Skip to main content
SpringerLink
Log in

Niereninsuffizienz und kardiovaskuläre Erkrankungen

Renal insufficiency and cardiovascular diseases

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

Zusammenfassung

Die chronische Niereninsuffizienz ist ein starker kardiovaskulärer Risikofaktor. Nicht nur renale, sondern auch kardiale Schädigungen werden durch eine Mikroalbuminurie früh angezeigt. Eine optimale Blutdrucktherapie sowie Senkung der Proteinurie sind wichtige Maßnahmen zur Reduktion der deutlich erhöhten kardiovaskulären Morbidität und Mortalität bei diesem speziellen Kollektiv. Sowohl eine medikamentöse Sekundärprophylaxe als auch interventionelle Verfahren bei Vorliegen einer koronaren Herzerkrankung kommen bei Nierenkranken vielfach nur in unzureichendem Maße zum Einsatz. Patienten mit Niereninsuffizienz sollten zur Verbesserung des kardiovaskulären Outcomes auch großzügig auf das Vorliegen einer schlafbezogenen Störung untersucht und ggf. entsprechend behandelt werden. Prospektive Daten zu neuen Therapieansätzen wie oralen Faktor-Xa- oder Thrombininhibitoren bei Vorhofflimmern liegen nicht vor. Selbst für Vitamin-K-Antagonisten ist die Situation bei Dialysepatienten unklar. Auch Studien zur Transkatheteraortenklappenimplantation bei schwerer Aortenklappenstenose und fortgeschrittener Niereninsuffizienz oder Dialysepflichtigkeit fehlen bislang.

Abstract

Chronic kidney disease (CKD) is a strong cardiovascular risk factor. Microalbuminuria is an early indicator of renal and cardiac damage. Optimal blood pressure therapy and reduction of proteinuria are important measures in order to reduce increased cardiovascular morbidity and mortality in this cohort. Secondary prevention by optimal medical as well as interventional therapy is employed in an inadequate number of CKD patients. In addition, CKD patients should be screened for sleep-related disorders and, if required, adequate therapy should be provided in order to improve cardiovascular outcome. Prospective data in advanced CKD patients concerning new therapeutical approaches such as oral factor Xa- or thrombin-inhibitor therapy are lacking. Optimal treatment of atrial fibrillation in dialysis patients with vitamin K antagonists is also unclear. Prospective studies of transcatheter aortic valve implantation for severe aortic stenosis in patients with advanced stages of renal insufficiency or dialysis therapy are still missing.

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

Literatur

  1. ACCORD Study Group, Cushman WC, Evans GW et al (2010) Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362:1575–1585

    Google Scholar 

  2. Anavekar NS, McMurray JJV, Velazguez EJ et al (2004) Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 351:1285–1295

    Google Scholar 

  3. Ashrith G, Lee VV, Elayda MA et al (2010) Short- and long-term outcomes of coronary artery bypass grafting or drug eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease. Am J Cardiol 106:348–353

    Article  PubMed  Google Scholar 

  4. Badve SV, Roberts MA, Hawley CM et al (2011) Effects of beta-adrenergic antagonists in patients with chronic kidney disease: a systematic review and meta-analysis. J Am Coll Cardiol 58:1152–1161

    Google Scholar 

  5. Baigent C, Landray MJ, Reith C et al (2011) The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 377:2181–2192

    Article  PubMed  CAS  Google Scholar 

  6. Boden WE, O’Rourke RA, Teo KK et al (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516

    Google Scholar 

  7. Brandt MC et al (2012) Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 59:901–909

    Google Scholar 

  8. Chan V, Chen L, Mesana L et al (2011) Heart valve prosthesis selection in patients with end-stage renal disease requiring dialysis: a systematic review and meta-analysis. Heart 97:2033–2037

    Article  PubMed  Google Scholar 

  9. Dudenbostel T, Calhoun DA (2012) Resistant hypertension, obstructive sleep apnoea and aldosterone. J Hum Hypertens 26:281–287

    Google Scholar 

  10. Fox CS, Muntner P, Chen AY et al (2010) Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry. Circulation 121:357–365

    Article  PubMed  CAS  Google Scholar 

  11. Fritz A, Rump LC (2011) Niereninsuffizienz und schlafbezogene Atemstörungen. Somnologie 15:160–164

    Article  Google Scholar 

  12. Garg P et al (2010) Impact of moderate renal insufficiency on restenosis and adverse clinical events after sirolimus-eluting and bare metal stent implantation (from the SIRIUS trials). Am J Cardiol 106:1436–1442

    Article  PubMed  CAS  Google Scholar 

  13. Go AS, Chertow GM, Fan D et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305

    Google Scholar 

  14. Hemmelgarn BR, Manns BJ, Lloyd A et al (2010) Relation between kidney function, proteinuria, and adverse outcomes. JAMA 303:423–429

    Article  PubMed  CAS  Google Scholar 

  15. Hermida RC, Ayala DE, Mojón A, Fernández JR (2011) Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J Am Soc Nephrol 22:2313–2321

    Google Scholar 

  16. Jamerson K, Weber MA, Bakris GL et al (2008) Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 359:2417–2428

    Google Scholar 

  17. Kodali SK, Williams MR, Smith CR et al (2012) Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 366:1686–1695

    Google Scholar 

  18. Levey AS et al (2011) The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int 80:17–28

    Article  PubMed  Google Scholar 

  19. Limdi NA et al (2009) Kidney function influences warfarin responsiveness and hemorrhagic complications. J Am Soc Nephrol 20:912–921

    Google Scholar 

  20. Mancia G, Laurent S, Agabiti-Rosei E et al (2009) European Society of Hypertension. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 27:2121–2158

    Google Scholar 

  21. Mega JL, Braunwald E, Wiviott SD et al (2012) Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med 366(1):9–19

    Article  PubMed  CAS  Google Scholar 

  22. Morel O et al (2011) Cardiovascular mortality in chronic kidney disease patients undergoing percutaneous coronary intervention is mainly related to impaired P2Y12 inhibition by clopidogrel. J Am Coll Cardiol 57:399–408

    Google Scholar 

  23. Nicholl DM, Ahmed SB, Loewen AH et al (2012) Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest (im Druck)

  24. Notaro LA, Usman MH, Burke JF et al (2009) Secondary prevention in concurrent coronary artery, cerebrovascular, and chronic kidney disease: focus on pharmacological therapy. Cardiovasc Ther 27:199–215

    Article  PubMed  CAS  Google Scholar 

  25. O’Dell KM, Igawa D, Hsin J (2012) New oral anticoagulants for atrial fibrillation: a review of clinical trials. Clin Ther 34:894–901

    Article  Google Scholar 

  26. Ohara T, Hashimoto Y, Matsumura A et al (2005) Accelerated progression and morbidity in patients with aortic stenosis on chronic dialysis. Circ J 69:1535–1539

    Article  PubMed  Google Scholar 

  27. Park SH, Kim W, Park CS et al (2009) A comparison of clopidogrel responsiveness in patients with versus without chronic renal failure. Am J Cardiol 104:1292–1295

    Article  PubMed  CAS  Google Scholar 

  28. Redon J, Plancha E, Swift PA et al (2010) Nocturnal blood pressure and progression to end-stage renal disease or death in nondiabetic chronic kidney disease stages 3 and 4. J Hypertens 28:602–607

    Google Scholar 

  29. Rump LC, Amann K, Orth S et al (2000) Sympathetic overactivity in renal disease: a window to understand progression and cardiovascular complications of uraemia? Nephrol Dial Transplant 15:1735–1738

    Article  PubMed  CAS  Google Scholar 

  30. Schmidt M et al (2011) Renal dysfunction and atrial fibrillation recurrence following cardioversion. J Cardiovasc Electrophysiol 22:1092–1098

    Google Scholar 

  31. Sedlis SP, Jurkovitz CT, Hartigan PM et al (2009) Optimal medical therapy with or without percutaneous coronary intervention for patients with stable coronary artery disease and chronic kidney disease. Am J Cardiol 104:1647–1653

    Article  PubMed  Google Scholar 

  32. Serruys PW, Morice MC, Kappetein AP et al (2009) Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 360:961–972

    Google Scholar 

  33. Soliman EZ, Prineas RJ, Go AS et al (2010) Chronic kidney disease and prevalent atrial fibrillation: the Chronic Renal Insufficiency Cohort (CRIC). Am Heart J 159:1102–1107

    Article  Google Scholar 

  34. Stergiopoulos K, Brown DL (2012) Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med 172:312–319

    Article  PubMed  Google Scholar 

  35. Szummer K et al (2009) SWEDEHEART. Influence of renal function on the effects of early revascularization in non-ST-elevation myocardial infarction: data from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Circulation 120:851–858

    Article  PubMed  CAS  Google Scholar 

  36. US Renal Data System (2011) USRDS 2011 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda/MD

  37. Vonend O, Marsalek P, Russ H et al (2003) Moxonidine treatment of hypertensive patients with advanced renal failure. J Hypertens 21:1709–1717

    Google Scholar 

  38. Wada M et al (2011) Chronic kidney disease and coronary artery vulnerable plaques. Clin J Am Soc Nephrol 6:2792–2798

    Article  PubMed  Google Scholar 

  39. Watanabe R, Lemos MM, Manfredi SR et al (2010) Impact of cardiovascular calcification in nondialyzed patients after 24 months of follow-up. Clin J Am Soc Nephrol 5:189–194

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Die korrespondierende Autorin gibt für sich und ihre Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Nephrologie, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    S. Kücükköylü & L.C. Rump

Authors
  1. S. Kücükköylü
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L.C. Rump
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Kücükköylü.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kücükköylü, S., Rump, L. Niereninsuffizienz und kardiovaskuläre Erkrankungen. Internist 53, 791–801 (2012). https://doi.org/10.1007/s00108-011-3010-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-011-3010-5

Schlüsselwörter

Keywords

Search

Navigation