Therapierefraktärer Bluthochdruck bei Dialysepatienten – Welche Behandlungsoptionen können wir anbieten?

Unkontrollierter Bluthochdruck tritt bei Dialysepatienten mit einer Prävalenz von 80–100 % auf. Dies ist ein maßgeblicher Risikofaktor für ungünstige kardiovaskuläre Verläufe. Obwohl für Dialysepatienten bisher keine Definition des therapierefraktären Hypertonus vorliegt, zeigen sich trotz adäquater Einstellung des Trockengewichts viele Patienten weiterhin hypertensiv. Oftmals ist der Blutdruck auch durch eine Vielfachkombination von Antihypertensiva nicht beherrschbar. Neben dem grundsätzlichen Blutdruckmanagement bei Dialysepatienten sollen in dieser Übersichtsarbeit neben bewährten Behandlungsstrategien bei Therapierefraktärität auch neue interventionelle Verfahren zur Blutdrucksenkung diskutiert werden. Dabei präsentiert sich die renale Denervation derzeit als hoffnungsvollste Therapieergänzung und kann bereits mit positiven Ergebnissen bei Patienten mit chronischer Niereninsuffizienz und in einem Einzelfall mit dialysepflichtiger Niereninsuffizienz aufwarten. Dennoch müssen beim Einsatz neuer Verfahren das spezielle Risikoprofil dieser Patienten und insbesondere die Gefäßveränderungen chronisch niereninsuffizienter Patienten gesondert berücksichtigt werden. Weitere Untersuchungen bleiben daher abzuwarten, bevor der generelle Einsatz neuer interventioneller blutdrucksenkender Verfahren bei dieser Patientengruppe empfohlen werden kann.

Uncontrolled hypertension has a high prevalence of 80–100 % in end-stage renal disease (ESRD) patients. This is potentially a negative risk factor for cardiovascular events. Currently, there is no definition for therapy-resistant hypertension in ESRD patients. Many patients have hypertension despite optimal volume control. There are many procedures to optimize blood pressure in ESRD patients which are presented in this review. In the last years, new interventional procedures to control blood pressure have been developed. These procedures might be promising even for ESRD patients. There is already some experience with chronic kidney disease patients which are very promising. The question arises whether the procedures might also work in ESRD patients. The possible new procedures are discussed in the context of ESRD patients. Data are very limited.

Key words

therapy-resistant hypertension - hemodialysis - intervention - simplicity - baroreceptor stimulation

• Literatur

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