Welcher Patient ist für die Peritonealdialyse (nicht) geeignet? – Absolute Kontraindikationen sind inzwischen selten

In Bezug auf die Peritonealdialyse ist in den letzten Jahren ein Paradigmenwechsel zu beobachten. Aufgrund der deutlich besseren Technik, eines besseren Patientenüberlebens sowie geringerer Peritonitisraten ist die Bauchfelldialyse zu einem etablierten Nierenersatzverfahren herangereift. Waren in den ersten Jahren nach der Einführung des Konzeptes der chronischen ambulanten Peritonealdialyse noch verhältnismäßig viele Kontraindikationen definiert, so sollte eine Peritonealdialyse heute als primäre Nierenersatztherapie angestrebt werden. Jüngere Daten verweisen auf ein zunehmend besseres Patientenüberleben im Vergleich zur Hämodialyse – insbesondere in den ersten Jahren nach dem Start der Dialysetherapie. Absolute Kontraindikationen sind inzwischen selten. Terminal niereninsuffiziente Nierenpatienten sollten daher über die verfahrensspezifischen Vorteile adäquat und rechtzeitig aufgeklärt und – sofern möglich bzw. erwünscht – mit der Peritonealdialyse initial behandelt werden.

Peritoneal dialysis has undergone a paradigm change in the course of recent years. Due to the significantly better technology and higher rates of patient survival as well as reduced rates of peritonitis, peritoneal dialysis matured to an established renal replacement therapy. Had there been comparatively many contraindications regarding the concept of continuous ambulatory peritoneal dialysis during the first years of implementation, today peritoneal dialysis should be the first choice of treatment in end-stage renal disease patients. Recent data demonstrate an increasingly higher patient survival rate in comparison to hemodialysis patients, especially in the first years after initiation of renal replacement therapy. Absolute contraindications are rare. Patients suffering from end-stage renal disease should be informed in time about procedure-specific advantages and be treated with peritoneal dialysis if possible.

Key words

peritoneal dialysis - indication - contraindication - patient survival rates - assisted peritoneal dialysis

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