Auswirkung des Mineral- und Knochenstoffwechsels auf die Progression chronischer Nierenerkrankungen

Zusammenfassung

Der Begriff „Chronic Kidney Disease – Mineral and Bone Disorder“ (CKD-MBD) beschreibt das komplexe Zusammenspiel des Kalzium-Phosphat-Stoffwechsels u. a. anhand von Vitamin D, Parathormon und Fibroblast-Growth-Faktor-23 (FGF-23) bei chronischer Nierenerkrankung (CKD), das insbesondere in fortgeschrittenen Stadien der CKD klinisch relevant wird und zu Knochenumbauprozessen und extraossären Verkalkungen einschließlich Gefäßverkalkung führt. Die Veränderungen gehen einher mit einem erhöhten Risiko für kardiovaskuläre Ereignisse, Osteoporose, Progress der CKD sowie erhöhter Gesamtmortalität. Regelmäßiges Screening auf das Vorliegen einer CKD-MBD und frühzeitige Therapieeinleitung sind essenziell für das Management von CKD-Patienten, vor allem in den Stadien G3–G5(d). Führende Therapieziele sind die Vermeidung einer Hyperphosphatämie und Hyperkalzämie, der Ausgleich eines Vitamin-D-Mangels sowie die adäquate Stufentherapie eines (sekundären) Hyperparathyreoidismus, um starke Anstiege des Parathormons zu vermeiden. Dazu stehen insbesondere diverse Phosphatbinder, inaktives und aktives Vitamin D, Vitamin-D-Analoga, Kalzium-Sensitizer, die operative Parathyreoidektomie sowie antiresorptive Therapieoptionen mit Bisphosphonaten oder Denosumab zur Verfügung.

Publication History

Article published online:
21 July 2025

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