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Assistierte Peritonealdialyse bei betagten Senioren – Eine realitätsnahe Alternative?

Assisted peritoneal dialysis for aged seniors—a realistic alternative?

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Hintergrund

Ältere Dialysepatienten nehmen weltweit zu. Gleichzeitig besteht auch bei diesen Patienten häufig ein großer Wunsch nach Autonomität und häuslichen Therapien. Die Heimdialyseverfahren wären geeignet, diesen Bedarf zu adressieren.

Fragestellung

Betagte Dialysepatienten haben häufig Einschränkungen der Funktionalitäten, welche die selbständige Durchführung von Heimdialyseverfahren erschweren. Assistenz bei Heimdialyse, insbesondere bei Peritonealdialyse (aPD), könnte dieses Dilemma überwinden, und es stellt sich die Frage, ob dies evidenzbasiert und kostengünstig angeboten werden kann.

Ergebnisse und Diskussion

PD bei betagten Patienten ist im Vergleich zur Hämodialyse (HD) hinsichtlich Mortalität, Hospitalisationen und Lebensqualität gleichwertig. Allerdings haben 90 % der betagten PD-Patienten Einschränkungen der Funktionalitäten. Bei Assistenz, welche dann notwendig wird, sind die methodenassoziierten Komplikationen nicht erhöht. Die Kosten der aPD sind im Vergleich zur Zentrums-HD geringer. Damit stellt die aPD bei betagten Patienten eine berechtigte Alternative dar.

Abstract

Background

The number of older dialysis patients is increasing worldwide. Simultaneously, these patients often have a great desire for autonomy and domestic treatment. Home dialysis procedures would be suitable to address these needs.

Objective

Aged dialysis patients often have impairments in functionalities. Therefore, they have limitations for home-based dialysis. Assistance with home dialysis, especially with assisted peritoneal dialysis (aPD) has the potential to overcome this problem. The question arises, if this can be provided as an evidence-based and cost-saving procedure.

Results and discussion

The use of aPD in aged patients is comparable to hemodialysis (HD) with respect to endpoints, such as mortality, hospitalization and quality of life; however, 90% of older PD patients have impairments of functionalities. With aPD as a solution to overcome these problems, method-associated complications are not increased. Furthermore, aPD is cost-saving in comparison to HD in a center. Therefore, aPD is a justified evidence-based alternative for older patients.

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Authors and Affiliations

  1. Abteilung für Allgemeine Innere Medizin und Nephrologie am Zentrum für Innere Medizin (Abteilung ZIM IV), Robert-Bosch-Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Deutschland

    M. D. Alscher

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J. Floege, Aachen

J. Hoyer, Marburg

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Alscher, M.D. Assistierte Peritonealdialyse bei betagten Senioren – Eine realitätsnahe Alternative?. Nephrologe 13, 314–320 (2018). https://doi.org/10.1007/s11560-018-0267-x

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