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Diabetes aktuell 2017; 15(07): 302-312
DOI: 10.1055/s-0043-121812
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© Georg Thieme Verlag Stuttgart · New York

Die Progression der Nierenerkrankung – wie ist sie zu verhindern? - Allgemeine therapeutische Ansätze für jeden CKD-Patienten

Markus P. Schneider
1   Medizinische Klinik 4 für Nephrologie und Hypertensiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg
,
Karl F. Hilgers
1   Medizinische Klinik 4 für Nephrologie und Hypertensiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg
› Author Affiliations
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Publication History

Publication Date:
23 November 2017 (online)

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Zusammenfassung

Ist aufgrund eines chronischen Nierenversagens eine Nierenersatztherapie notwendig, ist dies mit einer vergleichsweise schlechten Lebensqualität und einer hohen Mortalitätsrate assoziiert. Daher ist die Verlangsamung der Progression einer chronischen Nierenerkrankung ein wichtiges Ziel. Eine besonders wichtige Intervention ist die Einstellung des Blutdrucks mit einem Zielwert von maximal 140/90 mmHg, bei Patienten mit einer Albuminurie sogar von maximal 130/80 mmHg. Besteht eine Albuminurie, sollten bevorzugt Inhibitoren des Renin-Angiotensin-Systems eingesetzt werden – und zwar abhängig vom Diabetesstatus und von der Schwere der Albuminurie (Patienten Diabetes und Albuminurie ≥ 30 mg/Tag; Patienten ohne Diabetes, aber mit einer Albuminurie > 300 mg/Tag). Mineralocorticoid- und Endothelinrezeptorenblocker scheinen neue antiproteinurische Strategien zu ermöglichen, wenn auch ihre positiven Effekte auf die Nierenfunktion noch zu validieren sind. Ein HbA1c-Zielwert von etwa 7,0 % kann bei Patienten mit einer diabetischen Nierenerkrankung ebenfalls dazu beitragen, die Progression der Niereninsuffizienz zu verlangsamen. Darüber hinaus gilt heute die SGLT-2-Inhibition mit Empagliflozin als kardiovaskulär und renal protektiv. Aktuellen Studiendaten zufolge können auch eine Korrektur der metabolischen Azidose und das Vermeiden eines akuten Nierenversagens die Patienten vor einer Progression des Nierenschadens schützen.

 

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