[Renal replacement therapy in Germany: An overview with a clinical focus]

In Germany, around 80000 people are currently dependent on permanent renal replacement therapy (RRT). Due to demographic developments and improvements in life expectancy, the prevalence will continue to increase even if the effects of newer pharmacological substances such as SGLT2 inhibitors and GLP1 agonists are promising in inhibiting progression. There are basically three different methods of renal replacement therapy and their variants: Kidney transplantation (KTX), peritoneal dialysis (PD), hemodialysis (HD)/hemodiafiltration (HDF). The life expectancy of dialysis patients is reduced by around 67% compared to the normal population, particularly due to cardiovascular and infection-related complications. PD and HD are considered to be equivalent in terms of mortality. Currently, HDF is increasingly coming back into focus after the last randomized controlled trial (CONVINCE trial) proved its superiority over conventional HD. Kidney transplantation is clearly superior to dialysis therapy in terms of life expectancy; according to a meta-analysis, the risk of death is reduced by around 55% in comparison.