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DOI: 10.1055/a-0662-1919
Diabetes mellitus Typ 2: Wie schützen wir die Nieren am besten?
Diabetic Kidney Disease – How to Protect the Kidney?Publication History
Publication Date:
04 June 2019 (online)
![](https://www.thieme-connect.de/media/dmw/201911/lookinside/thumbnails/dmw-6621919_10-1055-a-0662-1919-1.jpg)
Was ist neu?
Neue Antidiabetika Unter den neueren blutzuckersenkenden Therapien haben Glucagon-like Peptid-1-Rezeptoragonisten und Gliflozine ihre protektiven Eigenschaften in der Vermeidung kardiovaskulärer Komplikationen und von Nierenschädigung bei Diabetes mellitus bewiesen. Dabei scheinen die kombinierten Effektstärken von Empagliflozin und anderen SGLT-2-Hemmern größer zu sein als die der GLP-1-Rezeptorantagonisten.
Glukosurika In der ersten Studie mit einem SGLT-2-Inhibitor zur kardiorenalen Protektion bei Patienten mit eingeschränkter Nierenfunktion und Albuminurie (CREDENCE) reduzierte Canagliflozin das Gesamtrisiko aus kardiorenaler Sterblichkeit und Fortschreiten der Nierenerkrankung deutlich. Die kardiorenalen Wirkungen anderer SGLT-2-Inhibitoren (Dapagliflozin und Empagliflozin) werden zurzeit in zwei weiteren großen klinischen Studien bei Patienten mit fortgeschrittener diabetischer und nicht-diabetischer Nierenerkrankung untersucht (DAPA-CKD, EMPA-KIDNEY).
Modulation der neurohumoralen Aktivierung Die Progressionsverzögerung der diabetischen Nierenerkrankung mit einem neuen Mineralokortikoid-Rezeptorantagonisten (Finrenone) wird derzeit in klinischen Studien (FIGARO/FIDELIO) geprüft.
Vasoregulatoren Der Endothelin-1 Rezeptorblocker Atrasentan reduzierte die renale Ereignisrate in einer großen Studie zur Progressionsverzögerung der diabetischen Nierenerkrankung (SONAR) deutlich.
Perspektiven Bei der absehbaren Verfügbarkeit von mehreren neuen Therapiekonzepten unterschiedlichen Potenzials ist die künftige Herausforderung, die jeweils optimale Kombination für einzelne Patientengruppen und auch individuelle Patienten zu finden.
Abstract
In diabetes, progression of cardio-renal disease is still the most important determinant of disease burden. Hence, the potential of glycaemic control is not the only measure any more to decide whether a new therapeutic approach is selected. Therapies with compelling cardiovascular and renal-protective effects are available. The two most promising new treatment concepts are sodium glucose co-transporter 2 (SGLT-2) inhibition and glucagon-like peptide-1 (GLP-1) receptor agonism. For both treatment concepts, prominent reductions in cardiovascular event rates and renal disease progression have been proven.
To date, these beneficial effects appear to be more significant with SGLT-2 inhibitors than with GLP-1 receptor agonists, and further clinical trials with SGLT-2 inhibitors in patients with more advanced diabetic and non-diabetic kidney disease are currently underway. Furthermore, there are two new treatment concepts for attenuation of diabetic kidney disease progression close to finalization: selective antagonism of the mineralocorticoid receptor with finerenone and selective antagonism of the endothelin-1 receptor with atrasentan. Hence, in the near future, more treatment approaches might be available to face the major challenges in diabetes mellitus.
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