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Die Nephrologie

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28.07.2021 | Typ-2-Diabetes | Leitthema

Antidiabetika zur Progressionshemmung der Nephropathie

verfasst von: PD Dr. rer. nat./med. habil. Nicolle Müller, PD Dr. med. Martin Busch, Prof. Dr. med. Gunter Wolf

Erschienen in: Die Nephrologie | Ausgabe 1/2022

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Zusammenfassung

Die Morbidität und Mortalität sind bei Patienten mit Diabetes mellitus und insbesondere bei Bestehen einer chronischen Nierenerkrankung (CKD) exzessiv erhöht. Daher ist die Progressionshemmung der Nephropathie von klinischer Bedeutung. Im Mittelpunkt der Therapie stand in den letzten Jahren die antihypertensive und nephroprotektive Therapie mit ACE(„angiotensin-converting enzyme“)-Hemmern/Angiotensinrezeptorblockern. Erstmalig konnte nun, zunächst als Nebeneffekt erfolgreicher kardiovaskulärer Endpunktstudien, ein signifikanter nephroprotektiver Effekt von Antidiabetika gezeigt werden, welcher über die reine Glukosesenkung hinausgeht. Im Mittelpunkt stehen dabei SGLT2(„sodium-glucose linked transporter 2“)-Hemmer und GLP(„glucagon-like peptide“)-1-Rezeptor-Agonisten (GLP-1-RA). GLP-1-RA konnten bei Patienten mit Typ-2-Diabetes v. a. die Progression der Albuminurie reduzieren. SGLT2-Hemmer verlangsamen jedoch den Abfall der glomerulären Filtrationsrate über die Zeit und konnten diesen nephroprotektiven Effekt bei Menschen sowohl mit als auch ohne Diabetes zeigen. Entsprechend wird in Leitlinien für Patienten mit Diabetes mellitus Typ 2 und CKD oder erhöhtem kardialen Risiko neben Metformin die Therapie mit SGLT2-Hemmern und additiv GLP-1-RA bei erhöhtem Glykämierisiko empfohlen.

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Titel: Antidiabetika zur Progressionshemmung der Nephropathie
verfasst von: PD Dr. rer. nat./med. habil. Nicolle Müller
PD Dr. med. Martin Busch
Prof. Dr. med. Gunter Wolf
Publikationsdatum: 28.07.2021
Verlag: Springer Medizin
Schlagwörter: Typ-2-Diabetes
Chronische Nierenerkrankung
Dapagliflozin
Diabetes mellitus
Albuminurie
Ertugliflozin
Erschienen in: Die Nephrologie / Ausgabe 1/2022
Print ISSN: 2731-7463
Elektronische ISSN: 2731-7471
DOI: https://doi.org/10.1007/s11560-021-00515-0

Praxisempfehlungen der Deutschen Diabetes Gesellschaft

Kurz, prägnant und aktuell: Die Praxisempfehlungen der Deutschen Diabetes Gesellschaft.

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