Der Dialysepatient auf der Intensivstation

Abstract

The number of dialysis patients needing intensive medical care is steadily increasing, mostly due to cardiovascular diseases. Of the patients 50% are admitted due to myocardial infarction, malignant arrhythmia or acute cardiac failure and many also due to hyperkalemia and acute volume overload against the background of anuria or oligouria associated with arterial hypertension and hypervolemic hypertensive pulmonary edema. The treatment of an acute cardiac syndrome is comparable to the treatment of patients with healthy kidneys and despite the significantly higher cardiovascular mortality of these patients the acute prognosis is not significantly different to non-dialysis patients. In association with hypervolemic hypertensive pulmonary edema and all forms of hyperkalemia, dialysis treatment is always necessary. In the case of complications due to infections, in particular septicemia, dialysis patients seem to profit from the general therapy guidelines for septic patients, such as early goal-directed therapy. Underdosing of antibiotics for dialysis patients with sepsis represents a substantial problem in the clinical practice and can additionally endanger these patients.