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Rhythmusstörungen bei Nierenerkrankungen und Nierenersatzverfahren

Cardiac arrhythmias in patients with chronic kidney disease

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Zusammenfassung

Patienten mit chronischer Nierenerkrankung weisen eine erhöhte kardiovaskuläre Morbidität und Mortalität auf, wobei die gesteigerte Prävalenz von supraventrikulären und ventrikulären Arrhythmien eine bedeutsame Ursache darstellt. Die zugrundeliegenden Pathomechanismen sind vielschichtig und resultieren vor allem in einer zunehmenden myokardialen Fibrosierung mit sog. kardialem Remodeling. Insbesondere Patienten mit fortgeschrittener Nierenerkrankung wurden bei vielen wegweisenden klinischen Studien ausgeschlossen, sodass für die Behandlung von Rhythmusstörungen in diesem Kollektiv vielfach keine eindeutigen Empfehlungen vorliegen. Bei der Einnahme von Antiarrhythmika ist in Abhängigkeit der Pharmakokinetik ggf. eine Dosisanpassung erforderlich. Der potenzielle Nutzen einer Therapie mit einem implantierbaren Kardioverter-Defibrillator (ICD) zur Prävention des plötzlichen Herztods oder der Nutzen einer Antikoagulation zum Schutz vor thrombembolischen Ereignissen bei Vorhofflimmern sollte deshalb bei fortgeschrittener Nierenerkrankung in Abhängigkeit von Komorbiditäten und der Prognose individuell evaluiert werden. Eine Vorhofflimmertherapie mittels Pulmonalvenenisolation kann zwar im Einzelfall auch zu einer Besserung der Nierenfunktion führen, aber die Erfolgsrate im Hinblick auf einen dauerhaften Erhalt eines Sinusrhythmus in diesem Patientenkollektiv ist deutlich reduziert. Insgesamt scheint bei fortgeschrittenen Nierenerkrankungen ein individuelles Therapie- und Behandlungskonzept sinnvoll.

Abstract

Patients with chronic kidney disease are at increased risk for cardiovascular morbidity and mortality, with the increased prevalence of supraventricular and ventricular arrhythmia being an important factor. The underlying pathomechanisms are diverse and mainly cause increasing atrial and ventricular fibrosis with so-called cardiac remodeling. In particular, patients with advanced kidney disease were excluded from many pioneering clinical trials, so there are no clear guidelines in the treatment of cardiac arrhythmia for these patients. The potential benefits of implantable cardioverter defibrillator (ICD) therapy for the prevention of sudden cardiac death or the benefits of anticoagulation for prevention of thromboembolic events in atrial fibrillation should therefore be evaluated individually for each patient with advanced kidney disease, taking comorbidities and the prognosis into account. When using antiarrhythmic drugs, a dose adjustment may be necessary depending on the pharmacokinetics and metabolism. Although atrial fibrillation treatment by means of pulmonary vein isolation can lead to an improvement in kidney function, the success rate seems to be significantly reduced in the presence of advanced kidney disease. Overall, an individual therapy and treatment concept for each patient with advanced chronic kidney disease is advisable.

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Authors and Affiliations

  1. Klinik für Kardiologie II – Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland

    Philipp Niehues, Christian Ellermann & Lars Eckardt

  2. Med. Klinik m. Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    Kai-Uwe Eckardt

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  1. Philipp Niehues
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  2. Christian Ellermann
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  3. Kai-Uwe Eckardt
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  4. Lars Eckardt
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Correspondence to Philipp Niehues.

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Interessenkonflikt

P. Niehues, C. Ellermann, K.‑U. Eckardt und L. Eckardt geben an, dass kein Interessenkonflikt im Hinblick auf diese Arbeit besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Niehues, P., Ellermann, C., Eckardt, KU. et al. Rhythmusstörungen bei Nierenerkrankungen und Nierenersatzverfahren. Herzschr Elektrophys 30, 251–255 (2019). https://doi.org/10.1007/s00399-019-0631-1

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  • DOI: https://doi.org/10.1007/s00399-019-0631-1

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