Therapie des Diabetes bei chronischer Niereninsuffizienz

In kaum einem anderen Bereich der Inneren Medizin hat sich in den letzten Jahren so viel getan wie in der Diabetologie. Unerwartet und überraschend haben neue Diabetesmedikamente gezeigt, dass sie nicht nur Blutglukose und Gewicht günstig beeinflussen, sondern auch einen signifikanten und über das Maß der Blutzuckerverbesserung hinausgehenden Einfluss auf das kardiovaskuläre Überleben haben. Viele dieser neu entwickelten Medikamente und Therapien sind nicht bei allen Stadien der chronischen Niereninsuffizienz einfach anwendbar und zugelassen. Es sind unter anderem Veränderungen des Metabolismus, die die chronische Niereninsuffizienz mit sich bringt, zu bedenken.

Abstract

Chronic kidney disease (CKD) is highly prevalent in patients with diabetes mellitus and has relevant impact on glucose metabolism, monitoring of such, and treatment options. In patients with higher grades of CKD and more prevalent cardiovascular disease, treatment-associated risk increases, necessitating adapted treatment goals. Novel treatment options for patients with type 2 diabetes with the potential for inhibition of both, cardiovascular and renal progression, have led to a rethinking of diabetes therapy. Currently, dialysis patients are mostly excluded from these medications; insulin treatment has to be adapted to the modality of the renal replacement therapy. In type 1 diabetes, modern diabetes technology has improved both quality of life as well as glucose control. These technologies are of special interest in patients with CKD. An interdisciplinary approach of primary care physicians, diabetologists and nephrologists is required for optimal treatment in patients with diabetes and CKD.

Schlüsselwörter

Diabetes mellitus - chronische Niereninsuffizienz - Glukosemetabolismus - Therapieziele - Monitoring

Key words

diabetes mellitus - chronic kidney disease - glucose metabolism - treatment goals - monitoring

Publication History

Article published online:
01 March 2021

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