Die Progression der Nierenerkrankung – wie ist sie zu verhindern?

Abstract

End stage chronic kidney disease (CKD) requiring renal replacement therapy is related to poor quality of life and high mortality. Thus, slowing the progression of CKD is an important purpose of therapy. Some general therapeutic approaches aim to slow the decline of renal function and they can be applied in all patients with CKD – irrespective of the underlying cause of CKD. A key intervention is lowering blood pressure (target: ≤ 140/90 mmHg, and in patients with albuminuria ≤ 130/80 mmHg). Inhibitors of the renin angiotensin system preferentially should be used in case of albuminuria, depending on the diabetic status and the level of albuminuria: in diabetics with albuminuria ≥ 30 mg/d, in non-diabetics with albuminuria > 300 mg/d. Mineralocorticoid receptor blockers and endothelin receptors blockers promise novel anti-proteinuric strategies – but still validation of their positive effects on retarding CKD progression is necessary. In patients with diabetic kidney disease, glycemic control aiming for an HbA1_c of ≈ 7.0 % has been established to slow CKD progression. Furthermore, SGLT-2 inhibition with empagliflozin may be considered as a new therapeutic approach that provides additional cardiovascular and renal protection. Finally, recent studies suggest: correction of metabolic acidosis and avoidance of episodes of acute renal failure may provide protection against the progression of CKD.

Ohne Zweifel haben „spezifische“ Maßnahmen bei der Therapie der chronischen Nierenerkrankung (CKD) einen hohen Stellenwert. In diesem Beitrag liegt der Fokus eher auf den „unspezifischen“ Interventionen, die bei allen Patienten mit CKD zum Einsatz kommen sollten, um den Verlust der Nierenfunktion so gut wie möglich zu bremsen. Dazu werden die verschiedenen Optionen anhand der aktuellen Studienlage vorgestellt.

Schlüsselwörter

Nierenerkrankungen - Progression - Blutdruck - Renin-Angiotensin-System

Key words

kidney diseases - disease progression - blood pressure - renin angiotensin system

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