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Diabetische Nephropathie und ACE-Hemmer

Diabetic nephropathy and ACE inhibitors

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Summary

The life expectancy of patients with type 2 diabetes and diabetic nephropathy is reduced; the main cause of death is cardiovascular disease. The majority of patients with renal replacement therapy are type 2 diabetics. Inhibition of the renin-aldosterone-angiotensin system is beneficial in diabetes mellitus. It reduces the incidence and slows the progression of nephropathy. ACE inhibitors are the accepted standard of care for nephropathy in type-1 diabetics; the role of ACE inhibitors versus angiotensin-receptor-blockers in type 2 diabetes is less clear. Large studies from the last 15 years and meta-analyses show a reduction of mortality of about 20% with ACE inhibitors in type 2 diabetic nephropathy; angiotensin-receptor-blockers have no documented effect on mortality yet, but do also slow the progression of nephropathy in type 2 diabetics. From these data and because of economic considerations, ACE inhibitors should be first choice therapy for diabetic nephropathy in type 2 diabetes mellitus.

Zusammenfassung

Patienten mit einer diabetischen Nephropathie haben eine deutlich verkürzte Lebenserwartung aufgrund einer deutlich erhöhten kardiovaskulären Mortalität; Diabetiker stellen den Großteil der neu dialysepflichtigen Patienten. Durch die Gabe von Hemmstoffen des Renin-Angiotensin-Aldosteron-Systems kann die Entwicklung einer klinisch bedeutsamen Nephropathie verhindert und die Progression einer manifesten Nephropathie verlangsamt werden. Für diese Indikationen ist für Typ-1-Diabetiker die Therapie mit ACE-Hemmern gesichert; bei Nephropathie aufgrund eines Typ-2-Diabetes sind Indikation und Stellenwert der ACE-Hemmer-Therapie gegenüber Angiotensin-Rezeptor-Blockern noch nicht endgültig geklärt. Anhand der großen Studien der letzten 15 Jahre sowie von Metaanalysen kann gezeigt werden, dass die Mortalität von Patienten mit Typ-2-Diabetes und diabetischer Nephropathie durch ACE-Hemmer um ca. 20% reduziert wird. Angiotensin-Rezeptor-Blocker verlangsamen ebenfalls das Fortschreiten der diabetischen Nephropathie, eine Senkung der Mortalität ist aber für diese Substanzgruppe nicht dokumentiert. Deshalb sollten—auch aufgrund pharmakoökonomischer Vorteile—ACE-Hemmer als Mittel der ersten Wahl auch bei Typ-2-Diabetikern mit Nephropathie eingesetzt werden.

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Authors and Affiliations

  1. Innere Abteilung Angiologie und Diabetologie, Franziskuskrankenhaus Berlin, Budapester Straße 15–19, 10787, Berlin, Germany

    B. Amann

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  1. B. Amann
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Amann, B. Diabetische Nephropathie und ACE-Hemmer. Clin Res Cardiol 95 (Suppl 1), i83–i87 (2006). https://doi.org/10.1007/s00392-006-1103-2

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  • DOI: https://doi.org/10.1007/s00392-006-1103-2

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