Emergencies in patients with renal failure [Notfälle bei patienten mit niereninsuffizienz]

The number of patients who suffer from chronic renal failure and who are dependent on dialysis is continually increasing due to demographic development. In 2006 almost 70.000 people in Germany were treated with dialysis. As a result the emergency physician is increasingly confronted with emergency situations involving patients who are terminally kidney deficient, hemodialysis dependent or have had a kidney transplant. The balance between water, electrolyte and acid base systems in terminally kidney deficient patients and those requiring dialysis is often unstable. Typical emergency situations are hyperkalemia, hyperhydration with pulmonary edema as well as hypertension with heart deficiency. But the emergency physician also is confronted with cases of acute hypotension during hemodialysis, infections related to continuous peritoneal dialysis or central venous catheters and acute shunt bleeding or shunt thrombosis. The on-site therapy is mostly symptom orientated, as a causal therapy of the clinical pictures prior to hospital admittance is often not possible. Therefore a liberal referral of these patients into a clinic suitable for such emergencies is required. © Springer Medizin Verlag 2008.