Optimierung des kardiovaskulären Risikos bei Dialysepatienten – Phosphat und Vitamin D

Die kardiovaskuläre Morbidität und Mortalität bei Patienten mit Dialysepflichtigkeit ist extrem hoch. Es kommt bei Niereninsuffizienz zu einer deutlichen Störung im Kalzium-Phosphat-Haushalt. Hierdurch entsteht auch eine stark progrediente vaskuläre Kalzifizierung, die die kardiovaskuläre Mortalität relevant beeinflusst. In den letzten Jahren gab es viele Bemühungen, den Phosphat- und Kalziumhaushalt durch die Gabe von unterschiedlichen Phosphatbindern, aber auch durch Gabe von Präparaten mit aktivem Vitamin D zu beeinflussen. Hier zeigt sich, dass sowohl Phosphatbinder wie auch die Gabe von Vitamin D in der Lage sind, die vaskuläre Kalzifizierung zu beeinflussen, wobei in klinischen Studien der Effekt dann sehr moderat bis kaum messbar war. In der vorliegenden Arbeit soll eine Übersicht über aktuell verwendete Phosphatbinder bzw. auch Vitamin-D-Derivate sowie über ihre Auswirkungen auf die potenziellen kardiovaskulären Effekte bei Patienten mit terminaler Niereninsuffizienz gegeben werden.

The cardiovascular morbidity and mortality in patients on chronic renal replacement therapy is extremely high. Chronic renal insufficiency induces substantial disturbances in the calcium phosphate homeostasis. An excessive strong progredient vascular calcification is observed which has deep impact on the patients' cardiovascular mortality. In the last years, many attempts were undertaken to reduce calcium and phosphate disturbances using phosphate resorption inhibitors or active vitamin D supplementation. Both phosphate resorption inhibitors and active vitamin D substances at low concentrations show an impact on vascular calcification. The effect shown in clinical studies, however, is very moderate and sometimes even not detectable. In the present work, a review is given on the cardiovascular risk reducing effects of phosphate binders and vitamin D supplementation in patients with end-stage renal disease.

Key words

cardiovascular risk - dialysis patients - phosphate - vitamin D

• Literatur

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