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<p>The management of end-stage renal disease and kidney failure in patients transitioning to the immediate need for a&#xa0;renal replacement procedure is one of the most important tasks for nephrologists. A&#xa0;timely, structured and patient-centered approach is crucial for improving the clinical prognosis and preserving the quality of life. This includes an early systematic assessment of risk and progression, taking factors such as proteinuria, the decline of the estimated glomerular filtration rate (eGFR-slope) and cardiovascular comorbidities into account, in order to determine the optimal timing for an intensive counselling. In the evaluation of older adults, numerous geriatric nephrological aspects must be incorporated and weighed up. Shared decision-making is always central to this, which fully informs patients and relatives about all therapeutic options, conservative therapy, hemodialysis, peritoneal dialysis and kidney transplantation, and actively incorporates their preferences into the treatment plan. The option of pre-emptive kidney transplantation should be presented early, and by the time dialysis is started, a&#xa0;timely registration on the transplant waiting list should be ensured for eligible patients. In treatment management, patient-centered home dialysis modalities should, whenever possible, be placed clearly at the forefront, especially given their advantages with respect to sustainability and demographic trends. This also applies to older patients, although center-based dialysis as well as continuation of treatment within a&#xa0;conservative management framework remain highly valuable.</p>

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Management des Nierenversagens

  • 期刊论文

  • 发表日期：

    2026年4月14日

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  • Margret Patecki,
  • Clara Daschner,
  • Bernd Hohenstein,
  • Martina Guthoff

摘要

The management of end-stage renal disease and kidney failure in patients transitioning to the immediate need for a renal replacement procedure is one of the most important tasks for nephrologists. A timely, structured and patient-centered approach is crucial for improving the clinical prognosis and preserving the quality of life. This includes an early systematic assessment of risk and progression, taking factors such as proteinuria, the decline of the estimated glomerular filtration rate (eGFR-slope) and cardiovascular comorbidities into account, in order to determine the optimal timing for an intensive counselling. In the evaluation of older adults, numerous geriatric nephrological aspects must be incorporated and weighed up. Shared decision-making is always central to this, which fully informs patients and relatives about all therapeutic options, conservative therapy, hemodialysis, peritoneal dialysis and kidney transplantation, and actively incorporates their preferences into the treatment plan. The option of pre-emptive kidney transplantation should be presented early, and by the time dialysis is started, a timely registration on the transplant waiting list should be ensured for eligible patients. In treatment management, patient-centered home dialysis modalities should, whenever possible, be placed clearly at the forefront, especially given their advantages with respect to sustainability and demographic trends. This also applies to older patients, although center-based dialysis as well as continuation of treatment within a conservative management framework remain highly valuable.