Kalzium, Phosphatbinder und Vitamin D - Rolle in der Therapie von Dialysepatienten

Sie sind für gut die Hälfte der Tablettenlast unserer Dialysepatienten verantwortlich, sind groß, schmecken bestenfalls neutral oder wie direkt aus der Aromenschmiede eines Süßwarenherstellers – gemeint sind die Phosphatbinder. Zusammen mit Vitamin D und Kalzium stehen sie im Zentrum der Therapie eines Krankheitskomplexes, der unter dem Namen CKD-MBD („chronic kidney disease – mineral and bone disorder“) firmiert. Noch unpopulärer als die o. g. Gruppen von Präparaten sind die additiven oder gar alternativen Therapiestrategien, wie die längere und effizientere Dialyse oder die leider nicht als N1-Packung verfügbare (wiederholte) Ernährungsberatung der Patienten oder der Krankenhausküchen. In dem vorliegenden Artikel sollen insbesondere die neuen Aspekte der kurz vor der Publikation stehenden KDIGO 2016 „Clinical practice guideline update on diagnosis, evaluation, prevention and treatment of CKD-MBD“ stehen. Darüber hinaus werden aber auch Themen wie die Renaissance der Knochenbiopsie zur Diagnose und Therapie von CKD-MBD adressiert.

They represent about 50 % of the pill burden of patients undergoing chronic dialysis treatment (CKD 5D), they are big, taste neutral at best, but sometimes like straight from the aroma lab of a candy store – phosphate binders. Together with vitamin D and calcium, they are the main pillars of the CKD-MBD (chronic kidney disease – mineral and bone disorder) treatment. There are only 2 things less appealing than the afore mentioned drugs – longer and more efficient dialysis hours and repeated dietary counselling, even though these 2 things might be as efficient as all the pharmacological interventions. The paper at hand will focus on the forthcoming 2016 Clinical practice guideline update on diagnosis, evaluation, prevention and treatment of CKD-MBD. Further, the renaissance of the good old bone biopsy for the diagnosis and therapy guidance of CKD-MBD are addressed.

Key words

calcium - phosphate binders - vitamin D - dialysis - CKD-MBD

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