Zusammenfassung
Kardiovaskuläre Erkrankungen sind in der Bevölkerung sehr häufig. Daten der letzten
4 Jahre belegen, dass mit zunehmender Niereninsuffizienz das kardiovaskuläres
Risiko enorm steigt. Schon bei milder Niereninsuffizienz ist das kardiovaskuläres
Risiko verdoppelt und zwar weitgehend unabhängig von klassischen kardiovaskulären Risiken. Wenn auch die Ursachen für diesen
Zusammenhang unklar sind, so raten Leitlinien zu einer besonders intensiven kardiovaskulären
Prävention und Therapie bei allen Graden der Niereninsuffizienz. Bei jeder Erhöhung
des Serumkreatinins sollte man durch Errechnung der glomerulären Filtrationsrate
(GFR) das Stadium der Niereninsuffizienz (Stadium 1 - 5) - und damit ihr tatsächliches
Ausmaß - erfassen.
Literatur
- 1
Al Suwaidi J, Reddan D N, Williams K, Pieper K S, Harrington R A, Califf R M, Granger C B,
Ohman E M, Holmes D R.
Prognostic implications of abnormalities in renal function in patients with
acute coronary syndrome.
Circulation.
2002;
106
974-980
- 2
Baigent C, Burbury K, Wheeler D.
Premature cardiovascular disease in chronic renal failure.
Lancet.
2000;
356
147-152
- 3
Besarab A, Bolton W K, Browne J K.
The effects of normal as compared to low hematocrit values in patients with
cardiac disease who are receiving hemodialysis and erythropoietin.
New Engl J Med.
1998;
339
584-590
- 4
Boaz M, Smetana S, Weinstein T, Matas F, Gaftas U, Iaina A, Green M S.
Secondary prevention with antioxidants of cardiovascular disease in end stage
renal disease (SAPCE): randomized controlled trial.
Lancet.
2000;
356
1213-1218
- 5
Flack J M, Neaton J D, Daniels B, Esunge P.
Ethnicity and renal disease: lessons from the Multiple Risk Factor Intervention
Trial and the Treatment of Mild Hypertension Study.
Am J Kidney Dis.
1993;
4
(Suppl 1)
31-40
- 6
Gerstein H C, Mann J FE, Qilong Y, Zinman B, Dineen S F, Hoogwerf B, Halle J P, Young J,
Rashkow A, Joyce C, Nawaz S, Yusuf S.
Albuminuria and cardiovascular events, death and heart failure in diabetic and
non-diabetic individuals.
J Am Med Ass.
2001;
286
421-426
- 7
Goodman W G, Goldin J, Kuizon B D, Yoon C, Wang Y, Greaser L, Elashoff R M, Salusky I B.
Coronary artery calcification in young adults with end stage renal disease who
are undergoing dialysis.
N Engl J Med.
2000;
342
1478-1483
- 8
Levey A S, Bosch J P, Lewis J B, Greene T, Rogers N, Roth D.
A more accurate method to estimate glomerular filtration rate from serum creatinine:
a new prediction equation.
Ann Int Med.
1999;
130
461-470
- 9
Mann J FE, Gerstein H C, Pogue J, Bosch J, Yusuf S.
Renal insufficiency as a predictor of cardiovascular outcomes and the impact
of ramipril: the HOPE randomized trial.
Ann Int Med.
2001;
134
629-636
- 10
Mann J FE, Lonn E M, Yi Q L, Gerstein H C, Hoogwerf B J, Pogue J, Bosch J, Dagenais G R,
Yusuf S.
Effects of vitamin E on cardiovascular outcomes in people with mild-to-moderate
renal insufficiency: results of the HOPE study.
Kidney International.
2004;
65
1375-1380
- 11
McCullough P A, Soman S S, Shah S S, Smith S T, Marks K R, Yee J, Borzak S.
Risks associated with renal dysfunction in patients in the coronary care unit.
J Am Coll Cardiol.
2000;
36
679-684
- 12
Parfrey P S, Foley R N.
The clinical epidemiology of cardiac disease in chronic uremia.
J Am Soc Nephrol.
1999;
10
1053-1058
- 13
Pinkau T, Hilgers K F, Veelken R, Mann J FE.
How does minor renal dysfunction influence cardiovascular risk and the management
of cardiovascular disease?.
J Am Soc Nephrol.
2004;
15
517-523
- 14
Pinkau T, Mann J FE, Ndrepepa G, Mehilli J, Hadamitzky M, Braun S, Kastrati A, Schömig A.
Coronary stenting in people with mild to moderate renal insufficiency: restenosis
rate and cardiovascular outcomes.
Am J Kid Dis.
2004;
in press
- 15
Ritz E, Orth S R.
Nephropathy in patients with type 2 diabetes mellitus.
N Engl J Med.
1999;
341
1127-1133
- 16
Ruilope L M, Salvetti A, Jamerson K, Hansson L, Warnold I, Wedel H, Zanchetti A.
Renal function and intensive lowering of blood pressure in hypertensive participants
of the hypertension optimal treatment (HOT) study.
J Am Soc Nephrol.
2001;
12
218-225
- 17
Sarnak M J, Levey A S, Schoolwerth A C, Coresh J, Culleton B, Hamm L L, McCullough P A,
Kasiske B L, Klag M J, Parfrey P, Wilson P W.
Kidney disease as a risk factor for the development of cardiovascular disease
(AHA scientific statement).
Circulation.
2003;
108
2154-2169
- 18
Shlipak M G, Heidenreich P A, Nogushi H, Chertow G M, Browner W S, McClellan M B.
Association of renal insufficiency with treatment and outcomes after myocardial
infraction in elderly patients.
Ann Int Med,.
2002;
137
555-562
- 19
Shulman N B, Ford C E, Hall W D, Blaufox W D, Simon D, Langford H G, Schneider K A.
Prognostic value of serum creatinine and the effect of treatment of hypertension
on renal function: HDFP results.
Hypertension.
1989;
13
I80-I93
(Suppl 1)
- 20
Tepel M, van der Giet M, Statz M, Jankowski J, Zidek W.
The antioxidant acetylcysteine reduces cardiovascular events in patients with
end-stage renal failure: a randomized, controlled trial.
Circulation.
2003;
107
992-995
- 21
Weiner D E, Tighiouart H, Amin M G, Stark P C, Macleod B, Griffith J L, Salem D N,
Levey A S, Sarnak M J.
Chronic kidney disease as a risk factor for cardiovascular disease and all-cause
mortality: a pooled analysis of community-based studies.
J Am Soc Nephrol.
2004;
15
1307-1315
- 22
Wright S R, Reeder G S, Herzog C A, Jaffe A S.
Acute myocardial infarction and renal dysfunction: a high risk combination.
Ann Int Med.
2002;
137
563-570
Prof. Dr. Johannes Mann
6. Medizinische Abteilung, Städtisches Klinikum Schwabing
Kölner Platz 1
80804 München
Telefon: 089-3068 2386
Fax: 089-3068 3917
eMail: Johannes.Mann@kms.mhn.de