By Dr. Gerhard Gahl, Professor Dr. Michael Kessel (auth.)
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Es fallt auf, daB einige Elektrolyte - insbesondere Natrium und Kalium - in der Waschl6sung in niedrigerer Konzentration als im Biut vorliegen, andere dagegen in gleicher oder h6herer Konzentration. Zum besseren Verstandnis werden im folgenden die wichtigsten Elektrolyte kurz besprochen: a) Natrium Wie bereits erwahnt, ist der NatriumiiberschuB des Organismus (sog. positive Natriumbilanz) hauptverantwortlich fiir die Hypertonie bei Nierenkranken. Durch Einschrankung der Kochsalzzufuhr und F6rderung der Ausscheidung laBt sich die Hypertonie vielfach bessem.
Sparks-Mandril- Prothese). Diese Shunt-Operationen sind durchweg komplizierter als die Anlage einer typischen Cimino-Fistel am Unterarm. Sie sind deshalb in der Regel nur durch einen Chirurgen auszufiihren. Diese Fisteln sollten zudem erst 4-6 Wochen nach griindlicher Einheilung punktiert werden, so daB gelegentlich eine Oberbriickung mit Hilfe von Peritonealdialysen notwendig wird (s. ). Daneben gibt es eine Reihe von modiJizierten Scribner-Shunts, die nach ihren Erfindem benannt sind. Der Buselmeier-Shunt, z.
16a u. b. Darstellung des extracorporalen Kreislaufs bei Single-Needle-Technik. (a) arterielle Hergabe freigegeben. (b) venoser Riicklauf freigegeben stige Menge an "Pendelblut" ist femer umso groBer, je kurzer die arterielle Offnungsphase eingestellt ist. Durch den geringeren Blutumlauf und die teilweise Rezirkulation ist die Single-N eedle-Dialyse etwas weniger (ca. 15-20%) effektiv als die Standard-Dialyse. Die Vorteile der Single-Needle-Technik - Schonung des Shunts und Verminderung der Schmerzen - liegen auf der Hand.