Therapie der chronischen Niereninsuffizienz bei Diabetes mellitus

Zusammenfassung

Die Therapie der chronischen Niereninsuffizienz (CKD) bei Diabetes mellitus (DM) fokussierte sich bisher auf die Gabe von Angiotensin-Converting-Enzyme-Hemmern (ACE-Hemmern) oder Angiotensin-II-Rezeptor-Subtyp-1-Antagonisten (AT₁-Antagonisten). Weiterhin erfolgte die Kontrolle von Risikofaktoren wie Hyperglykämie, arterieller Hypertonie und Hyperlipidämie. Mit Natrium-Glukose-Kotransporter-2-Inhibitoren (SGLT-2i), Glukagonähnliches-Peptid-1-Rezeptor-Agonisten (GLP-1-RA) und einem nichtsteroidalen Mineralokortikoid-Rezeptor-Agonisten stehen neue Therapieoptionen zur Verfügung, die kardiorenale Endpunkte verbessern. Weitere Medikamentenklassen wie Endothelin-Rezeptor-Antagonisten, Aldosteron-Synthetase-Inhibitoren und Inkretin-Hormon-Therapeutika befinden sich in der klinischen Erprobung. Durch die Vielzahl der neuen Optionen wird die zukünftige Herausforderung in der Individualisierung der Therapie und Identifikation von Hochrisikopatienten liegen.

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