Dialyse aktuell 2009; 13(10): 572-575
DOI: 10.1055/s-0029-1245022
Forum der Industrie

© Georg Thieme Verlag KG Stuttgart ˙ New York

Chronische Nierenerkrankung - Möglichkeiten der kardiorenalen Protektion

Further Information

Publication History

Publication Date:
05 January 2010 (online)

Also available at
 

Die Mehrzahl der Dialysepatienten verstirbt aufgrund kardiovaskulärer Ursachen [1]. Wie Prof. Eberhard Ritz, Heidelberg, auf dem Kongress für Nephrologie 2009 in Göttingen ausführte, erhöht eine geringe GFR-Reduktion (GFR: glomeruläre Filtrationsrate) - auch innerhalb des GFR-Normbereichs - bereits bei gesunden Menschen das relative Risiko für einen kardiovaskulären Tod sowie die Inzidenz koronarer Schädigungen [2], [3]. Das relative Risiko steigt um jeweils 1,26 pro 5 ml/min GFR-Verlust [4]. Hinter einer normalen GFR kann sich also eine deutliche Nierenfunktionsstörung verbergen, da die verbliebenen Nephrone mittels kompensatorischer Hyperfiltration eine lange Zeit die Funktionseinschränkung des Organs ausgleichen können.

Literatur

  • 01 Wanner C . Krane V . März W . et al . Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis.  New Engl J Med. 2005;  353 238-248
    Google Scholar
  • 02 Pereg D . Tirosh A . Shochat T . et al . Mild renal dysfunction associated with incident coronary artery disease in young males.  Eur Heart J. 2008;  29 198-203
    Google Scholar
  • 03 Van Biesen W . De Bacquer D . Verbeke F . et al . The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years.   Eur Heart J. 2007;  28 478-483
    Google Scholar
  • 04 Henry RM . Kostense PJ . Bos G . et al . Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study.  Kidney Int. 2002;  62 1402-1407
    Google Scholar
  • 05 Stefanski A . Schmidt KG . Waldherr R . et al . Early increase in blood pressure and diastolic left ventricular malfunction in patients with glomerulonephritis.  Kidney Int. 1996;  50 1321-1326
    Google Scholar
  • 06 Shlipak MG . Fried LF . Crump C . et al . Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency.  Circulation. 2003;  107 87-92
    Google Scholar
  • 07 Landray MJ . Wheeler DC . Lip GY . et al . Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: the chronic renal impairment in Birmingham (CRIB) study.  Am J Kid Dis. 2004;  43 244-253
    Google Scholar
  • 08 Amann K . Wanner C . Ritz E . Cross-talk between the kidney and the cardiovascular system.  J Am Soc Nephrol. 2006;  17 2112-2119
    Google Scholar
  • 09 Di Marco GS . Reuter S . Hillebrand U . et al . The soluble VEGF receptor sFlt1 contributes to endothelial dysfunction in CKD.  J Am Soc Nephrol. 2009;  20 2235-2245
    Google Scholar
  • 10 David S . Kümpers P . Hellpap J . et al . Angiopoietin 2 and cardiovascular disease in dialysis and kidney transplantation.  Am J Kid Dis. 2009;  53 770-778
    CrossrefGoogle Scholar
  • 11 Isbel NM . Haluska B . Johnson DW . et al . Increased targeting of cardiovascular risk factors in patients with chronic kidney disease does not improve atheroma burden or cardiovascular function.  Am Heart J. 2006;  151 745-753
    CrossrefGoogle Scholar
  • 12 Teng M . Wolf M . Ofshun MN . et al . Activated injectable vitamin D and hemodialysis survival: a historical cohort study.  J Am Soc Nephrol. 2005;  16 1115-1125
    CrossrefGoogle Scholar
  • 13 Shoben AB . Rudser KD . De Boer IH . et al . Association of oral calcitriol with improved survival in nondialyzed CKD.  Jam Soc Nephrol. 2008;  19 1613-1619
    Google Scholar
  • 14 Teng M . Wolf M . Lowrie E . et al . Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy.  N Engl J Med. 2003;  349 446-456
    CrossrefGoogle Scholar
  • 15 Agarwal R . Acharya M . Tian J . et al . Antiproteinuric effect of oral paricalcitol in chronic kidney disease.  Kidney Int. 2005;  68 2823-2828
    CrossrefGoogle Scholar
  • 16 Alborzi P . Patel NA . Peterson C . et al . Paricalcitol reduces albuminuria and inflammation in chronic kidney disease: a randomized double-blind pilot trial.  Hypertension. 2008;  52 249-255
    Google Scholar
  • 17 Fishbane S . Chittineni H . Packman M . et al . Oral paricalcitol in the treatment of patients with CKD and proteinuria: a randomized trial.  Am J Kid Dis. 2009;  54 647-652
    CrossrefGoogle Scholar
  • 18 Bodyak N . Ayus JC . Achinger S . et al . Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals.  Proc Natl Acad Sci USA. 2007;  104 16810-16815
    CrossrefGoogle Scholar
  • 19 Tan X . Li Y . Liu Y . Paricalcitol attenuates renal interstitial fibrosis in obstructive nephropathy.  J Am Soc Nephrol. 2006;  17 3382-3393
    CrossrefGoogle Scholar
  • 20 Mizobuchi M . Morrissey J . Finch JL . et al . Combination therapy with an angiotensin-converting enzyme inhibitor and a vitamin D analog suppresses the progression of renal insufficiency in uremic rats.  JASN. 2007;  18 1796-1806
    CrossrefGoogle Scholar
  • 21 Mizobuchi M . Finch JL . Martin DR . et al . Differential effects of vitamin D receptor activators on vascular calcification in uremic rats.  Kid Int. 2007;  72 709-715
    CrossrefGoogle Scholar
  • 22 Coyne D . Acharya M . Qiu P . et al . Paricalcitol capsule for the treatment of secondary hyperparathyroidism in stages 3 and 4 CKD.  Am J Kid Dis. 2006;  47 263-276
    CrossrefGoogle Scholar
  • 23 Hamdy NA . Kanis JA . Beneton MN . et al . Effect of alfacalcidol on natural course of renal bone disease in mild to moderate renal failure.  BMJ. 1995;  310 358-363
    CrossrefGoogle Scholar
  • 24 Sprague SM . Llach F . Amdahl M . et al . Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism.  Kidney Int. 2003;  63 1483-1490
    CrossrefGoogle Scholar
  • 25 Ross EA . Kant KS . Melnick JZ . et al . Comparison of Two Dosing Regimens of Oral Paricalcitol for Secondary Hyperparathryoidism (SHPT) in Peritoneal Dialysis (PD) Patients. [ASN Poster TH-PO722].  JASN. 2006;  17 691
    Google Scholar
  • 26 Nordal KP . Dahl E . Low dose calcitriol versus placebo in patients with predialysis chronic renal failure.  J Clin Endocrin Metab. 1988;  67 929-936
    Google Scholar
  • 27 US Food and Drug Administration .Rocaltrol/Calcitriol oral solution and capsules. Im Internet: www.fda.gov . 
    Google Scholar
  • 28 Slatopolsky E . Cozzolino M . Finch JL . Differential effects of 19-nor-1,25-(OH)(2)D(2) and 1alpha-hydroxyvitamin D(2) on calcium and phosphorus in normal and uremic rats.  Kidney Int. 2002;  62 1277-1284
    CrossrefGoogle Scholar
      >