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Aktuelle Rheumatologie 2020; 45(02): 173-179
DOI: 10.1055/a-1121-7469
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Innovative rheumatologische und osteologische Medikation im Kontext der chronischen Niereninsuffizienz – Was ist möglich?

Innovative Rheumatological and Osteological Medication in the Context of Chronic Kidney Failure: What is Possible?
Alexander Pfeil
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
,
Martin Busch
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
,
Amelie Lupp
2   Institut für Pharmakologie und Toxikologie, Jena University Hospital, Jena
,
Gabriele Lehmann
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
,
Peter Oelzner
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
,
Gunter Wolf
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
› Author Affiliations
Further Information

Publication History

Publication Date:
02 April 2020 (online)

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Zusammenfassung

Die chronische Niereninsuffizienz stellt eine häufige Komorbidität bei rheumatischen Erkrankungen dar. Durch die Einführung der biologischen und der targeted synthetischen Disease-Modifying Antirheumatic Drugs (DMARD) konnte eine Verbesserung der Behandlungsoptionen entzündlich-rheumatischer Erkrankungen erreicht werden. Valide Daten zum Einsatz biologischer DMARD in der Behandlung rheumatischer Grunderkrankungen und dem gleichzeitigen Vorhandensein einer chronischen Niereninsuffizienz sind sehr begrenzt vorhanden. Bezüglich der targeted synthetischen DMARD bestehen Anwendungsbeschränkungen bei Patienten mit einer rheumatischen Erkrankung und einer chronischen Niereninsuffizienz. Des Weiteren stellt die sekundäre Osteoporose eine Hauptkomorbidität bei Patienten mit entzündlich-rheumatischen Erkrankungen dar, welche hauptsächlich durch den Einsatz von Bisphosphonaten therapiert wird. Bei einer eingeschränkten Nierenfunktion (glomeruläre Filtrationsrate < 30 ml/min) besteht eine Kontraindikation für den Einsatz von Bisphosphonaten, sodass hier Denosumab als einzige antiresorptive Therapieoption zur Verfügung steht. Neuere Langzeitdaten haben gezeigt, dass nach der Beendigung der Denosumab-Therapie mit einem Anstieg der Frakturrate zu rechnen ist. Aus diesem Grund kann eine Therapie mit Denosumab nicht ohne ein anschließendes Therapieverfahren beendet werden oder die Denosumab-Therapie muss unbegrenzt fortgesetzt werden.

Abstract

Chronic kidney failure is a common comorbidity in rheumatic diseases. The implementation of biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) has improved the treatment options for rheumatic diseases. Valid data for biological DMARDs in the treatment of rheumatic diseases in association with chronic kidney failure are limited. Targeted synthetic DMARDs have some limitations in rheumatic patients with chronic kidney failure. Secondary osteoporosis is one of the main comorbidities in patients with rheumatic diseases, with bisphosphonates being the drugs of choice for treatment. In case of impaired renal function (glomerular filtration rate <30 ml/min), however, bisphosphonates are contraindicated. In these cases, denosumab should be used as an antiresorptive and biological therapy. New data indicate an increase in fracture rates after completion of denosumab treatment. In these cases, alternative treatments must be initiated or denosumab treatment has to be continued indefinitely.

Schlüsselwörter

Chronische Niereninsuffizienz - rheumatologische Basismedikation - osteologische Medikation - Indikation - Kontraindikation

Key words

chronic kidney failure - disease modifying antirheumatic drugs - osteological medication - indication - contraindication
 

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