Kardiovaskuläre Kalzifikationen bei Niereninsuffizienz

Ein Update

Cardiovascular calcification in kidney disease

An update

Zusammenfassung

Die Gefäßverkalkung in der Urämie ist nach wie vor eine der wesentlichen Herausforderungen in der Nephrologie. Kardiovaskuläre Komplikationen stehen an erster Stelle der Morbidität und Mortalität von Dialysepatienten. Das Verstehen der Zusammenhänge der Entstehung von Gefäßverkalkungen sowie ein Früherkennen von Patienten mit besonders hohem Risiko für kardiovaskuläre Komplikationen sowie mögliche neue Therapien sind für eine Präventivmedizin essenziell. Die bis vor einiger Zeit herrschende Meinung einer allein passiven Entstehung der Kalzifikation gilt als überholt und ist durch Ergebnisse abgelöst worden, die ein aktives biologisches Geschehen beschreiben. Die Entwicklungen in den letzten Jahren konnten zeigen, dass eine Reihe von Verkalkungsinhibitoren und zellulärer Mechanismen beteiligt sind. In dieser Übersichtsarbeit werden wir den aktuellen Stand der Pathomechanismen der Gefäßkalzifikation erläutern sowie diese letzten Erkenntnisse zusammenfassen. Darüber hinaus werden wir neue therapeutische Strategien diskutieren.

Abstract

Uremic vascular calcification is still a major challenge in nephrology. Cardiovascular complications contribute substantially to morbidity and mortality of patients with renal replacement therapy. Understanding the development of vascular calcification and enabling the reliable identification of patients at high risk for cardiovascular complications as well as the development of new therapeutic options are of utmost importance. The traditional view of the development of vascular calcification as a passive process has been challenged since results emerged supporting an active, cell-driven pathomechanistic process instead. This review gives an update on the current hypotheses on the development of vascular calcification and a summary of the latest results. In addition new therapeutic strategies for tackling vascular calcification will be discussed.

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Interessenkonflikt

TK ist als Referent für die Firmen Sanofi/Genzyme, Abbott, Fresenius, Roche und Tecomedical tätig und erhält ein Beraterhonorar von der Firma Sanofi/Genzyme. GS erhielt Honorare für Vorträge und/oder Beratertätigkeit bzw. Forschungsdrittmittel von Amgen, Fresenius, Sanofi/Genzyme, Gambro und Köhler-Chemie.

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Correspondence to Dr. T. Krüger.

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Krüger, T., Schlieper, G. Kardiovaskuläre Kalzifikationen bei Niereninsuffizienz. Nephrologe 8, 28–36 (2013). https://doi.org/10.1007/s11560-012-0648-5

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Schlüsselwörter

  • Gefäßverkalkung
  • Kalziproteinpartikel
  • Matrix-Gla-Protein (MGP)
  • Vitamin K
  • Pyrophosphat
  • Thiosulfat

Keywords

  • Vascular calcification
  • Calciprotein particles
  • Matrix Gla protein
  • Vitamin K
  • Pyrophosphate
  • Thiosulfate