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Verminderung der Progression einer chronischen Niereninsuffizienz

Strategien

Reduction the progression of chronic kidney disease

Strategies

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Zusammenfassung

Chronische Nierenerkrankungen (CKD) sind ein weltweit zunehmendes Problem, so dass diese auch eine rasch zunehmende Bedeutung als Mortalitätsursache erlangen. Wesentlich für die Progressionsverlangsamung einer CKD ist die optimale Einstellung des Blutdrucks wobei die Zielblutdruckwerte bei Patienten mit CKD keine klare Evidenz für die jeweiligen Zielwerte besteht. Diese hängen zudem auch von der Grundkrankheit, wie z. B. einer ADPKD, ab. Ein wesentlicher Mechanismus zur Kontrolle des arteriellen Blutdrucks beseht in der Blockade des Renin-Angiotensin-Aldosteronsystems (RAAS) mittels ACE-Inhibitoren (ACEI) bzw. Angiotensinrezeptorblockern (ARB). Aufgrund der zusätzlichen blutdruckunabhängigen Reduktion von Proliferations- und Entzündungsprozessen sind diese Substanzen sehr gut für eine Progressionsverminderung einer CKD geeignet. Des weiteren sollte eine Dyslipidämie bei Patienten mit einer CKD behandelt werden, wobei die Effekte im Hinblick auf eine Reduktion des kardiovaskulären Risikos bei Patienten mit CKD geringer sind als in der Allgemeinbevölkerung. Die Behandlung sollte mit Statinen erfolgen; zu den Wirkungen der neuen PCSK 9 Inhibitoren fehlen bisher Daten zu Patienten mit CKD. Bei Patienten mit Diabetes mellitus und CKD sollte der Blutzucker sollte so behandelt werden, dass das HbA1c unter 7 % liegt. Metformin kann dabei bei Patienten mit einer mäßigen GFR-Einschränkung gegeben werden. Allerdings sollte die Nierenfunktion kontrolliert werden und bei einer weiteren Verschlechterung das Medikament abgesetzt/pausiert werden. Auch Faktoren des sog. Lifestyles, darunter vor allem die Ernährung, sind von wesentlicher Bedeutung für die Progression einer CKD. In diesem Zusammenhang sollte vor allem die Natriumzufuhr, die Harnsäureproduktion und der Säure-Basenhaushalt behandelt werden. Insgesamt kann auf diese Weise die Progression einer CKD vermindert werden, wobei zukünftige Studien helfen müssen, Zielwerte besser zu definieren und neue Therapeutika vor allem bei Patienten mit CKD zu untersuchen.

Abstract

Chronic kidney diseases (CKD) are a worldwide increasing problem that is also reflected by the fact that CKD is an increasing reason for overall mortality. Blood pressure control is a key factor to delay the progression of CKD. However, little evidence exists for the correct target levels in patients with CKD. Such targets depend also from the underlying disease, i.e. ADPKD. A central mechanism to control the blood pressure in CKD patients is blockade of the renin angiotensin aldosterone (RAAS) system by ACEI or ARB. Due to their additional effects regarding the reduction of proliferation and inflammation independent of their blood pressure lowering effects, these compounds are well suitable for delaying the progression of CKD. Furthermore, a dyslipidemia should be treated in patients with CKD, although such effects in reducing cardiovascular risk are lower in CKD patients as compared to the general population. The treatment should be started with statins. Regarding the effects of the new PCSK 9 inhibitors data in patients with CKD are not yet available. Blood glucose should be managed in order to reach HbA1c levels below 7 %. Metformin can be administered in patients with a moderate CKD. However the renal function should be monitored and in case of further declining renal function metformin should be stopped or paused. Life style factors, among them particularly the diet, are of special importance for the progression of CKD. Here, especially the sodium intake, the production of uric acid as well as the control of the acid base metabolism. Altogether the progression of CKD can be delayed by a control of these factors, while it is necessary to better define target values as well as to analyze new therapeutics particularly in patients with CKD.

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  1. I. Medizinische Klinik und Poliklink, Poliklinik Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    D. Sollinger, B. Schamberger, J. Weinmann-Menke &  J. Lutz

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Sollinger, D., Schamberger, B., Weinmann-Menke, J. et al. Verminderung der Progression einer chronischen Niereninsuffizienz. Nephrologe 11, 260–267 (2016). https://doi.org/10.1007/s11560-016-0076-z

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