crit Care 11: 533–536

    Article  PubMed  Google Scholar 

  17. Levy EM, Viscoli CM, Horwitz RI (1996) The effect of acute renal failure on mortality. A cohort analysis. Jama 275: 1489–1494

    Article  PubMed  Google Scholar 

  18. Maher ER, Robinson KN, Scoble JE et al. (1989) Prognosis of critically-ill patients with acute renal failure: APACHE II score and other predictive factors. Q J Med 72: 857–866

    PubMed  Google Scholar 

  19. Marenzi G, Marana I, Lauri G et al. (2003) The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 349: 1333–1340

    Article  PubMed  Google Scholar 

  20. Mehta RL, McDonald B, Gabbai FB et al. (2001) A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 60: 1154–1163

    Article  PubMed  Google Scholar 

  21. Mehta RL, Pascual MT, Soroko S et al. (2004) Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int 66: 1613–1621

    Article  PubMed  Google Scholar 

  22. Morgera S, Kraft AK, Siebert G et al. (2002) Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis 40: 275–279

    Article  PubMed  Google Scholar 

  23. Morgera S, Scholle C, Voss G et al. (2004) Metabolic complications during regional citrate anticoagulation in continuous venovenous hemodialysis: single-center experience. Nephron Clin Pract 97: c131–136

    Article  PubMed  Google Scholar 

  24. Ouseph R, Ward RA (2000) Anticoagulation for intermittent hemodialysis. Semin Dial 13: 181–187

    Article  PubMed  Google Scholar 

  25. Palevsky PM (2006) Dialysis modality and dosing strategy in acute renal failure. Semin Dial 19: 165–170

    Article  PubMed  Google Scholar 

  26. Phu NH, Hien TT, Mai NT et al. (2002) Hemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam. N Engl J Med 347: 895–902

    Article  PubMed  Google Scholar 

  27. Ponikvar JB, Rus RR, Kenda RB et al. (2001) Low-flux versus high-flux synthetic dialysis membrane in acute renal failure: prospective randomized study. Artif Organs 25: 946–950

    Article  PubMed  Google Scholar 

  28. Rangel-Frausto MS, Pittet D, Costigan M et al. (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. Jama 273: 117–123

    Article  PubMed  Google Scholar 

  29. Ronco C, Bellomo R, Homel P et al. (2000) Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 356: 26–30

    Article  PubMed  Google Scholar 

  30. Ronco C, Levin NW (2005) Mechanisms of solute transport in extracorporeal therapies. Contrib Nephrol 149: 10–17

    PubMed  Google Scholar 

  31. Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 346: 305–310

    Article  PubMed  Google Scholar 

  32. Schrier RW, Wang W (2004) Acute renal failure and sepsis. N Engl J Med 351: 159–169

    Article  PubMed  Google Scholar 

  33. Subramanian S, Venkataraman R, Kellum JA (2002) Influence of dialysis membranes on outcomes in acute renal failure: a meta-analysis. Kidney Int 62: 1819–1823

    Article  PubMed  Google Scholar 

  34. Tonelli M, Manns B, Feller-Kopman D (2002) Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery. Am J Kidney Dis 40: 875–885

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Heidelberg

    C. Hainer & M. A. Weigand

  2. Nierenzentrum Heidelberg, Medizinische Universitätsklinik Heidelberg, Im Neuenheimer Feld 162, 69120 , Heidelberg

    C. Morath, N. Miftari, R. Dikow, M. Zeier & V. Schwenger

Authors
  1. C. Morath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Miftari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Dikow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Hainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Zeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Schwenger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. A. Weigand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Morath.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morath, C., Miftari, N., Dikow, R. et al. Nierenersatztherapie auf der Intensivstation. Anaesthesist 55, 901–914 (2006). https://doi.org/10.1007/s00101-006-1071-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-006-1071-y

Schlüsselwörter

Keywords

Search

Navigation