Klinische Ergebnisse an der Peritonealdialyse im Vergleich zur Hämodialyse

Abstract

In addition to kidney transplantation, peritoneal dialysis (PD) and hemodialysis represent two options for renal replacement therapy in patients with end-stage renal disease (ESRD). Given that most patients are suitable for both types of dialysis and that many of them require lifelong therapy, differences in clinical outcome between these treatments are of major interest. Differences between the two dialysis treatments have been described in single clinical aspects (e.g., hyperkalemia, volume status, blood pressure control, cardiac complications), the relevance of which are reflected by mortality rates. Data available so far indicate that overall outcome of patients with ESRD is comparable in the two types of dialysis. However, there are significant differences in subgroups of patients, such as those with diabetes or coronary heart disease. In order to achieve the best possible survival and quality of life in ESRD, the optimal sequence of dialysis treatments during the course of renal replacement therapy, rather than a single type of treatment, has to be considered. The "integrated care concept" takes into account this sequence of dialysis treatments, suggesting that patients should start on PD but be transferred to hemodialysis as soon as PD is no longer adequate. This concept allows longer preservation of residual renal function, better early survival on dialysis and better short-term results of graft survival after kidney transplantation. Thus, if medically suitable, PD should be the first treatment option in patients with ESRD who need renal replacement therapy.

Relationship Between Genomic Damage and Clinical Features in Dialysis Patients

“…In our study, no significant difference was observed between HD and PD patients in terms of MN frequency. Some studies recommend PD as an initial therapy, when applicable, to better preserve the important residual renal function and prolong overall survival (Divino Filho, 2004;Roob, 2005). The benefits of PD for survival are maintained up to the third year, after which survival with PD and HD is the same, or even slightly lower in patients on PD (Oreopoulos et al, 2008).…”

“…Several recent large-scale epidemiological studies comparing mortality rates among patients with ESRD receiving HD versus PD show conflicting results. PD was generally found to be associated with equal or better survival (Divino Filho, 2004;Roob, 2005;Oreopoulos et al, 2008). Our hypothesis was that PD is expected to lead to less genomic damage than HD, because in patients undergoing PD, the blood does not interact with foreign membranes.…”

Report of the First Peritoneal Dialysis Program in Guyana, South America

“…Although the cost-effectiveness of a dialysis program is important for a developing country, providing patients with the best available option that has also been proved to be an effective treatment is essential. Overall, several studies have shown that outcomes with the use of HD and PD are not significantly different, and available data show that, overall, outcomes in patients with ESRD are comparable between those two dialysis modalities (17,18). A Canadian research team analyzed survival trends among 11,970 patients with ESRD and found that, compared with the patients receiving HD, those receiving PD had a significantly lower mortality rate after adjustments for known prognostic factors (19).…”

Genomic Damage in Endstage Renal Disease—Contribution of Uremic Toxins

“…Recent studies recommend peritoneal dialysis as an initial therapy, when applicable, to better preserve the important residual renal function and prolong overall survival [43,44]. The benefits of PD for survival are maintained up to the third year, after which survival with PD and HD is the same, or even slightly lower in patients on PD [45,46].…”