Zusammenfassung
Ein gestörter Mineral- und Knochenhaushalt ist eine wesentliche Komorbidität bei fortgeschrittener chronischer Niereninsuffizienz. Ältere Patienten mit chronischer Niereninsuffizienz werden beispielsweise hinsichtlich der Auswahl des Nierenersatzverfahrens unter besonderen Aspekten betrachtet, mit Blick auf das Management des Mineral- und Knochenhaushalts bei chronischer Nierenerkrankung („chronic kidney disease – mineral and bone disorder“, CKD-MBD) im Alter gibt es jedoch kaum aussagekräftige Untersuchungen. Die aktuellen KDIGO-Empfehlungen zu CKD-MBD geben dementsprechend auch keine besonderen Hinweise zur Diagnostik und zur Therapie bei älteren Patienten. Ein individueller Ansatz, der biologisches Alter, Komorbiditäten und Lebensqualität berücksichtigt, erscheint sinnvoll, um den besonderen Bedürfnissen älterer Patienten mit CKD-MBD gerecht zu werden. Bei hochbetagten Patienten mit hoher Morbidität und geringer Lebenserwartung kann wahrscheinlich von sehr strikten Empfehlungen hinsichtlich Diagnostik und Therapie abgesehen werden.
Abstract
Chronic kidney disease (CKD) is frequently associated with disturbed mineral and bone metabolism and greatly contributes to morbidity and mortality. Concerning the choice of renal replacement therapy, the elderly have been regarded differently than the younger CKD population. However, there is a major lack of data regarding the management of CKD mineral and bone disorders (CKD-MBD). Current KDIGO guidelines do not emphasize specific diagnostics and therapy of CKD-MBD in the elderly. The elderly patient should thus be approached individually with consideration to age, comorbidities and quality of life in order to cope with the special needs of aged patients with CKD-MBD. In very elderly patients with higher morbidity and reduced life expectancy the very strict recommendations concerning diagnostics and therapy can probably be relaxed.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. M. Ketteler hat Referenten- und Beraterhonorar von AbbVie, Amgen, FMC, Medice, Mitsubishi, Sanofi, Shire und Vifor erhalten und bezieht Forschungsdrittmittel von AbbVie und Amgen. G. Schlieper hat Honorare für Vorträge und/oder Beratertätigkeit bzw. Forschungsdrittmittel von Amgen, Bayer, Braun, Fresenius, Sanofi/Genzyme, Gambro und Köhler-Chemie erhalten.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Ketteler, M., Schlieper, G. CKD-MBD beim betagten Patienten. Nephrologe 9, 26–32 (2014). https://doi.org/10.1007/s11560-013-0764-x
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DOI: https://doi.org/10.1007/s11560-013-0764-x
Schlüsselwörter
- Dialysepatient
- Alter
- Mineralstoffwechsel
- Knochenstoffwechsel
- Renale Osteodystrophie
- Hyperparathyreodismus