Alte und neue kardiovaskuläre Risikofaktoren bei diabetischer Nephropathie – Ein Update

Patienten mit diabetischer Nephropathie weisen ein deutlich erhöhtes Risiko für kardiovaskuläre Erkrankungen auf. Sowohl Diabetes mellitus als auch die chronische Nierenerkrankung stellen unabhängige kardiovaskuläre Risikofaktoren dar. Infolge Diabetes mellitus ist das Risiko bereits auf das Doppelte erhöht. Das Vorhandensein einer reduzierten glomerulären Filtrationsrate von < 60 ml/min jeglicher Ursache ist mit einem höheren Mortalitätsrisiko als bei Diabetes mellitus assoziiert. Das Risiko steigt in Abhängigkeit des Grades der Nierenfunktionseinschränkung exponentiell an. Beide Erkrankungen gehen zudem mit einer erhöhten Prävalenz klassischer kardiovaskulärer Risikofaktoren einher. Dies erklärt die Risikoerhöhung zum Teil. Diverse neue Biomarker können das Risikoprofil ebenfalls nur bedingt fokussieren. Ihre therapeutische Beeinflussbarkeit ist bislang gering. Die Veränderung des Lebensstils in der Kombination mit einem intensiven medizinischen Management erzielt wahrscheinlich die beste Risikoreduktion. Der Review gibt einen Überblick über konventionelle und neue kardiovaskuläre Risikomarker bei diabetischer Nephropathie.

Patients with diabetic nephropathy have an increased risk of cardiovascular diseases. Both diabetes mellitus and chronic kidney disease are independent cardiovascular risk factors. DM results in a doubling of cardiovascular risk. Any decrease of the glomerular filtration rate below 60 ml/min is associated with a higher mortality risk than diabetes alone. The risk increases exponentially in dependence from the stage of renal disease. Moreover, both diseases are accompanied by an increased prevalence of classical atherosclerotic risk factors which does explain the increase in risk only in part. The impact of several new biomarkers on the risk profile is limited. The therapeutic manipulation of such newer factors is often poor. Probably, lifestyle changes together with an intensive medical management lead to the best results in risk reduction. This review gives an overview of traditional and new cardiovascular risk markers in diabetic nephropathy.

Key words

Diabetes mellitus - chronic kidney disease - diabetic nephropathy - cardiovascular risk - traditional risk factors - novel risk factors

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