Europäische Leitlinien bei der Behandlung alter und gebrechlicher Dialysepatienten

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1 Europäische Leitlinien bei der Behandlung alter und gebrechlicher Dialysepatienten Prof. Dr. Markus Ketteler Berliner Dialyseseminar, 6. Dezember 2014

2

3 Vielseitige Methoden des Shunttrainings

4 Aber es gibt mehrere Formen des Alterns Healthy Vulnerable Frail

5 Aber es gibt mehrere Formen des Alterns

6 Aber es gibt mehrere Formen des Alterns

7 Aber es gibt mehrere Formen des Alterns

8 Behandlung alter und gebrechlicher Dialysepatienten Prof. Wim van Biesen: Hi Markus, The elderly guideline is still being developed, so no conclusions there yet. Iattachasummaryofthesurveydonelastyear,asIpresentedattheERA-EDTAfree communications. I also attach an overview of the current guideline project on frail and elderly. Hope this is useful; if you need some other additional info, I do have some general overview papers on different topics in this patient category. Best regards!

9 Behandlung alter und gebrechlicher Dialysepatienten - Leitlinien

10 Früher oder später Dialysebeginn die IDEAL Studie

11 Früher oder später Dialysebeginn die IDEAL Studie

12 Behandlung alter und gebrechlicher Dialysepatienten - Leitlinien

13 Behandlung alter und gebrechlicher Dialysepatienten KDIGO CKD-MBD Kommentar Kidney Int 2014 (in press)

14 Behandlung alter und gebrechlicher Dialysepatienten KDIGO CKD-MBD Kommentar Topic # 1: Vascular calcification Ketteler M et al. Kidney Int2014 (in press)

15 Altersassoziierte Komplikationen bei medizinischen Entscheidungsprozessen

16 Inzidenz der Nierenersatztherapie in Altersgruppe

17 Überlebensprognose im Terminalstadium Dialysepatient vs. Krebspatient vs. Herzversagen

18 Lebenserwartung und Startmodus der Nierenersatztherapie

19 Prognosevergleich: Maximal konservatives Management (MCM) vs. Nierenersatztherapie Carson RC et al. CJASN 2009; 4: 1611

20 Prognosevergleich: Maximal konservatives Management (MCM) vs. Nierenersatztherapie Carson RC et al. CJASN 2009; 4: 1611

21 Prognosevergleich: Maximal konservatives Management (MCM) vs. Nierenersatztherapie Carson RC et al. CJASN 2009; 4: 1611

22 Prognosevergleich: Maximal konservatives Management (MCM) vs. Nierenersatztherapie

23 Prognosevergleich: Maximal konservatives Management (MCM) vs. Nierenersatztherapie

24 Prognosevergleich: Maximal konservatives Management (MCM) vs. Nierenersatztherapie Patienten > 75 Jahre

25 Komorbiditäten-Scores: Eine Entscheidungshilfe? Body mass index <18.5 kg/m2 (2 points), diabetes (1), congestive heart failure stages III to IV (2), peripheral vascular disease stages III to IV (2), dysrhythmia (1), active malignancy (1), severe behavioural disorder (2), total dependency for transfers (3) and unplanned dialysis (2)

26 Komorbiditäten-Scores: Eine Entscheidungshilfe?

27 Komorbiditäten-Scores: Eine Entscheidungshilfe?

28 Komorbiditäten-Scores: Eine Entscheidungshilfe?

29 Auswirkungen der Nierenersatztherapie auf den Funktionsstatus im Alter

30 Auswirkungen der Nierenersatztherapie auf den Funktionsstatus im Alter

31 Auswirkungen der Nierenersatztherapie auf den Funktionsstatus im Alter

32 Absetzen der Dialyse welcher Modus?

33 Behandlung alter und gebrechlicher Dialysepatienten die Umfrage

34 Behandlung alter und gebrechlicher Dialysepatienten die Umfrage Method An electronic, 36-item survey disseminated among ERA-EDTA members via an blast. Results In total, 514 nephrologists from 45 European countries completed the survey.: o 36.4% female o 52% >50 years old o 53% in a university centre o 48% practising >20 years o 49% spent >75% of their time in direct patient care. Van Biesen W; personal communication

35 Van Biesen W; personal communication

36 Behandlung alter und gebrechlicher Dialysepatienten die Umfrage Percentage of patients withdrawn from dialysis over the last 12 months Van Biesen W; personal communication

37 Behandlung alter und gebrechlicher Dialysepatienten die Umfrage Physician perception of legal background of dialysis withdrawal Van Biesen W; personal communication

38 Behandlung alter und gebrechlicher Dialysepatienten die Umfrage Van Biesen W; personal communication

39 Van Biesen W; personal communication

40 Behandlung alter und gebrechlicher Dialysepatienten die Umfrage Withdrawal of dialysis occurs with variable frequency over different countries in Europe frequency of withdrawal appears to be associated with: o o o o Perception of legal character Perception of presence of an explicit right on palliative care Health economic model (profit vs not for profit) gender Preparation is suboptimal (even in those centres/countries were withdrawal is more frequent): o o o o no involvement of associated specialties no protocol on who, when, how to organise withdrawal and subsequent PC withdrawal/end of life not part of official nephrology training low interest for CME s on this topic Van Biesen W; personal communication

41 Vielen Dank für Ihre Aufmerksamkeit! Klinikum Coburg GmbH Prof. Dr. Markus Ketteler Kontaktdaten: Klinikum Coburg GmbH III. Medizinische Klinik: Nephrologie Ketschendorfer Straße Coburg Telefon

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