Chronische Niereninsuffizienz bei Typ-2-Diabetes – die stille Bedrohung einer Multisystemerkrankung

Zusammenfassung

Die hohe Prävalenz von Typ-2-Diabetes (T2 D) und die damit einhergehenden Auswirkungen auf verschiedene Organsysteme stellen in der Behandlung der betroffenen Patienten eine große Herausforderung dar. Eine der häufigsten Komplikationen ist die diabetische Nephropathie, die weltweit etwa 700 Millionen Menschen betrifft. Sie ist die Hauptursache für die Entwicklung einer chronischen Niereninsuffizienz (CNI) und führt zu einem signifikant erhöhten kardiovaskulären Risiko. Die diabetische Nephropathie präsentiert sich somit als Multisystemerkrankung und erfordert einen umfassenden Behandlungsansatz. Dieser Ansatz umfasst neben der Optimierung des Lebensstils auch die medikamentöse Therapie einschließlich antihyperglykämischer, antihypertensiver und lipidsenkender Wirkstoffe sowie neuere Wirkstoffe wie SGLT2-Inhibitoren, nicht steroidale Mineralokortikoid-Rezeptorantagonisten und GLP-1-Rezeptoragonisten zur Nephro- und Kardioprotektion.

Publication History

Article published online:
14 August 2025

• Literatur

• 1 Deutsche Diabetes Gesellschaft, Deutsche Diabetes Hilfe. Hrsg. Deutscher Gesundheitsbericht Diabetes. 2023 unter: Accessed June 06, 2024 at: https://www.diabetesde.org/system/files/documents/gesundheitsbericht_2023_final.pdf
• 2 Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clin J Am Soc Nephrol 2017; 12: 2032-2045
• 3 Kidney Disease. Improval Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 2022; 102: S1-S127
• 4 Merker L, Bautsch BW, Ebert T. et al. Nephropathie bei Diabetes. Diabetologie 2021; 16 (Suppl. 2) S324-S328
• 5 American Diabetes Association Professional Practice Committee. 11. Chronic Kidney Disease and Risk Management: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45 (Suppl. 1) S175-S184
• 6 Cheung AK, Chang TI, Cushman WC. et al. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int 2021; 99: 559-569
• 7 Mancia G, Kreutz R, Brunström M. et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41: 1874-2071
• 8 Hausberg M. Finerenon – Ein neuer selektiver nichtsteroidaler Mineralokortikoid-Rezeptor-Antagonist für die Behandlung der diabetischen Nephropathie. Dialyse aktuell 2021; 25: 103-105
• 9 Mach F, Baigent C, Catapano AL. et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188
• 10 Heerspink HJL, Stefánsson BV, Correa-Rotter R. et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2020; 383: 1436-1446
• 11 The EMPA-KIDNEY Collaborative Group. Herrington WG, Staplin N. et al. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2023; 388: 117-127
• 12 Perkovic V, Jardine MJ, Neal B. et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med 2019; 380: 2295-2306
• 13 Agarwal R, Filippatos G, Pitt B. et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J 2022; 43: 474-484
• 14 Bakris GL, Agarwal R, Anker SD. et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med 2020; 383: 2219-2229
• 15 Pitt B, Filippatos G, Agarwal R. et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med 2021; 385: 2252-2263
• 16 Agarwal R, Kolkhof P, Bakris G. et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J 2021; 42: 152-161
• 17 Agarwal R, Pitt B, Palmer BF. et al. A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-toadvanced chronic kidney disease. Clin Kidney J 2023; 16: 293-302
• 18 Grune J, Beyhoff N, Smeir E. et al. Selective Mineralocorticoid Receptor Cofactor Modulation as Molecular Basis for Finerenone’s Antifibrotic Activity. Hypertension 2018; 71: 599-608
• 19 Kolkhof P, Delbeck M, Kretschmer A. et al. Finerenone, a novel selective nonsteroidal mineralocorticoid receptor antagonist protects from rat cardiorenal injury. J Cardiovasc Pharmacol 2014; 64: 69-78
• 20 Kolkhof P, Jaisser F, Kim SY. et al. Steroidal and Novel Non-steroidal Mineralocorticoid Receptor Antagonists in Heart Failure and Cardiorenal Diseases: Comparison at Bench and Bedside. Handb Exp Pharmacol 2017; 243: 271-305
• 21 Filippatos G, Anker SD, Agarwal R. et al. Finerenone Reduces Risk of Incident Heart Failure in Patients With Chronic Kidney Disease and Type 2 Diabetes: Analyses From the FIGARO-DKD Trial. Circulation 2022; 145: 437-447
• 22 ElSayed NA, Aleppo G, Aroda VR. et al. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46 (Suppl. 1) S140-S157
• 23 ElSayed NA, Aleppo G, Aroda VR. et al. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46 (Suppl. 1) S158-S190
• 24 Jastreboff AM, Aronne LJ, Ahmad NN. et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med 2022; 387: 205-216
• 25 Perkovic V, Tuttle KR, Rossing P. et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med 2024; (online ahead of print)
• 26 Rossing P, Agarwal R, Anker SD. et al. Efficacy and safety of finerenone in patients with chronic kidney disease and type 2 diabetes by GLP-1RA treatment: A subgroup analysis from the FIDELIO-DKD trial. Diabetes Obes Metab 2022; 24: 125-134
• 27 Green JB, Mottl AK, Bakris G. et al. Design of the COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint study (CONFIDENCE). Nephrol Dial Transplant 2023; 38: 894-903
• 28 Marx N, Federici M, Schütt K. et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44: 4043-4140
• 29 McMurray JJV, Solomon SD, Inzucchi SE. et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; 381: 1995-2008
• 30 Packer M, Anker SD, Butler J. et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med 2020; 383: 1413-1424
• 31 Bakris GL, Weir MR. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: is this a cause for concern?. Arch Intern Med 2000; 160: 685-693
• 32 Cherney DZI, Cosentino F, Dagogo-Jack S. et al. Initial eGFR Changes with Ertugliflozin and Associations with Clinical Parameters: Analyses from the VERTIS CV Trial. Am J Nephrol 2022; 53: 516-525
• 33 Holtkamp FA, de Zeeuw D, Thomas MC. et al. An acute fall in estimated glomerular filtration rate during treatment with losartan predicts a slower decrease in long-term renal function. Kidney Int 2011; 80: 282-287
• 34 Kraus BJ, Weir MR, Bakris GL. et al. Characterization and implications of the initial estimated glomerular filtration rate ‘dip’ upon sodium-glucose cotransporter-2 inhibition with empagliflozin in the EMPA-REG OUTCOME trial. Kidney Int 2021; 99: 750-762
• 35 Oshima M, Jardine MJ, Agarwal R. et al. Insights from CREDENCE trial indicate an acute drop in estimated glomerular filtration rate during treatment with canagliflozin with implications for clinical practice. Kidney Int 2021; 99: 999-1009