nach oben

Drugs & Aging

Erschienen in:

01.10.2000 | Disease Management

Peritoneal Dialysis

Prevention and Control of Infection

verfasst von: Dr Ram Gokal

Erschienen in: Drugs & Aging | Ausgabe 4/2000

Einloggen, um Zugang zu erhalten

Abstract

In spite of the reduction in peritonitis and catheter-related infection rates in patients undergoing peritoneal dialysis, these infections remain major sources of morbidity and transfer to haemodialysis. Touch contamination at the time of doing the exchanges is still a major cause of peritonitis and leads to Gram-positive organisms (coagulation-negative staphylococcus) being the most common pathogens. Newer exchange techniques have reduced this incidence but the more serious pathogens (Staphylococcal aureus, pseudomonas and fungi) remain a major problem. Treatment has to be immediate, and hence empirical, giving adequate cover for both Gram-positive and Gram-negative organisms. The use of vancomycin as an initial antibacterial has been discontinued because of the problem of vancomycin-resistant enterococcus. Recent guidelines advocate the use of a first generation cephalosporin combined with ceftazidime (if the urine output is >100 ml/day) or an aminoglycoside in anuric patients. Subsequent therapy changes are made upon bacterial isolation and sensitivities. Vancomycin is reserved for methicillin-resistant staphylococcus.

Peritoneal catheter-related infections (exit site and tunnel) are predominantly caused by S. aureus and pseudomonal organisms and can be difficult to eradicate. Tunnel infections invariably involve the catheter dacron cuffs and therefore are more likely to lead to peritonitis; in this situation catheter removal is the treatment of choice. Treatment of exit-site infections is with oral antibacterials (penicillinase-resistant penicillins, cefalexin). Vancomycin is avoided if possible. The identification that nasal carriage of S. aureus predisposes to exit-site and tunnel infections has led to prophylactic regimens to combat this problem. Mupirocin applied at the exit site leads to a reduction in catheter-related infections and peritonitis.

Popovich RP, Moncrief JW, Dechard JB, et al. The definition of a normal portable/wearable equilibrium peritoneal dialysis technique [abstract]. Abst Am Soc Artif Intern Organs 1976; 5: 64

Buoncrustiani C, Bianca P, Cozzani M. A new safe simple connection system for CAPD. Int J Urol Nephrol 1980; 1: 50–3

Majorca R, Cantaluppi A, Cancarini GC, et al. Prospective controlled trial of a Y connector and disinfectant to prevent peritonitis in CAPD. Lancet 1983; II: 642–4CrossRef

Canadian CAPD Clinical Trials Group. Peritonitis in continuous ambulatory peritoneal dialysis (CAPD): a multicentre, randomised clinical trial comparing the Y connector disinfectant system to standard system. Perit Dial Int 1989; 9: 159–63

Gokal R. Peritoneal dialysis. Medicine 1999; 27: 47–9

Pierratos A. Peritoneal dialysis glossary. Perit Dial Bull 1984;4:2–3

Keane WF, Vas SI. Peritonitis. In: Gokal R, Nolph KD, editors. The textbook of peritoneal dialysis. Dordrecht: Kluwer Academic Publishers, 1994: 473–502CrossRef

Tzamaloukas AH. Peritonitis in peritoneal dialysis patients: an overview. Adv Renal Replace Ther 1996; 3: 232–6

Peterson DK, Matzke GR, Keane WF. Current concepts in the management of peritonitis in CAPD patients. Rev Infect Dis 1987; 9: 604–12PubMedCrossRef

10.

Lindholm B, Bergstrom J. Nutritional requirement of peritoneal dialysis. In: Gokal R, Nolph KD, editors. The textbook of peritoneal dialysis. Dordrecht: Kluwer Academic Publishers, 1994: 443–72CrossRef

11.

Miller TE, Findon G. Touch contamination of connection devices in peritoneal dialysis: a quantitative microbiological analysis. Perit Dial Int 1997; 17: 560–7PubMed

12.

Gokal R, Bogle S, Hunt L, et al. CAPD peritonitis still a major problem in CAPD: results of a multi-centre study. J Nephrol 1989; 2: 95–9

13.

Golper TA, Hartstein A. Analysis of the causative pathogens on uncomplicated CAPD associated peritonitis: duration of therapy, relapses and prognosis. Am J Kidney Dis 1986; 7: 141–5PubMed

14.

Piraino B, Bernadini J, Sorkin M. The influence of peritoneal catheter exit site infections on peritonitis tunnel infections and catheter loss on CAPD. Am J Kidney Dis 1986; 8: 436–40PubMed

15.

Piraino B, Bernadini J, Sorkin M. Five-year study of the microbiological results of exit site infections and peritonitis in CAPD. Am J Kidney Dis 1987; 4: 281–6

16.

Plum J, Sudkamp S, Grabansee B. Results of ultrasound assisted diagnosis of tunnel infections in CAPD. Am J Kidney Dis 1994; 23: 99–104PubMed

17.

Scheinburg FB, Seligman AM, Fine J. Transmural migration of intestinal bacteria. N Engl J Med; 242: 747–51

18.

Steiner RW, Halasz NA. Abdominal catastrophes and other unusual events in CAPD. Am J Kidney Dis 1990: 15: 1–7PubMed

19.

Wood CJ, Fleming V, Turnridge J, et al. Campylobacter peritonitis in CAPD: report of eight cases and a review of the literature. Am J Kidney Dis 1992; 19: 162–6

20.

Holley JL, Bernadini J, Piraino B. Polymicrobial peritonitis in patients on CAPD. Am J Kidney Dis 1992; 19: 162–6PubMed

21.

Holley JL, Bernadini J, Piraino B. Infecting organisms in CAPD patients on the Y set. Am J Kidney Dis 1994; 23: 569–73PubMed

22.

Bunke M, Brier ME, Golper TA. Culture negative CAPD peritonitis: the Network 9 Study. Adv Perit Dial 1994; 10: 174–8PubMed

23.

Eisele G, Adewunni C, Bailie CR, et al. Surreptitious use of antimicrobial agents by CAPD patients. Perit Dial Int 1993; 13: 315–7

24.

Ryan S, Fessia S. Improved method for recovering of peritonitis-causing micro-organisms from peritoneal dialysis. J Clin Microbiol 1987; 25: 383–4PubMed

25.

Lewis SL, Holmes CJ. Host defence mechanisms in the peritoneal cavity of CAPD patients. Perit Dial Int 1991; 11: 14–21PubMed

26.

Zemel D, Betjes M, Dinkla C, et al. Analysis of inflammatory mediators and peritoneal permeability to macromolecules shortly before the onset of overt peritonitis in patients treated with CAPD. Perit Dial Int 1995; 15: 134–41PubMed

27.

Gokal R, Mistry CD, Peers EM, Midas Study Group. Peritonitis occurrence in a multicentre study of icodextrin and glucose in CAPD. Perit Dial Int 1995; 15: 226–30PubMed

28.

Ejlersen E, Brandi L, Lokkegaard H, et al. Is initial (24 hours) lavage necessary in treatment of CAPD peritonitis? Perit Dial Int 1991; 11:38–42PubMed

29.

Diagnosis and management of peritonitis in continuous ambulatory peritoneal dialysis: report of a working party of the British Society of Antimicrobial Chemotherapy. Lancet 1987; I: 845–9

30.

Ad-Hoc Advisory Committee on Peritonitis Management. CAPD peritonitis treatment recommendations: 1989 update. Perit Dial Int 1989; 9: 247–56

31.

Keane W, Everett ED, Golper TA, et al. Peritoneal dialysis-related peritonitis treatment recommendations: 1993 update. Perit Dial Int 1993; 13: 14–28PubMed

32.

Keane W, Alexander SR, Bailie GR, et al. Peritoneal dialysis-related peritonitis treatment recommendations: 1996 update. Perit Dial Int 1996; 16: 557–73PubMed

33.

Nosocomial enterococci resistant to Vancomycin. United States 1989–1993. MMWR Morb Mortal Wkly Rep 1993; 42: 597–9

34.

Tabaqchali S. Vancomycin-resistant Staphylococcus aureus: apocalypse now? Lancet 1997; 350: 1644–5PubMedCrossRef

35.

Centers for Disease Control. Staphylococcus aureus with reduced susceptibility to vancomycin. United States. MMWR Morb Mortal Wkly Rep 1997; 46: 765–6

36.

Keane WF, Baillie G, Boeschoten E, et al. Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 update. Perit Dial Int 2000; 20: In press

37.

Shemin D, Maaz D, St Pierre D, et al. Effect of aminoglycoside use on residual renal function in peritoneal dialysis. Am J Kidney Dis 1999; 34: 14–20PubMedCrossRef

38.

Lai MN, Kao MT, Chen CC, et al. Intraperitoneal once-daily dose of cefazolin and gentamicin for treating CAPD peritonitis. Perit Dial Int 1997; 17: 87–9PubMed

39.

Vas SI, Bargman J, Oreopoulos DG. Treatment in PD patients of peritonitis caused by Gram-positive organisms with single daily dose of antibiotics. Perit Dial Int 1997; 17: 91–4PubMed

40.

Kiernan L, Finkelstein FO, Kliger FS, et al. Outcome of polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis 1995; 25: 461–4PubMedCrossRef

41.

Traeneus A, Heimburger O, Lindholm B. Peritonitis in CAPD: diagnostic findings, therapeutic outcomes and complications. Perit Dial Int 1989; 13: 179–90

42.

Rotillar C, Black J, Winchester J, et al. Ten years experience with CAPD. Am J Kidney Dis 1991; 17: 156–64

43.

Pollock CA, Ibels LS, Caterson RJ, et al. CAPD — eight years of experience at a single centre. Medicine 1989; 68: 293–308PubMedCrossRef

44.

Kerr CM, Perfect JR, Craven PC, et al. Fungal peritonitis in patients on CAPD. Ann Intern Med 1983; 99: 334–7PubMed

45.

Lee Sh, Chiang SH, Hseih SJ, Shen HM. Successful treatment of fungal peritonitis with intracatheter antifungal retention. Adv Perit Dial 1995; 11: 172–5PubMed

46.

Benevent D, Peyronnet P, Lagarde C, et al. Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: three recoveries in 5 cases without catheter removal. Nephron 1985; 41: 203–6PubMedCrossRef

47.

Johnson RJ, Ramsey PG, Gallagher N, et al. Fungal peritonitis in patients on peritoneal dialysis. Am J Nephrol 1985; 5: 169–75PubMedCrossRef

48.

Robitaille P, Meerouani, A, Clermont MJ, et al. Successful antifungal prophylaxis in chronic peritoneal dialysis: a pediatric experience. Perit Dial Int 1995; 15: 77–8PubMed

49.

Zaruba K, Peters J, Jungbluth H. Successful prophylaxis for fungal peritonitis in patients on CAPD: six years’ experience. Am J Kidney Dis 1991; 17:43–6PubMed

50.

Williams PF, Moncrief N, Marriot J. No benefit in using ny statin prophylaxis against fungal peritonitis in peritoneal dialysis patients. Perit Dial Int 2000; 20: 352–3PubMed

51.

Cheng IKP, Chan PCK, Chan MK. Tuberculous peritonitis complicating long-term peritoneal dialysis. Am J Nephrol 1989; 9: 155–61PubMedCrossRef

52.

Mallat SG, Brensilver JM. Tuberculous peritonitis in a CAPD patient cured without catheter removal: case report, review of the literature, and guidelines for treatment and diagnosis. Am J Kidney Dis 1989; 13: 154–7PubMed

53.

Vas SI. Renaissance of tuberculosis in the 1990’s: lesson for the nephrologist. Perit Dial Int 1994; 14: 209–14PubMed

54.

Dunmire RB, Breyer JA. Nontuberculous mycobacterial peritonitis during continuous ambulatory peritoneal dialysis: case report and review of diagnostic and therapeutic strategies. Am J Kidney Dis 1991; 18: 126–30PubMed

55.

White R, Abreo K, Flanagan R, et al. Nontuberculous Mycobacterial infections in continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis 1993; 22: 581–7PubMed

56.

Gokal R, Francis DMA, Goodship THJ, et al. Peritonitis in continuous ambulatory peritoneal dialysis. Lancet 1982; II: 1388–91CrossRef

57.

Gokal R, King J, Bogle S, et al. Outcome in patients on continuous ambulatory peritoneal dialysis and haemodialysis: 4-year analysis of a prospective multicentre study. Lancet 1987; II: 1105–9CrossRef

58.

Woodrow G, Turney JH, Brownjohn AM. Technique failure in peritoneal dialysis and its impact on patient survival. Perit Dial Int 1997; 17:360–4PubMed

59.

Ataman R, Burton PR, Gokal R, et al. Long-term CAPD: some U.K. experience. Clin Nephrol 1988; 30Suppl. 1: S71–5PubMed

60.

Fried LF, Bernardini J, Johnston JR, et al. Peritonitis influences mortality in peritoneal dialysis patients. J Am Soc Nephrol 1996; 7: 2176–82PubMed

61.

Rubin J, McFarland S, Hellems EW, et al. Peritoneal dialysis during peritonitis. Kidney Int 1981; 19: 460–4PubMedCrossRef

62.

Raja RM, Kramer SM, Barber K. Solute transport and ultra-filtration during peritonitis in CAPD patients. J Am Soc Artif Intern Organs 1984; 7: 8–11

63.

Sennesael JJ, De Smedt GC, Van der Niepen P, et al. The impact of peritonitis on peritoneal and systemic acid-base status of patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 1994; 14:61–5PubMed

64.

Davies SJ, Bryan J, Phillips L, et al. Longitudinal changes in peritoneal kinetics: the effects of peritoneal dialysis and peritonitis. Nephrol Dial Transplant 1996; 11: 498–506PubMedCrossRef

65.

Weber J, Mettang T, Hubel E, et al. Survival of 138 surgically placed straight double-cuff Tenckhoff catheters in patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 1993; 13: 224–7PubMed

66.

Paterson AD, Bishop MC, Morgan AG, et al. Removal and replacement of Tenckhoff catheter at a single operation: successful treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis. Lancet 1986; II: 1245–7CrossRef

67.

Swartz R, Messana J, Reynolds J, et al. Simultaneous catheter replacement and removal in refractory peritoneal dialysis infection. Kidney Int 1991; 40: 1160–5PubMedCrossRef

68.

Posthuma N, Borgstein BJ, Eijsbouts Q, et al. Simultaneous peritoneal dialysis catheter insertion and removal in catheter-related infections without interruption of peritoneal dialysis. Nephrol Dial Transplant 1998; 13: 700–3PubMedCrossRef

69.

Mayo RR, Messana JM, Boyer CJ, et al. Pseudomonas peritonitis treated with simultaneous catheter replacement and removal. Perit Dial Int 1995; 15: 389–90PubMed

70.

Churchill DN. CAPD peritonitis: acritical appraisal of prophylactic strategies. Semin Dial 1991; 4: 94–100CrossRef

71.

Fellin G, Gentile MG, Cancarini G, et al. Peritonitis in CAPD: role of patients and staff: a report from the Italian CAPD study group. Adv Perit Dial 1988; 4: 165–8

72.

Churchill DN, Taylor W, Vas SI, et al. Peritonitis in CAPD patients: a randomized clinical trial of cotrimoxazole prophylaxis. Perit Dial Int 1988; 8: 125–8

73.

Fried L, Bernardini J, Piraino B. Iatrogenic peritonitis: the need for prophylaxis. Perit Dial Int 2000; 20: 343–4PubMed

74.

Abraham G, Savin E, Ayiomamitis A, et al. Natural history of exit-site infection in patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 1988; 8: 211–6

75.

Twardowski ZJ, Prowant BF. Classification of normal and diseased exit sites. Perit Dial Int 1996; 16Suppl. 3: S32–50PubMed

76.

Gokal R, Alexander S, Ash S, et al. Peritoneal catheters and exit site practices toward optimum peritoneal access: 1998 update. Perit Dial Int 1998; 18: 11–33PubMed

77.

Korzets Z, Erdberg A, Golan E, et al. Frequent involvement of the internal cuff segment in CAPD peritonitis and exit-site infection: an ultrasound study. Nephrol Dial Transplant 1996; 11:336–9PubMedCrossRef

78.

Oxton LL, Zimmerman SW, Roecker EB, et al. Risk factors for peritoneal dialysis-related infections. Perit Dial Int 1994; 14: 137–44PubMed

79.

Piraino B, Perlmutter JA, Holley JL, et al. Staphylococcus aureus peritonitis is associated with Staphylococcus aureus nasal carriage in peritoneal dialysis patients. Perit Dial Int 1993; 13Suppl. 2: S332–4PubMed

80.

Sesso R, Draibe S, Castelo A, et al. Staphylococcus aureus skin carriage and development of peritonitis in patients on continuous ambulatory peritoneal dialysis. Clin Nephrol 1989; 31: 264–8PubMed

81.

Sewell CM, Clarridge J, Lacke C, et al. Staphylococcal nasal carriage and subsequent infection in peritoneal dialysis patients. JAMA 1982; 248: 1493–5PubMedCrossRef

82.

Pignatari A, Pfaller M, Hollis R, et al. Staphylococcus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis. J Clin Microbiol 1990; 28: 1898–902PubMed

83.

Swartz R, Messana J, Starmann B, et al. Preventing Staphylococcus aureus infection during chronic peritoneal dialysis. J Am Soc Nephrol 1991; 2: 1085–91PubMed

84.

Davies SJ, Ogg CS, Cameron JS, et al. Staphylococcus aureus nasal carriage, exit-site infection and catheter loss in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Int 1989; 9: 61–4PubMed

85.

Luzar MA, Brown CB, Balf D, et al. Exit site care and exit site infection in continuous ambulatory peritoneal dialysis: results of a randomized multicenter trial. Perit Dial Int 1990; 10: 25–9PubMed

86.

Luzar MA. Exit site infection in continuous ambulatory peritoneal dialysis: a review. Perit Dial Int 1991; 11: 333–40PubMed

87.

Vychytil A, Lorenz M, Schneider B, et al. New strategies to prevent Staphylococcus aureus infections in peritoneal dialysis patients. J Am Soc Nephrol 1998; 9: 669–76PubMed

88.

Twardowski ZJ, Prowant BF. Current approaches to exit site infections in patients on peritoneal dialysis. Nephrol Dial Transplant 1997; 12: 1284–95PubMedCrossRef

89.

Golper TA, Tranaeus A. Vancomycin revisited. Perit Dial Int 1996: 16; 116–7PubMed

90.

Taber TE, Hegeman TF, York SM, et al. Treatment of pseudomonas infections in peritoneal dialysis patients. Perit Dial Int 1991; 11:213–6PubMed

91.

Kazmi HR. Raffone FD, Kliger AS, et al. Pseudomonas exit site infections in CAPD patients. J Am Soc Nephol 1992; 2: 1498–501

92.

Pecoits-Filho R, Twardowski ZJ, Khanna R, et al. The effect of antibiotic prophylaxis on the healing of exit sites of peritoneal dialysis catheters in rats. Perit Dial Int 1998; 18: 60–3PubMed

93.

Bennett-Jones DN, Martin J, Barratt AJ, et al. Prophylacatic gentamicin in the prevention of early exit site infections and peritonitis in CAPD. Adv Perit Dial 1988; 4: 147–50

94.

Newman LN, Tessman M, Hanslik T, et al. Aretrospective view of factors that affect catheter healing: four years of experience. Adv Perit Dial 1993; 9: 217–22PubMed

95.

Copley JB, Smith BJ, Koger DM, et al. Prevention of postoperative peritoneal dialysis catheter related infections. Perit Dial Int 1988; 8: 195–7

96.

Turner K, Edgar D, Hair M, et al. Does catheter immobilization reduce exit-site infections in CAPD patients? Adv Perit Dial 1992; 8: 265–8PubMed

97.

Warady BA, Sullivan EK, Alexander SR. Lessons from the peritoneal dialysis patient database: a report of the North American Paediatric Renal Transplant Co-operative Study. Kidney Int 1996; 49Suppl. 53: S68–71

98.

Golper TA, Brier ME, Bunke M, et al. Risk factors for peritonitis in long term peritoneal dialysis: the Network 9 Peritonitis and Catheter survival studies. Am J Kidney Dis 1996: 38; 428–36CrossRef

99.

Wilson AP, Lewis C, O’Sullivan, et al. The use of povidone iodine in exit site care for patients undergoing CAPD. J Hosp Infect 1997; 35: 287–93PubMedCrossRef

100.

Bending M, Mellotte G, Hashmi C, et al. Nasal mupirocin prevents S. aureus exit site infection during peritoneal dialysis. J Am Soc Nephrol 1996; 7: 2403–8

101.

Perez-Fontan M, Garcia-Falcon T, Rodrigues-Carmona A, et al. Treatment of Staphylococcal aureus nasal carriages in continuous ambulatory peritoneal dialysis (CAPD) with mupirocin: long term results. Am J Kidney Dis 1993; 22: 708–12PubMed

102.

Zimmerman SW, Ahrens E, Johnson CA, et al. Randomised controlled trial of prophylactic rifampin for peritoneal dialysis-related infections. Am J Kidney Dis 1991; 18: 225–31PubMed

103.

Bernardini J, Piraino B, Holley JL, et al. Randomised trial of Staphylococcal aureus prophylaxis in peritoneal dialysis patients: mupirocin calcium ointment 2% applied to exit site versus cyclic oral rifampin. Am J Kidney Dis 1996; 26: 695–700CrossRef

104.

Thodis E, Bhaskaran S, Pasadakis P, et al. Decrease in Staphy-lococcus aureus exit site infections and peritonitis in CAPD patients by local application of mupirocin ointment at the catheter exit site. Perit Dial Int 1998; 18: 261–70PubMed

105.

Vas S, Conly J, Bargman J, et al. Resistance to mupirocin: no indication of it to date while using mupirocin ointment for prevention of Staphylococcus aureus exit site infections in peritoneal dialysis patients. Perit Dial Int 1999; 19: 313–4PubMed

Titel: Peritoneal Dialysis
Prevention and Control of Infection
verfasst von: Dr Ram Gokal
Publikationsdatum: 01.10.2000
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 4/2000
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.2165/00002512-200017040-00003

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2000

Conceptualisation and Measurement of Frailty in Elderly People

Preventing Fractures in Postmenopausal Women with Osteoporosis

Optimising Therapy for Insulin-Treated Type 2 Diabetes Mellitus

Chemotherapy-Induced Oral Mucositis

Aging-Related Changes in Skeletal Muscle