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Dtsch Med Wochenschr 2019; 144(15): 1044-1050
DOI: 10.1055/a-0654-0783
Klinischer Fortschritt
Nephrologie
© Georg Thieme Verlag KG Stuttgart · New York

Therapie des Diabetes mellitus bei chronischer Nierenerkrankung

Therapy of diabetes mellitus in patients with chronic kidney disease
Jörg Bojunga
  Medizinische Klinik I, Universitätsklinikum Frankfurt am Main
,
Antonia Mondorf
  Medizinische Klinik I, Universitätsklinikum Frankfurt am Main
› Author Affiliations
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Publication History

Publication Date:
26 July 2019 (online)

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Pathophysiologie, Besonderheiten bei Diagnose und Therapiezielen Eine eingeschränkte Nierenfunktion wirkt sich nicht nur auf die Clearance exogen zugeführten Insulins und die Ausscheidung von Medikamenten aus, sondern auch auf diagnostische Verfahren wie die Bestimmung des HbA1c. Eine adäquate Blutzuckerselbstkontrolle ist daher für Patienten mit Diabetes und chronischer Nierenerkrankung (CKD, chronic kidney disease) besonders wichtig. Diabetiker mit CKD haben zudem ein deutlich höheres Risiko für Hypoglykämie als Diabetiker mit normaler Nierenfunktion.

Pharmakologie und Zulassung von Antidiabetika bei eingeschränkter Nierenfunktion Viele Antidiabetika müssen bei CKD entsprechend der glomerulären Filtrationsrate (GFR) dosisangepasst werden oder sollten nicht bei vorliegender oder fortschreitender CKD verwendet werden, insbesondere bei Patienten mit einer CKD G5 und bei Dialysepatienten. Eine Insulintherapie ist für Patienten geeignet, die sich einer Dialyse unterziehen. Bei diesen Patienten können jedoch auch einige oral verabreichte glukosesenkende Mittel sicher eingesetzt werden.

Auswahl der Präparate und praktisches Vorgehen Entsprechend der europäischen Konsensus- und deutschen Praxisempfehlungen sollte bei Patienten mit CKD eine individualisierte Diabetestherapie erfolgen, die auch Komorbiditäten, wie z. B. kardiovaskuläre Erkrankungen und Übergewicht, berücksichtigt.

Abstract

Chronic kidney disease (CKD) is a common complication of diabetes mellitus and besides vascular nephropathy the most common cause of kidney failure (CKD G5). Along with an increase of the prevalence of diabetes the number of patients with diabetes and CKD will rise. General knowledge of the interactions between diabetes and CKD are essential for a safe and effective therapy. Appropriate glycemic control in patients with diabetes is important to prevent progression of CKD and hereby improve cardiovascular complications, quality of life and reduce mortality. However, many antidiabetics need to be dose-adjusted in CKD or should not be used in existing or progressive CKD, especially in patients with CKD G5, whereas insulin therapy is suitable for patients undergoing dialysis. However, some orally administered glucose-lowering agents can be safely used in these patients. This review provides an overview of the use and goals of diabetes therapy in the presence of CKD.

Schlüsselwörter

Diabetes mellitus - diabetische Nephropathie - orale Antidiabetika

Key words

diabetes mellitus - diabetic nephropathy - oral hypoglycemic agents
 

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