Akzelerierte Atherosklerose - Chronische Niereninsuffizienz ist ein etablierter kardiovaskulärer Risikofaktor

Patienten mit chronischer Niereninsuffizienz weisen eine vielfach erhöhte kardiovaskuläre Morbidität und Mortalität auf. Dieser akzelerierten Atherosklerose liegen unter anderem ein chronisch inflammatorischer Prozess, aber auch zahlreiche mit der Niereninsuffizienz assoziierte Faktoren (z.B. Proteinurie, gestörter Kalzium-Phosphat-Stoffwechsel, Anämie) zugrunde. Da bei vielen Patienten mit chronischer Niereninsuffizienz die koronare Herzkrankheit (KHK) asymptomatisch verläuft, sollte die Indikation zur Koronarangiografie bei Verdacht auf eine koronare Herzkrankheit großzügig gestellt werden. Zur Reduktion der kardiovaskulären Mortalität ist an erster Stelle ein Erhalt der Nierenfunktion zu nennen. Die Therapie der relevanten koronaren Herzerkrankung umfasst neben der medikamentösen Therapie die interventionelle Therapie mittels perkutaner Koronarangioplastie - auch mit Stent - oder die chirurgische Therapie mittels aortokoronarer Bypassoperation. Der Erfolg beider Verfahren hängt sowohl im Kurzzeit- als auch im Langzeitverlauf vom Ausmaß der Nierenfunktionseinschränkung ab. Mit zunehmender Niereninsuffizienz nimmt die postinterventionelle oder postoperative Überlebensrate signifikant ab. Zusammenfassend lässt sich feststellen, dass die Niereninsuffizienz ein eigenständiger kardiovaskulärer Risikofaktor ist.

Patients with end-stage renal disease suffer from increased cardiovascular death and morbidity. The increased gradient of cardiovascular risk is present even in mild renal dysfunction (GFR < 60 ml/min). Chronic inflammation is one of the major factors known to be associated with accelerated atherosclerosis in renal insufficency. Nevertheless, there are several uremia-related risk factors such as proteinuria, anemia, or disorders in calcium-phosphate metabolism (hyperparathyroidism) contributing to an increased cardiovascular mortality. In patients with impaired renal function there is a high incidence of asymptomatic coronary artery disease. Coronary angiography should be performed as frequent as done in patients with normal kidney function. To the treatment strategy of coronary artery disease in patients with impaired kidney function account medical therapy, percutaneous transluminal coronary angioplasty (PTCA/stent) or revascularization with coronary artery bypass surgery (CABG). For both interventional procedures the degree of impairment of kidney function is significantly associated with increased morbidity and mortality. To improve the poor prognosis of patients with any degree of renal insufficiency and coronary artery disease everything should be done to preserve kidney function at first and secondly to treat them as good as patients with normal kidney function and coronary artery disease.

Key Words

end-stage renal disease - accelerated atherosclerosis - cardiovascular risc factor - percutaneous transluminal coronary angioplasty - coronary artery bypass

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1 Heart Outcomes Prevention Evaluation

2 United Kingdom Prospective Diabetes Study

3 arterial revascularization therapy study

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