Evidenzbasierte Therapie von Hyperphosphatämie und Vitamin-D-Mangel

ZUSAMMENFASSUNG

Patienten mit einer chronischen Nierenkrankheit (CKD: „chronic kidney disease“) weisen eine hohe kardiovaskuläre Morbidität und Mortalität auf. Auf traditionelle Risikofaktoren der Atherosklerose zielende Strategien, die in der Allgemeinbevölkerung erfolgreich sind, erbringen jedoch bei schwerer CKD keinen eindeutigen Benefit. Daher haben Präventionsstrategien bei CKD lange auf nichttraditionelle Risikofaktoren fokussiert – insbesondere auf Komponenten der CKD-assoziierten Mineral- und Knochenstörungen (CKD-MBD: „chronic kidney disease – mineral and bone disorder“). Allerdings ist die Evidenz für eine kardiovaskuläre Risikoreduktion durch die Therapie der CKD-MBD begrenzt. Jenseits der CKD-MBD sind nun mit SGLT-2-Inhibitor (SGLT-2: „sodium-glucose linked transporter 2“), GLP-1-Analoga (GLP-1: „glucagon-like peptide-1“) und nichtsteroidalem Mineralo-Kortikoid-Rezeptor-Antagonist Pharmaka verfügbar, die in Phase-III-Studien eine klare kardiovaskuläre Risikoreduktion erlaubt haben und zudem bei nichtdialysepflichtiger CKD nephroprotektiv sind. Daher sollten nun Therapiestrategien der CKD-MBD kritisch reevaluiert werden.

Publication History

Article published online:
12 December 2024

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