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Dialyse aktuell 2019; 23(05): 214-218
DOI: 10.1055/a-0886-1263
Schwerpunkt | Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Medikamentöse Therapie des kardiorenalen Syndroms

Was ist zu beachten?
Gunnar Henrik Heine
AGAPLESION MARKUS KRANKENHAUS, Frankfurt am Main
,
Vincent Brandenburg
Rhein-Maas Klinikum, Würselen
,
Kyrill Sebastian Rogacev
Sana-Hanse Klinikum, Wismar, und MVZ Schwerin West GmbH
› Author Affiliations
Further Information

Publication History

Publication Date:
19 June 2019 (online)

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ZUSAMMENFASSUNG

Patienten mit chronischer Nierenerkrankung (CKD) weisen eine massiv erhöhte kardiovaskuläre Morbidität und Mortalität auf. Insbesondere myokardiale Erkrankungen – linksventrikuläre Hypertrophie mit konsekutiver linksventrikulärer Insuffizienz und maligner Arrhythmie – haben bei CKD-Patienten eine zentrale prognostische Bedeutung. Dennoch werden bisher zu selten kardioprotektive Therapiestrategien bei CKD-Patienten eingesetzt. Ein mögliches Argument ist, dass positive Studienergebnisse für die Therapie der Herzinsuffizienz mit reduzierter Ejektionsfraktion (HFREF: Heart Failure with Reduced Ejection Fraction) nicht unkritisch auf Patienten mit fortgeschrittener CKD übertragen werden dürfen. So hatten die großen Landmark-Trials der vergangenen Jahre Patienten mit höhergradiger Nierenfunktionsstörung zumeist ausgeschlossen, und Nebenwirkungen wie Elektrolytstörungen unter medikamentöser Herzinsuffizienztherapie sind bei CKD-Patienten deutlich häufiger. Unumstritten jedoch ist, dass für Patienten mit moderater CKD und HFREF Subgruppenanalysen der gleichen Landmark-Trials einen prognostischen Benefit einer Therapie mit Inhibitoren des Renin-Aldosteron-Systems und von Betablockern aufzeigen, der zumindest genauso groß ist wie der Benefit bei nierengesunden Patienten mit HFREF. Die Interventionsmöglichkeiten bei HFREF werden sich in den nächsten Jahren erweitern, falls neue Therapiestrategien – insbesondere eine intravenöse Eisensubstitution und SGLT-Inhibitoren – in aktuell laufenden klinischen Studien bei herzinsuffizienten Patienten eine Reduktion kardialer Ereignisse erreichen.

 

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