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Nephrologie aktuell 2023; 27(06): 261-270
DOI: 10.1055/a-2055-3322
Schwerpunkt
Nephrologie

Effektive antidiabetische Therapie zur Vorbeugung einer diabetischen Nephropathie

Antidiabetika als Teil eines multimodalen Therapiekonzepts bei Typ-2-Diabetes und CKD
Nicolle Müller
1   Funktionsbereich Endokrinologie – Diabetes/Stoffwechselerkrankungen, Klinik für Innere Medizin III, Universitätsklinikum Jena
,
Martin Busch
2   Funktionsbereich Nephrologie, Klinik für Innere Medizin III, Universitätsklinikum Jena
,
Christian Gerdes
2   Funktionsbereich Nephrologie, Klinik für Innere Medizin III, Universitätsklinikum Jena
,
Gunter Wolf
2   Funktionsbereich Nephrologie, Klinik für Innere Medizin III, Universitätsklinikum Jena
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ZUSAMMENFASSUNG

Die chronische Nierenkrankheit (CKD: „chronic kidney disease“) stellt eine der häufigsten Folgekomplikationen bei Menschen mit Diabetes mellitus dar und erhöht exzessiv die Morbidität und Mortalität. Daher ist die Vorbeugung einer Nephropathie von klinischer Bedeutung. Im Mittelpunkt der Therapie stand in den letzten Jahren die antihypertensive und nephroprotektive Therapie mit ACE-Hemmern (ACE: „angiotensin converting enzyme“) oder ATII1-Rezeptor-Antagonisten (ATII1: Angiotensin-II-Rezeptor Subtyp-1; Blockade des Renin-Angiotensin-Systems (RAS)) in der Kombination mit einer antiglykämischen und lipidsenkenden Therapie im Rahmen eines multimodalen Therapiekonzepts. Inzwischen zeigen Antidiabetika signifikante und intrinsische nephroprotektive Effekte, die über die reine Glukosesenkung hinausgehen. Als besonders potent haben sich dabei Hemmer des Natrium-Glukose-Kotransporters 2 (SGLT-2: „sodium glucose linked transporter 2“) und GLP1-Rezeptor-Agonisten (GLP1: „glucagon-like peptide 1“) herausgestellt. GLP1-Rezeptor-Agonisten reduzieren vor allem die Albuminurie bei Menschen mit Typ-2-Diabetes. SGLT-2-Hemmer verlangsamen auch den Abfall der glomerulären Filtrationsrate (GFR) über die Zeit und konnten diesen nephroprotektiven Effekt sowohl bei Menschen mit Diabetes als auch bei jenen ohne Diabetes zeigen. Entsprechend wird in Leitlinien für Menschen mit Diabetes mellitus Typ 2 und CKD oder erhöhtem kardialen Risiko empfohlen, neben Metformin und der RAS-Blockade, die Therapie mit SGLT-2-Hemmern und – sofern zur Glykämiesenkung notwendig – additiv GLP1-Rezeptor-Agonisten anzuwenden.



Publikationsverlauf

Artikel online veröffentlicht:
20. Juli 2023

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