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Niereninsuffizienz und kardiovaskuläre Erkrankungen

Kidney insufficiency and cardiovascular disease

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Zusammenfassung

Kardiovaskuläre Erkrankungen (CVD) sind der Hauptgrund für die hohe Morbidität und Mortalität bei Patienten mit Niereninsuffizienz. Häufig sind schon bei leichter Nierenfunktionseinschränkung linksventrikuläre Hypertrophie, koronare Herzerkrankung sowie Arteriosklerose der Gefäße nachweisbar. Oft sind bereits junge Patienten betroffen. Trotz relevanter Fortschritte in der Dialysetherapie und der Behandlung von Begleiterkrankungen ist die Mortalität bei niereninsuffizienten Patienten 10- bis 30-mal höher als in der Normalbevölkerung. Das Krankheitsbild ist multifaktoriell bedingt und addiert sich aus klassischen Risikofaktoren, Volumenbelastung und endokrinen sowie metabolischen Veränderungen im Rahmen der Nierenerkrankung. Daher sollten regelmäßige präventive Untersuchungen und eine optimale Kontrolle der modifizierten Risikofaktoren sowie eine intensive Therapie der CVD im Vordergrund des therapeutischen Bemühens stehen.

Abstract

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in patients with chronic renal disease. Severe cardiac and arterial disorders such as left ventricular hypertrophy, coronary artery disease, and arteriosclerosis of the large vessels are already evident in early renal disease, even in young patients.

Despite major advances in dialysis therapy and treatment options for acute coronary syndromes, mortality remains high – up to 10–30 times higher than in the general population. The increased risk for cardiovascular disorders results from the additive effect of traditional risk factors, volume overload, and endocrine and metabolic abnormalities in uremia. During the course of the renal disease, the progression of CVD disease manifestations significantly influences outcome. Thus, preventive measures and optimal treatment are mandatory and should be among the main targets of early management of patients with chronic renal disease.

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Danksagung

Herzlicher Dank gebührt Dr. med. Frank Noack, Institut für Pathologie, UK-SH, Campus Lübeck, für die freundliche Bereitstellung des histologischen Bildmaterials.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Medizinische Klinik II, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    B. Weidtmann &  H. Schunkert

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  1. B. Weidtmann
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  2. H. Schunkert
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Correspondence to H. Schunkert.

Internetlinks

Internetlinks

www.dgk.org

Deutsche Gesellschaft für Kardiologie inklusive der Leitlinien zur Behandlung von Patienten mit koronarer Herzerkrankung und Niereninsuffizienz

www.hochdruckliga.de

Deutsche Hochdruckliga, Fachinformationen für Ärzte und Patienten, Leitlinien zur Behandlung der Hypertonie

www.nephrologie.de

Deutsche Arbeitsgemeinschaft für Klinische Nephrologie e.V. (DAGKN), Informationen zur Optimierung der Behandlungsqualität bei Nieren- und Hochdruckerkrankungen

www.nierengesellschaft.de

Portal der deutschen Gesellschaft für Nephrologie mit Leitlinien, Aufführung von Kongressen und nephrologischen Links

www.americanheart.org

American Heart Association, unter anderem mit Empfehlungen der Arbeitsgruppe „Kidney in Cardiovascular disease“

www.kidney.org

National Kidney Foundation inklusive der National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF KDOQI)

www.usrds.org

US Renal Data System, jährliche Präsentation der Inzidenz, Prävalenz, Morbidität und Mortalität nierenerkrankter Patienten in den USA

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Weidtmann, B., Schunkert, H. Niereninsuffizienz und kardiovaskuläre Erkrankungen. Internist 48, 770–778 (2007). https://doi.org/10.1007/s00108-007-1901-2

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