Anwendung von GLP-1-Rezeptoragonisten bei Patienten mit Niereninsuffizienz – ein Update

Zusammenfassung

Menschen mit Typ-2-Diabetes steht in der Regel eine große Bandbreite an Antidiabetika zur Verfügung. Für Patienten mit eingeschränkter Nierenfunktion ist die Auswahl jedoch begrenzt, da die Pharmakokinetik unterschiedlicher Substanzen durch die renale Funktionsstörung verändert werden kann. So ist hier der Abbau exogenen Insulins verzögert. Basierend auf einer erhöhten Insulinresistenz besteht gleichzeitig ein erhöhter Insulinbedarf. Diese Dysbalancen lassen eine allgemeine Dosisempfehlung kaum zu. Vielmehr sollte die Therapie mit einer niedrigen Insulindosis begonnen und nach Bedarf auftitriert werden. GLP-1-Rezeptoragonisten weisen hingegen kein intrinsisches Hypoglykämierisiko auf und stellen daher eine mögliche Alternative für Patienten mit Niereninsuffizienz dar. Die Datenlage zu den GLP-1-Rezeptoragonisten verdeutlicht jedoch auch Unterschiede innerhalb dieser Substanzklasse. So werden Lixisenatid und Exenatide glomerulär filtriert, die Substanzen Liraglutid, Albiglutid und Dulaglutid hingegen nicht. Häufige gastrointestinale Nebenwirkungen sowie vereinzelte Berichte von schwerwiegenden Nebenwirkungen nach Anwendung von Exenatide bei Patienten mit Nephropathie verlangen eine strikte Überwachung und wenn nötig eine konservative Dosisanpassung durch den Arzt.

Abstract

A broad range of anti-diabetic drugs is available for people with type 2 diabetes. However, limitations exist for patients with renal insufficiency as this condition affects the pharmacokinetic properties of substances. Due to increased insulin resistance the requirement for exogenous insulin rises while at the same time its degradation is impeded. As a consequence of this imbalance, dose recommendations can hardly be given. Hence, a low dose therapeutic onset is recommended with dose escalations as required. GLP-1 receptor agonists however exhibit no intrinsic risk for hypoglycemia thus representing a potential treatment alternative for patients with renal insufficiency. According to available literature, substances within this class show differences such that lixisenatide and exenatide are subject to glomerular filtration, whereas liraglutide, albiglutide and dulaglutide are not. Application of exenatide in patients with nephropathy is associated with frequent gastrointestinal adverse reactions and occasionally serious adverse drug reactions. This demands strict monitoring and conservative dose adjustments if necessary.

Schlüsselwörter

Niereninsuffizienz - inkretinbasierte Therapie - Hyperglykämie - Niere - Typ-2-Diabetes - GLP-1-Rezeptoragonisten

Key words

renal insufficiency - incretin-based therapy - hyperglycemia - kidney - type 2 diabetes - GLP-1 receptor agonist

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