The endocrine disorders at (decreased production of erythropoietin and 1,25-dihydroxyvitamin D3) renal failure can not be corrected by the NET. During dialysis serum diffuse solutes (eg., Sodium, chloride, potassium, bicarbonate, calcium, magnesium, phosphate, urea, creatinine, uric acid) passively between two liquid compartments along a concentration gradient (diffusive transport). During filtration, serum water passes between the compartments along a hydrostatic pressure gradient and pulls solutes with it (convective transport). These two processes are often used in combination with each other (hemodiafiltration). Hemoperfusion is a rarely used technology to remove toxins by blood flows over a bed of adsorbent material (usually a resin or carbon).

Renal replacement therapy (NRT) replaced in patients with renal failure nichtendokrinen kidney functions; Moreover, it is used occasionally for some types of poisoning. The methods include intermittent hemodialysis, continuous hemofiltration and hemodialysis and peritoneal dialysis. These techniques exchange solutes and remove fluid from the blood by taking advantage of dialysis and filtration through permeable membranes. The endocrine disorders at (decreased production of erythropoietin and 1,25-dihydroxyvitamin D3) renal failure can not be corrected by the NET. During dialysis serum diffuse solutes (eg., Sodium, chloride, potassium, bicarbonate, calcium, magnesium, phosphate, urea, creatinine, uric acid) passively between two liquid compartments along a concentration gradient (diffusive transport). During filtration, serum water passes between the compartments along a hydrostatic pressure gradient and pulls solutes with it (convective transport). These two processes are often used in combination with each other (hemodiafiltration). Hemoperfusion is a rarely used technology to remove toxins by blood flows over a bed of adsorbent material (usually a resin or carbon). Dialysis and filtration can be carried out either intermittently or continuously. A continuous therapy is used only in acute renal injury. Continuous therapy is tolerated sometimes better than intermittent therapy of unstable patients because substances and water are slowly removed. Apart from the peritoneal all forms of NET requiring vascular access. Continuous techniques require a direct arteriovenous or venovenous shunt. The choice of method depends on many factors, some of the primary objectives (eg., Removal of solutes or water or both) and the underlying indications (acute or chronic kidney failure, poisoning), vascular access, hemodynamic stability, availability, local experience and the patient’s preference. Indications and contraindications of general renal replacement therapies lists the indications and contraindications for the commonly used forms of NET. Indications and contraindications of general renal replacement therapies renal replacement therapy Contraindications hemodialysis renal insufficiency or failure (acute or chronic) with any of the following, which are not controlled in other ways: fluid overload (including refractory heart failure) hyperkalemia hypercalcemia metabolic acidosis pericarditis uremic symptoms GFR * <10 ml / min / 1.732 BSA (chronic kidney disease, no diabetes) GFR * <15 ml / min / 1.732 BSA (chronic kidney disease, D iabetes) poisoning uncooperative or hemodynamically unstable patients peritoneal same indications such as (for hemodialysis own or except in cases of poisoning) in patients who have insufficient vascular access self-therapy prefer absolute loss of peritoneal function Ashäsionen, the dialysate flow limit Current abdominal injuries Abdominal fistula abdominal wall defects effectively a dialysis prevent or increase the risk of infection (eg. B. irreparable strips or diaphragmatic hernia, "bladder extrophy"). The patient's condition does not allow dialysis to relative abdominal infection Frequent episodes of diverticulitis inability large amounts of peritoneal dialysate to tolerate Inflammatory bowel disease Ischemic colitis Morbid obesity Peritoneal leaks Severe malnutrition Hemoperfusion poisoning or toxicity (z. B. due to barbiturates, many antidepressants, ethchlorvynol, meprobamate, paraquat, glutethimide, metals such as lithium and barium, or toxic doses of aminoglycosides or cardiovascular medications) uncooperative or hemodynamically unstable patients * For the calculation of GFR, study of nephrology patients: GFR. BSA = body surface GFR = glomerular filtration rate on the care of patients with long-term-NET a nephrologist, psychiatrists, social workers, dieticians, dialysis nurse, vascular surgeon (or another surgeon who has mastered the laying of a Peritonealdialysekatheters) and a surgical transplant team involved in the ideal case , The investigation of patients should begin when the terminal kidney failure looming, but still no NET is necessary for the treatment coordinated, patients informed of their options, asked about their resources and needs and a vascular access can be placed. A psychosocial assessment is important as a NET makes the patient socially and emotionally vulnerable. Because the NET interrupts the everyday work, school and leisure activities, causing anger, frustration, stress and guilt from the environment. It changes the body image by the lack of physical energy, loss or change in sexual function, change the external appearance due to shunts, dialysis catheters, punctures, bone disease and other physical changes. Some patients respond to these feelings by tardiness or lack of cooperation with the treatment team. Personality traits that improve the prognosis for a successful long-term adaptation, are u. a. Adaptability, independence, self-control, frustration tolerance and optimism. Emotional stability, encouragement of the family, continued support by the treatment team and the participation of the patient and family in decision-making are also important. Programs that encourage the patient in terms of its independence and extensive resume his former interests can reduce psychosocial problems with greater success.

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