Skip to main content
SpringerLink
Log in

Therapie und Prophylaxe von Endorganschäden der Niere

  • Schwerpunkt: Endorganschäden
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die Zahl terminal niereninsuffizienter Patienten steigt beständig. Bei rechtzeitiger Identifikation von Risikopatienten könnte jedoch eine potente Primär- und Sekundärprävention des progredienten Nierenversagens erreicht werden. Nach Ausschöpfen kausaler Therapieansätze liegt das Schwergewicht der Behandlung von Patienten mit renalen Endorganschäden auf der supportiven Behandlung: antihypertensive und ggf. diabetische Therapie, diätetische Maßnahmen, Meiden von Zusatznoxen etc. Zusätzlich stellt bereits eine milde Einschränkung der Nierenfunktion einen potenten kardiovaskulären Risikofaktor dar, sodass das 2. zentrale Ziel der Therapie in der Reduktion der erheblich gesteigerten kardiovaskulären Morbidität dieser Patienten besteht. Eine essenzielle Rolle kommt daher der gleichzeitigen Therapie diverser Folgeerkrankungen der Niereninsuffizienz wie z.B. des Hyperparathyreoidismus, der renalen Anämie etc. zu. Damit stellt die supportive Therapie eine sehr komplexe, multimodale und interdisziplinäre Behandlung dar, in die möglichst frühzeitig Nephrologen mit einbezogen werden sollten.

Abstract

The number of patients with end-stage renal disease is constantly growing. If patients at risk are identified early enough, currently available therapeutic options allow a potent primary and secondary prevention of progressive renal failure. If the underlying disease can not be eliminated, the mainstay of the therapy are supportive measures such as antihypertensive and, in case of an underlying diabetes mellitus, antidiabetic therapy, dietary restrictions as well as avoidance of additional nephrotoxic agents. Furthermore, even a mild renal insufficiency has been identified as a potent cardiovascular risk factor. The second major goal of supportive therapy therefore is a reduction of the markedly increased cardiovascular morbidity of these patients. This can be achieved through treatment of various consequences of renal failure, such as hyperparathyroidism, renal anemia etc. Supportive therapy thus represents a highly complex and interdisciplinary treatment, which should prompt an early inclusion of a nephrologist into the therapeutic strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1.
Abb. 2.
Abb. 3.
Abb. 4.
Abb. 5.

Literatur

  1. Remuzzi G, Bertani T (1998) Pathophysiology of progressive nephropathies. N Engl J Med 339: 1448–1456

    Google Scholar 

  2. Manjunath G, Tighiouart H, Ibrahim H et al. (2003) Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol 41: 47–55

    Google Scholar 

  3. Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S (2001) Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 134: 629–636

    Google Scholar 

  4. Ritz E, Tarng DC (2001) Renal disease in type 2 diabetes. Nephrol Dial Transplant 16 (Suppl 5): 11–18

    Google Scholar 

  5. Koch M, Kutkuhn B, Grabensee B, Ritz E (1997) Apolipoprotein A, fibrinogen, age, and history of stroke are predictors of death in dialysed diabetic patients: a prospective study in 412 subjects. Nephrol Dial Transplant 12: 2603–2611

    Google Scholar 

  6. Salusky IB, Goodman WG (2002) Cardiovascular calcification in end-stage renal disease. Nephrol Dial Transplant 17: 336–339

    Google Scholar 

  7. Levin A (2001) Prevalence of cardiovascular damage in early renal disease. Nephrol Dial Transplant 16 (Suppl 2): 7–11

    Google Scholar 

  8. Schomig M, Ritz E (2000) Cardiovascular problems in diabetic patients on renal replacement therapy. Nephrol Dial Transplant 15 (Suppl 5): 111–116

    Google Scholar 

  9. Goodman WG, Goldin J, Kuizon BD et al. (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342: 1478–1483

    Google Scholar 

  10. Vanholder R, Glorieux G, Lameire N (2003) Uraemic toxins and cardiovascular disease. Nephrol Dial Transplant 18: 463–466

    Google Scholar 

  11. Massy ZA (2000) Importance of homocysteine, lipoprotein (a) and non-classical cardiovascular risk factors (fibrinogen and advanced glycation end-products) for atherogenesis in uraemic patients. Nephrol Dial Transplant 15 (Suppl 5): 81–91

    Google Scholar 

  12. Ketteler M, Bongartz P, Westenfeld R et al. (2003) Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. Lancet 361: 827–833

    Google Scholar 

  13. Kielstein JT, Boger RH, Bode-Boger SM et al. (1999) Asymmetric dimethylarginine plasma concentrations differ in patients with end-stage renal disease: relationship to treatment method and atherosclerotic disease. J Am Soc Nephrol 10: 594–600

    Google Scholar 

  14. Billion S, Tribout B, Cadet E et al. (2002) Hyperhomocysteinaemia, folate and vitamin B12 in unsupplemented haemodialysis patients: effect of oral therapy with folic acid and vitamin B12. Nephrol Dial Transplant 17: 455–461

    Google Scholar 

  15. De Vriese AS, Verbeke F, Schrijvers BF, Lameire NH (2002) Is folate a promising agent in the prevention and treatment of cardiovascular disease in patients with renal failure? Kidney Int 61: 1199–1209

    Google Scholar 

  16. Nebel M (2002) Behandlungskosten der Nierenersatztherapie in Deutschland 1999. Nieren- und Hochdruckkrankheiten 31: 85–92

  17. Xue JL, Ma JZ, Louis TA, Collins AJ (2001) Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol 12: 2753–2758

    Google Scholar 

  18. Bommer J (2002) Prevalence and socio-economic aspects of chronic kidney disease. Nephrol Dial Transplant 17 (Suppl 11): 8–12

    Google Scholar 

  19. Parving HH, Andersen AR, Smidt UM, Svendsen PA (1983) Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet 1: 1175–1179

    Google Scholar 

  20. Brazy PC, Stead WW, Fitzwilliam JF (1989) Progression of renal insufficiency: role of blood pressure. Kidney Int 35: 670–674

    Google Scholar 

  21. Adler AI, Stratton IM, Neil HA et al. (2000) Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 321: 412–419

    Google Scholar 

  22. Peterson JC, Adler S, Burkart JM et al. (1995) Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med 123: 754–762

    Google Scholar 

  23. Keane WF, Lyle PA (2003) Recent advances in management of type 2 diabetes and nephropathy: Lessons from the RENAAL study. Am J Kidney Dis 41: S22–S25

    Google Scholar 

  24. Stefanski A, Schmidt KG, Waldherr R, Ritz E (1996) Early increase in blood pressure and diastolic left ventricular malfunction in patients with glomerulonephritis. Kidney Int 50: 1321–1326

    Google Scholar 

  25. The EUCLID Study Group (1997) Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet 349: 1787–1792

    Google Scholar 

  26. Hansson L, Zanchetti A, Carruthers SG et al. (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351: 1755–1762

    Google Scholar 

  27. Schafers RF, Lutkes P, Ritz E, Philipp T (1999) Leitlinie zur Behandlung der arteriellen Hypertonie bei Diabetes mellitus. Dtsch Med Wochenschr 124: 1356–1372

    Google Scholar 

  28. Young JH, Klag MJ, Muntner P et al. (2002) Blood pressure and decline in kidney function: findings from the Systolic Hypertension in the Elderly Program (SHEP). J Am Soc Nephrol 13: 2776–2782

    Google Scholar 

  29. Timio M, Venanzi S, Lolli S et al. (1995) "Non-dipper" hypertensive patients and progressive renal insufficiency: a 3-year longitudinal study. Clin Nephrol 43: 382–387

    Google Scholar 

  30. Lurbe E, Redon J, Kesani A et al. (2002) Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med 347: 797–805

    Google Scholar 

  31. Hebert LA, Wilmer WA, Falkenhain ME et al. (2001) Renoprotection: one or many therapies? Kidney Int 59: 1211–1226

    Google Scholar 

  32. Maschio G, Alberti D, Janin G et al. (1996) Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N Engl J Med 334: 939–945

    Google Scholar 

  33. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD (1993) The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 329: 1456–1462

    Google Scholar 

  34. Ruggenenti P, Perna A, Gherardi G et al. (1999) Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 354: 359–364

    Google Scholar 

  35. Gainer JV, Morrow JD, Loveland A, King DJ, Brown NJ (1998) Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects. N Engl J Med 339: 1285–1292

    Google Scholar 

  36. Weidmann P, Schneider M, Bohlen L (1995) Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: an updated meta-analysis. Nephrol Dial Transplant 10 (Suppl 9): 39–45

    Google Scholar 

  37. Giatras I, Lau J, Levey AS (1997) Effect of angiotensin-converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta-analysis of randomized trials. Angiotensin-Converting-Enzyme Inhibition and Progressive Renal Disease Study Group. Ann Intern Med 127: 337–345

    Google Scholar 

  38. Jafar TH, Schmid CH, Landa M et al. (2001) Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med 135: 73–87

    Google Scholar 

  39. Kshirsagar AV, Joy MS, Hogan SL, Falk RJ, Colindres RE (2000) Effect of ACE inhibitors in diabetic and nondiabetic chronic renal disease: a systematic overview of randomized placebo-controlled trials. Am J Kidney Dis 35: 695–707

    Google Scholar 

  40. Bakris GL, Weir M (2002) ACE inhibitors and protection against kidney disease progression in patients with type 2 diabetes: what's the evidence. J Clin Hypertens 4: 420–423

    Google Scholar 

  41. van Hout BA, Simeon GP, McDonnell J, Mann JF (1997) Economic evaluation of benazepril in chronic renal insufficiency. Kidney Int 63 (Suppl): S159–S162

    Google Scholar 

  42. Brenner BM, Cooper ME, De Zeeuw D et al. (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345: 861–869

    Google Scholar 

  43. Lewis EJ, Hunsicker LG, Clarke WR et al. (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345: 851–860

    Google Scholar 

  44. Parving HH, Lehnert H, Brochner-Mortensen J et al. (2001) The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 345: 870–878

    Google Scholar 

  45. Rossing K, Christensen PK, Hansen BV, Carstensen B, Parving HH (2003) Optimal dose of candesartan for renoprotection in type 2 diabetic patients with nephropathy: A double-blind randomized cross-over study. Diabetes Care 26: 150–155

    Google Scholar 

  46. Mogensen CE, Neldam S, Tikkanen I et al. (2000) Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 321: 1440–1444

    Google Scholar 

  47. Bakris GL, Siomos M, Richardson D et al. (2000) ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. VAL-K Study Group. Kidney Int 58: 2084–2092

    Google Scholar 

  48. Tepel M, van der Giet M, Zidek W (1997) Praktische Therapie der chronischen Niereninsuffizienz durch Progressionshemmung. Dtsch Ärztebl 94: 2648–2652

    Google Scholar 

  49. Mann JF, Hilgers KF, Schmieder RE, Veelken R (1998) Renale Wirkungen und Nebenwirkungen der Angiotensin-Rezeptor-Antagonisten. Dtsch Ärztebl 95: 3287–3291

    Google Scholar 

  50. Luno J, Barrio V, Goicoechea MA et al. (2002) Effects of dual blockade of the renin-angiotensin system in primary proteinuric nephropathies. Kidney Int 62 (Suppl 82): 47–52

    Google Scholar 

  51. Nakao N, Yoshimura A, Morita H et al. (2003) Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial. Lancet 361: 117–124

    Google Scholar 

  52. Wing LM, Reid CM, Ryan P et al. (2003) A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 348: 583–592

    Google Scholar 

  53. (2002) Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 288: 2981–2997

  54. Remuzzi G, Schieppati A, Ruggenenti P (2002) Clinical practice. Nephropathy in patients with type 2 diabetes. N Engl J Med 346: 1145–1151

    Google Scholar 

  55. Nosadini R, Tonolo G (2002) Cardiovascular and renal protection in type 2 diabetes mellitus: the role of calcium channel blockers. J Am Soc Nephrol 13 (Suppl 3): S216–S223

    Google Scholar 

  56. Orth SR, Schomig M, Ritz E (2001) Pharmacological intervention in progressive renal diseases. Nephrol Dial Transplant 16 (Suppl 5): 19–25

    Google Scholar 

  57. Klein IH, Ligtenberg G, Oey PL, Koomans HA, Blankestijn PJ (2003) Enalapril and losartan reduce sympathetic hyperactivity in patients with chronic renal failure. J Am Soc Nephrol 14: 425–430

    Google Scholar 

  58. Adler AI, Stevens RJ, Manley SE et al. (2003) Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 63: 225–232

    Google Scholar 

  59. Ritz E, Rychlik I, Locatelli F, Halimi S (1999) End-stage renal failure in type 2 diabetes: A medical catastrophe of worldwide dimensions. Am J Kidney Dis 34: 795–808

    Google Scholar 

  60. Landgraf R, Meisel R, Pommer W (1997) Effektive Erkennung und Behandlung von Diabetespatienten mit hohem Risiko. Dtsch Ärztebl 94: 1944–1945

    Google Scholar 

  61. Gaede P, Vedel P, Parving HH, Pedersen O (1999) Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet 353: 617–622

    Google Scholar 

  62. (2002) Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA 287: 2563–2569

  63. UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837–853

    Google Scholar 

  64. Charpentier G, Riveline JP, Varroud-Vial M (2000) Management of drugs affecting blood glucose in diabetic patients with renal failure. Diabetes Metab 26 (Suppl 4): 73–85

    Google Scholar 

  65. Hasslacher C, Wittmann W (2003) Schwere Hypoglykämien bei Diabetikern mit eingeschränkter Nierenfunktion. Dtsch Med Wochenschr 128: 253–256

    Google Scholar 

  66. Yamashita H, Nagai Y, Takamura T, Nohara E, Kobayashi K (2002) Thiazolidinedione derivatives ameliorate albuminuria in streptozotocin-induced diabetic spontaneous hypertensive rat. Metabolism 51: 403–408

    Google Scholar 

  67. Myers DI, Poole LJ, Imam K, Scheel PJ, Eustace JA (2003) Renal artery stenosis by three-dimensional magnetic resonance angiography in type 2 diabetics with uncontrolled hypertension and chronic renal insufficiency: prevalence and effect on renal function. Am J Kidney Dis 41: 351–359

    Google Scholar 

  68. Gohda T, Makita Y, Shike T et al. (2001) Association of the DD genotype and development of Japanese type 2 diabetic nephropathy. Clin Nephrol 56: 475–480

    Google Scholar 

  69. Solini A, Dalla VM, Saller A et al. (2002) The angiotensin-converting enzyme DD genotype is associated with glomerulopathy lesions in type 2 diabetes. Diabetes 51: 251–255

    Google Scholar 

  70. Hadjadj S, Belloum R, Bouhanick B et al. (2001) Prognostic value of angiotensin-I converting enzyme I/D polymorphism for nephropathy in type 1 diabetes mellitus: a prospective study. J Am Soc Nephrol 12: 541–549

    Google Scholar 

  71. Ritz E, Zeier M, Kühn KW, Kütemeyer H (2002) Patienten werden zu spät zum Nephrologen überwiesen. Dtsch Ärztebl 39: 2528–2529

    Google Scholar 

  72. Bostom AG, Kronenberg F, Ritz E (2002) Predictive performance of renal function equations for patients with chronic kidney disease and normal serum creatinine levels. J Am Soc Nephrol 13: 2140–2144

    Google Scholar 

  73. Mussap M, Dalla VM, Fioretto P et al. (2002) Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients. Kidney Int 61: 1453–1461

    Google Scholar 

  74. Winkelmayer WC, Owen WF, Levin R, Avorn J (2003) A propensity analysis of late versus early nephrologist referral and mortality on dialysis. J Am Soc Nephrol 14: 486–492

    Google Scholar 

  75. Stack AG (2003) Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. Am J Kidney Dis 41: 310–318

    Google Scholar 

  76. Keller C, Ritz E, Pommer W et al. (2000) Behandlungsqualität niereninsuffizienter Diabetiker in Deutschland. DtschMed Wochenschr 125: 240–244

    Google Scholar 

  77. LeLorier J, Bombardier C, Burgess E et al. (2002) Practical considerations for the use of nonsteroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors in hypertension and kidney disease. Can J Cardiol 18: 1301–1308

    Google Scholar 

  78. Giovanni G, Giovanni P (2002) Do non-steroidal anti-inflammatory drugs and COX-2 selective inhibitors have different renal effects? J Nephrol 15: 480–488

    Google Scholar 

  79. Ahmad SR, Kortepeter C, Brinker A, Chen M, Beitz J (2002) Renal failure associated with the use of celecoxib and rofecoxib. Drug Saf 25: 537–544

    Google Scholar 

  80. Swan SK, Rudy DW, Lasseter KC et al. (2000) Effect of cyclooxygenase-2 inhibition on renal function in elderly persons receiving a low-salt diet. A randomized, controlled trial. Ann Intern Med 133: 1–9

    Google Scholar 

  81. Kitahara M, Eitner F, Ostendorf T et al. (2002) Selective cyclooxygenase-2 inhibition impairs glomerular capillary healing in experimental glomerulonephritis. J Am Soc Nephrol 13: 1261–1270

    Google Scholar 

  82. Fored CM, Ejerblad E, Lindblad P et al. (2001) Acetaminophen, aspirin, and chronic renal failure. N Engl J Med 345: 1801–1808

    Google Scholar 

  83. Solomon R, Werner C, Mann D, D'Elia J, Silva P (1994) Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med 331: 1416–1420

    Google Scholar 

  84. Tepel M, van der GM, Schwarzfeld C et al. (2000) Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 343: 180–184

  85. Durham JD, Caputo C, Dokko J et al. (2002) A randomized controlled trial of N-acetylcysteine to prevent contrast nephropathy in cardiac angiography. Kidney Int 62: 2202–2207

    Google Scholar 

  86. Aspelin P, Aubry P, Fransson SG et al. (2003) Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 348: 491–499

    Google Scholar 

  87. Lehnert T, Keller E, Gondolf K et al. (1998) Effect of haemodialysis after contrast medium administration in patients with renal insufficiency. Nephrol Dial Transplant 13: 358–362

    Google Scholar 

  88. Fabrizii V, Thalhammer F, Horl WH (1997) Aminoglycosid-induzierte Nephrotoxizität. Wien Klin Wochenschr 109: 830–835

    Google Scholar 

  89. Slaughter RL, Cappelletty DM (1998) Economic impact of aminoglycoside toxicity and its prevention through therapeutic drug monitoring. Pharmacoeconomics 14: 385–394

    Google Scholar 

  90. Chuahirun T, Khanna A, Kimball K, Wesson DE (2003) Cigarette smoking and increased urine albumin excretion are interrelated predictors of nephropathy progression in type 2 diabetes. Am J Kidney Dis 41: 13–21

    Google Scholar 

  91. Briganti EM, Branley P, Chadban SJ et al. (2002) Smoking is associated with renal impairment and proteinuria in the normal population: the AusDiab kidney study. Australian Diabetes, Obesity and Lifestyle Study. Am J Kidney Dis 40: 704–712

    Google Scholar 

  92. Orth SR, Ritz E (2002) The renal risks of smoking: an update. Curr Opin Nephrol Hypertens 11: 483–488

    Google Scholar 

  93. Grassi G, Seravalle G, Calhoun DA et al. (1994) Mechanisms responsible for sympathetic activation by cigarette smoking in humans. Circulation 90: 248–253

    Google Scholar 

  94. Koizumi T, Murakami K, Nakayama H, Kuwahara T, Yoshinari O (2002) Role of dietary phosphorus in the progression of renal failure. Biochem Biophys Res Commun 295: 917–921

    Google Scholar 

  95. Loghman-Adham M (1993) Role of phosphate retention in the progression of renal failure. J Lab Clin Med 122: 16–26

    Google Scholar 

  96. Klahr S, Levey AS, Beck GJ et al. (1994) The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med 330: 877–884

    Google Scholar 

  97. Meloni C, Morosetti M, Suraci C et al. (2002) Severe dietary protein restriction in overt diabetic nephropathy: benefits or risks? J Ren Nutr 12: 96–101

    Google Scholar 

  98. Maroni BJ (1998) Protein restriction in the pre-end-stage renal disease (ESRD) patient: who, when, how, and the effect on subsequent ESRD outcome. J Am Soc Nephrol 9: S100–S106

    Google Scholar 

  99. Mitch WE (2000) Dietary therapy in uremia: the impact on nutrition and progressive renal failure. Kidney Int 75 (Suppl): S38–S43

    Google Scholar 

  100. (1996) Effects of dietary protein restriction on the progression of moderate renal disease in the Modification of Diet in Renal Disease Study. J Am Soc Nephrol 7: 2616–2626

  101. Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH (1996) The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Ann Intern Med 124: 627–632

    Google Scholar 

  102. Fried LF, Orchard TJ, Kasiske BL (2001) Effect of lipid reduction on the progression of renal disease: a meta-analysis. Kidney Int 59: 260–269

    Google Scholar 

  103. Kuriyama S, Tomonari H, Yoshida H et al. (1997) Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients. Nephron 77: 176–185

    Google Scholar 

  104. Rossert J, McClellan WM, Roger SD, Verbeelen DL (2002) Epoetin treatment: what are the arguments to expect a beneficial effect on renal disease progression? Nephrol Dial Transplant 17: 359–362

    Google Scholar 

  105. Rossert JA, McClellan WM, Roger SD, Verbeelen DL, Horl WH (2002) Contribution of anaemia to progression of renal disease: a debate. Nephrol Dial Transplant 17 (Suppl 1): 60–66

    Google Scholar 

  106. Besarab A, Bolton WK, Browne JK et al. (1998) The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med 339: 584–590

    Google Scholar 

  107. Eckardt KU (2001) The CREATE trial--building the evidence. Nephrol Dial Transplant 16 (Suppl 2): 16–18

    Google Scholar 

  108. Garg AX, Clark WF, Haynes RB, House AA (2002) Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int 61: 1486–1494

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik II, Nephrologie und klinische Immunologie, Rheinisch Westfälische Technische Hochschule Aachen

    V. M. Brandenburg, B. Heintz &  J. Floege

  2. Medizinische Klinik II, Universitätsklinikum der RWTH Aachen, Pauwelsstraße 30, 52057, Aachen

    J. Floege

Authors
  1. V. M. Brandenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Heintz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Floege
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Floege.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brandenburg, V.M., Heintz, B. & Floege, J. Therapie und Prophylaxe von Endorganschäden der Niere. Internist 44, 819–830 (2003). https://doi.org/10.1007/s00108-003-0948-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-003-0948-y

Schlüsselwörter

Keywords

Search

Navigation