Der Diabetes mellitus Typ 2 ist eine der führenden Ursachen der chronischen Niereninsuffizienz in den industrialisierten Ländern. Zur Behandlung dieser Stoffwechselstörung stehen inzwischen mehrere orale Antidiabetika zur Verfügung, die sich jedoch für Patienten mit reduzierter Nierenfunktion oft nur eingeschränkt oder gar nicht eignen. Denn in diesen Fällen ist mit einer Akkumulation der eingesetzten Substanzen oder ihrer Metaboliten zu rechnen, was beispielsweise bei den Sulfonylharnstoffen und Gliniden eine vermehrte Hypoglykämieneigung bedingt. Wird mit Metformin behandelt, besteht bei einer Anreicherung des Wirkstoffs das Risiko einer Laktatazidose. Die Gabe von Thiazolidindionen ist mit einer vermehrten Ödemneigung assoziiert. Auch bei einer Insulintherapie sind aufgrund einer veränderten Insulinclearance und einem höheren Hypoglykämierisiko bei Patienten mit eingeschränkter Nierenfunktion einige Besonderheiten zu beachten.
Type 2 diabetes mellitus is one of the leading causes of chronic kidney disease in the industrialised countries. Besides consequent lifestyle management, type 2 diabetes may be treated by several oral drugs or exogenous insulin therapy. However, in diabetic patients with impaired renal function, the use of these drugs is either restricted or even impossible. The use of metformin is restricted to patients with a glomerular filtration rate > 60 ml/min/1,73 m2 due to the increased risk of lactic acidosis. The accumulation of the sulfonylureas and their metabolites - except gliquidon - in patients with reduced glomerular filtration rate leads to an increased risk of hypoglycaemia. The thiazolidinones are primarily metabolized hepatically and may therefore be used in diabetic patients with impaired renal function, but their use may be restricted by an increased risk of edema in such patients. In patients with insulin therapy, both altered clearance and metabolic efficacy of exogenous insulin lead to an increased risk of hypoglycaemia, making tight blood glucose control more difficult.
Key words
diabetes mellitus type 2 - chronic kidney disease - impaired renal function - oral drug therapy - insulin therapy
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1 United Kingdom Prospective Diabetes Study
Korrespondenz
Prof. Dr. Martin Pfohl
Medizinische Klinik I, Evangelisches Krankenhaus Bethesda gGmbH
Heerstraße 219
47053 Duisburg
Email: MnPfohl@o2online.de
