nach oben

01.03.2023 | Innere Medizin

Nephrologisches Management und Medikamentendosierung bei Rheumapatienten mit Niereninsuffizienz

verfasst von: Prof. Dr. med. Stefan M. Weiner

Erschienen in: Wiener klinisches Magazin

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Bei Patienten mit entzündlich rheumatischen Erkrankungen und Niereninsuffizienz ergeben sich für den Therapeuten zwei Herausforderungen: die Rheumatherapie an die Nierenfunktion anzupassen und eine nephroprotektive Behandlung durchzuführen, die eine langfristige Verschlechterung der Nierenfunktion verhindert und das erhöhte kardiovaskuläre Risiko reduziert.

Methoden

Mittels Literaturrecherche (PubMed) wurde der aktuelle Wissensstand zur nephroprotektiven Therapie und zur Therapie rheumatischer Erkrankungen bei Niereninsuffizienz erhoben, bewertet und zusammengefasst.

Ergebnisse

Lifestyle-Interventionen, insbesondere die Beendigung eines Nikotinkonsums, und medikamentöse Therapieansätze bilden die Grundlage der Nephroprotektion inklusive Kontrolle des Diabetes mellitus mit Metformin, SGLT2(„sodium glucose transporter 2“)-Inhibitoren, GLP1(„glucagon-like peptide 1“)-Analoga, des Bluthochdrucks mit RAAS(„renin-angiotensin-aldosterone system“)-Blockade, der Hyperlipidämie, der Hyperphosphatämie und metabolischen Azidose. SGLT2-Inhibitoren sind auch bei nichtdiabetischer Nephropathie wirksam. Das erhöhte kardiovaskuläre Risiko wird mittels effektiver Kontrolle der Rheumaaktivität weiter gesenkt. Zahlreiche konventionelle Basismedikamente, insbesondere Methotrexat und die JAK(Januskinase)-Inhibitoren Baricitinib und Filgotinib müssen an die Nierenfunktion meist angepasst werden, während unter den Biologika dies nur für Anakinra der Fall ist. Das erhöhte kardiovaskuläre Risiko bei Niereninsuffizienz limitiert derzeit den Einsatz von Tofacitinib.

Schlussfolgerung

Patienten mit rheumatischen Erkrankungen und Niereninsuffizienz bedürfen einer Anpassung der medikamentösen Therapie und eines komplexen nephroprotektiven Behandlungskonzepts, das im optimalen Fall durch eine enge interdisziplinäre Zusammenarbeit von internistischen Rheumatologen und Nephrologen gewährleisten werden kann.

Abdulaziz N, Shah AR, Mccune WJ (2018) Hydroxychloroquine: balancing the need to maintain therapeutic levels with ocular safety: an update. Curr Opin Rheumatol 30:249–255PubMedCrossRef

Agarwal R, Joseph A, Anker SD et al (2022) Hyperkalemia risk with finerenone: results from the FIDELIO-DKD trial. J Am Soc Nephrol 33:225–237PubMedPubMedCentralCrossRef

Agarwal R, Sinha AD, Cramer AE et al (2021) Chlorthalidone for hypertension in advanced chronic kidney disease. N Engl J Med 385:2507–2519PubMedPubMedCentralCrossRef

Anker SD, Butler J, Filippatos G et al (2021) Effect of empagliflozin on cardiovascular and renal outcomes in patients with heart failure by baseline diabetes status: results from the EMPEROR-reduced trial. Circulation 143:337–349PubMedCrossRef

Anonymous (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42:1–201CrossRef

Anonymous (2017) KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7:1–59CrossRef

Anonymous (2020) KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int 98:S1–S115CrossRef

Anonymous (2021) KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int 99:S1–S87CrossRef

Badve SV, Pascoe EM, Tiku A et al (2020) Effects of allopurinol on the progression of chronic kidney disease. N Engl J Med 382:2504–2513PubMedCrossRef

10.

Baigent C, Landray MJ, Reith C et al (2011) The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (study of heart and renal protection): a randomised placebo-controlled trial. Lancet 377:2181–2192PubMedPubMedCentralCrossRef

11.

Bakris GL, Agarwal R, Anker SD et al (2020) Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med 383:2219–2229PubMedCrossRef

12.

Binda V, Trezzi B, Del Papa N et al (2020) Belimumab may decrease flare rate and allow glucocorticoid withdrawal in lupus nephritis (including dialysis and transplanted patient). J Nephrol 33:1019–1025PubMedCrossRef

13.

Bourré-Tessier J, Haraoui B (2010) Methotrexate drug interactions in the treatment of rheumatoid arthritis: a systematic review. J Rheumatol 37:1416–1421PubMedCrossRef

14.

Bozic M, Diaz-Tocados JM, Bermudez-Lopez M et al (2022) Independent effects of secondary hyperparathyroidism and hyperphosphataemia on chronic kidney disease progression and cardiovascular events: an analysis from the NEFRONA cohort. Nephrol Dial Transplant 37:663–672PubMedCrossRef

15.

Brandenburg VM, Verhulst A, Babler A et al (2019) Sclerostin in chronic kidney disease-mineral bone disorder think first before you block it! Nephrol Dial Transplant 34:408–414PubMedCrossRef

16.

Carriazo S, Sarafidis P, Ferro CJ et al (2022) Blood pressure targets in CKD 2021: the never-ending guidelines debacle. Clin Kidney J 15:845–851PubMedPubMedCentralCrossRef

17.

Chen J, Jin Y, Li C et al (2020) Symptomatic hyponatremia induced by low-dose cyclophosphamide in patient with systemic lupus erythematosus: a case report. Medicine 99:e22498PubMedPubMedCentralCrossRef

18.

Chou CI, Shih CJ, Chen YT et al (2016) Adverse effects of oral nonselective and cyclooxygenase-2-selective NSAIDs on hospitalization for acute kidney injury: a nested case-control cohort study. Medicine 95:e2645PubMedPubMedCentralCrossRef

19.

Coluzzi F, Caputi FF, Billeci D et al (2020) Safe use of opioids in chronic kidney disease and hemodialysis patients: tips and tricks for non-pain specialists. Ther Clin Risk Manag 16:821–837PubMedPubMedCentralCrossRef

20.

Cozzolino M, Minghetti P, Navarra P (2022) Extended-release calcifediol in stage 3–4 chronic kidney disease: a new therapy for the treatment of secondary hyperparathyroidism associated with hypovitaminosis D. J Nephrol 35:863–873PubMedCrossRef

21.

Doria A, Galecki AT, Spino C et al (2020) Serum urate lowering with allopurinol and kidney function in type 1 diabetes. N Engl J Med 382:2493–2503PubMedPubMedCentralCrossRef

22.

Evenepoel P, Cunningham J, Ferrari S et al (2021) European consensus statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4–G5D. Nephrol Dial Transplant 36:42–59PubMedCrossRef

23.

Godron-Dubrasquet A, Woillard JB, Decramer S et al (2021) Mycophenolic acid area under the concentration-time curve is associated with therapeutic response in childhood-onset lupus nephritis. Pediatr Nephrol 36:341–347PubMedCrossRef

24.

Hamet P (2012) What matters in ADVANCE and ADVANCE-ON. Diabetes Obes Metab 14(1):20–29PubMedCrossRef

25.

Harężlak T, Religioni U, Szymański FM et al (2022) Drug interactions affecting kidney function: beware of health threats from triple whammy. Adv Ther 39(1):140–147. https://doi.org/10.1007/s12325-021-01939-9CrossRefPubMed

26.

Heerspink HJL, Jongs N, Chertow GM et al (2021) Effect of dapagliflozin on the rate of decline in kidney function in patients with chronic kidney disease with and without type 2 diabetes: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol 9:743–754PubMedCrossRef

27.

Hsu CY, Yang W, Parikh RV et al (2021) Race, genetic ancestry, and estimating kidney function in CKD. N Engl J Med 385:1750–1760PubMedPubMedCentralCrossRef

28.

Idzerda NMA, Pena MJ, Parving HH et al (2019) Proteinuria and cholesterol reduction are independently associated with less renal function decline in statin-treated patients; a post hoc analysis of the PLANET trials. Nephrol Dial Transplant 34:1699–1706PubMedCrossRef

29.

Ingrasciotta Y, Sultana J, Giorgianni F et al (2015) Association of individual non-steroidal anti-inflammatory drugs and chronic kidney disease: a population-based case control study. PLoS ONE 10:e122899PubMedPubMedCentralCrossRef

30.

Inker LA, Eneanya ND, Coresh J et al (2021) New creatinine- and cystatin C‑based equations to estimate GFR without race. N Engl J Med 385:1737–1749PubMedPubMedCentralCrossRef

31.

Karasawa K, Ogura S, Takabe T et al (2022) Successful treatment with belimumab in a patient with refractory systemic lupus erythematosus after initiation of hemodialysis: considering the synergistic effect of Belimumab and immunological burn-out phenomenon in end-stage renal disease patients on hemodialysis. Blood Purif 51(2):182–188. https://doi.org/10.1159/000512585CrossRefPubMed

32.

Kendrick J, Chonchol M (2011) The role of phosphorus in the development and progression of vascular calcification. Am J Kidney Dis 58:826–834PubMedPubMedCentralCrossRef

33.

Ketteler M, Block GA, Evenepoel P et al (2017) Executive summary of the 2017 KDIGO chronic kidney disease-mineral and bone disorder (CKD-MBD) guideline update: what’s changed and why it matters. Kidney Int 92:26–36PubMedCrossRef

34.

Kimura K, Hosoya T, Uchida S et al (2018) Febuxostat therapy for patients with stage 3 CKD and asymptomatic hyperuricemia: a randomized trial. Am J Kidney Dis 72:798–810PubMedCrossRef

35.

Kochi M, Kohagura K, Shiohira Y et al (2018) Chronic kidney disease, inflammation, and cardiovascular disease risk in rheumatoid arthritis. J Cardiol 71:277–283PubMedCrossRef

36.

Krishnaswami S, Chow V, Boy M et al (2014) Pharmacokinetics of tofacitinib, a janus kinase inhibitor, in patients with impaired renal function and end-stage renal disease. J Clin Pharmacol 54:46–52PubMedCrossRef

37.

Kwon OC, Lee JS, Kim YG et al (2018) Safety of the concomitant use of methotrexate and a prophylactic dose of trimethoprim-sulfamethoxazole. Clin Rheumatol 37:3215–3220PubMedCrossRef

38.

Lee JS, Oh JS, Kim YG et al (2020) Methotrexate-related toxicity in patients with rheumatoid arthritis and renal dysfunction. Rheumatol Int 40:765–770PubMedCrossRef

39.

Lee JY, Park JT, Joo YS et al (2021) Association of blood pressure with the progression of CKD: findings from KNOW-CKD study. Am J Kidney Dis 78:236–245PubMedCrossRef

40.

Levey AS, Coresh J, Greene T et al (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254PubMedCrossRef

41.

Lu JL, Molnar MZ, Naseer A et al (2015) Association of age and BMI with kidney function and mortality: a cohort study. Lancet Diabetes Endocrinol 3:704–714PubMedPubMedCentralCrossRef

42.

Lv J, Zhang H, Wong MG et al (2017) Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA 318:432–442PubMedPubMedCentralCrossRef

43.

Ma HY, Chen S, Lu LL et al (2021) Raloxifene in the treatment of osteoporosis in postmenopausal women with end-stage renal disease: a systematic review and meta-analysis. Horm Metab Res 53:730–737PubMedCrossRef

44.

Mach F, Baigent C, Catapano AL et al (2020) 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 41:111–188PubMedCrossRef

45.

Major RW, Cheng MRI, Grant RA et al (2018) Cardiovascular disease risk factors in chronic kidney disease: a systematic review and meta-analysis. PLoS ONE 13:e192895PubMedPubMedCentralCrossRef

46.

Marlow CF, Sharma S, Babar F et al (2018) Severe hypocalcemia and hypomagnesemia with denosumab in advanced chronic kidney disease: case report and literature review. Case Rep Oncol Med 2018:2059364PubMedPubMedCentral

47.

Matsushita K, van der Velde M, Astor BC et al (2010) Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 375:2073–2081PubMedPubMedCentralCrossRef

48.

Miller PD (2014) Chronic kidney disease and the skeleton. Bone Res 2:14044PubMedPubMedCentralCrossRef

49.

Mohamed MF, Trueman S, Feng T et al (2019) Characterization of the effect of renal impairment on upadacitinib pharmacokinetics. J Clin Pharmacol 59:856–862PubMedPubMedCentralCrossRef

50.

Mukai M, Kurihara Y, Ito Y et al (2020) Successful treatment with secukinumab of three psoriatic patients undergoing dialysis. J Dermatol 47:e26–e28PubMedCrossRef

51.

Namour F, Fagard L, Van der Aa A et al (2018) Influence of age and renal impairment on the steady state pharmacokinetics of filgotinib, a selective JAK1 inhibitor. Br J Clin Pharmacol 84:2779–2789PubMedPubMedCentralCrossRef

52.

Navaneethan SD, Shao J, Buysse J et al (2019) Effects of treatment of metabolic acidosis in CKD: a systematic review and meta-analysis. Clin J Am Soc Nephrol 14:1011–1020PubMedPubMedCentralCrossRef

53.

Naylor KL, Mcarthur E, Leslie WD et al (2014) The three-year incidence of fracture in chronic kidney disease. Kidney Int 86:810–818PubMedCrossRef

54.

Nespoux J, Vallon V (2020) Renal effects of SGLT2 inhibitors: an update. Curr Opin Nephrol Hypertens 29:190–198PubMedPubMedCentralCrossRef

55.

Nissen SE, Yeomans ND, Solomon DH et al (2016) Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med 375:2519–2529PubMedCrossRef

56.

Ozen G, Pedro S, Michaud K (2021) The risk of cardiovascular events associated with disease-modifying antirheumatic drugs in rheumatoid arthritis. J Rheumatol 48:648–655PubMedCrossRef

57.

Patel H, Barr A, Jeejeebhoy KN (2009) Renal effects of long-term treatment with 5‑aminosalicylic acid. Can J Gastroenterol 23:170–176PubMedPubMedCentralCrossRef

58.

Paudyal S, Yang FM, Rice C et al (2017) End-stage renal disease in patients with rheumatoid arthritis. Semin Arthritis Rheum 46:418–422PubMedCrossRef

59.

Pazianas M, Miller PD (2021) Osteoporosis and chronic kidney disease-mineral and bone disorder (CKD-MBD): back to basics. Am J Kidney Dis 78:582–589PubMedCrossRef

60.

Pitt B, Filippatos G, Agarwal R et al (2021) Cardiovascular events with finerenone in kidney disease and type 2 diabetes. N Engl J Med 385:2252–2263PubMedCrossRef

61.

Puisset F, White-Koning M, Kamar N et al (2013) Population pharmacokinetics of rituximab with or without plasmapheresis in kidney patients with antibody-mediated disease. Br J Clin Pharmacol 76:734–740PubMedPubMedCentralCrossRef

62.

Ridker PM, Macfadyen JG, Glynn RJ et al (2018) Inhibition of interleukin-1β by canakinumab and cardiovascular outcomes in patients with chronic kidney disease. J Am Coll Cardiol 71:2405–2414PubMedCrossRef

63.

Robinson DE, Ali MS, Pallares N et al (2021) Safety of oral bisphosphonates in moderate-to-severe chronic kidney disease: a binational cohort analysis. J Bone Miner Res 36:820–832PubMedCrossRef

64.

Rovin BH, Teng YKO, Ginzler EM et al (2021) Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 397:2070–2080PubMedCrossRef

65.

Saag KG, Petersen J, Brandi ML et al (2017) Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med 377:1417–1427PubMedCrossRef

66.

Sato M, Inaba M, Yamada S et al (2021) Efficacy of romosozumab in patients with osteoporosis on maintenance hemodialysis in Japan; an observational study. J Bone Miner Metab 39:1082–1090PubMedCrossRef

67.

Schiffl H, Lang SM, Fischer R (2002) Stopping smoking slows accelerated progression of renal failure in primary renal disease. J Nephrol 15:270–274PubMed

68.

Shaman AM, Bain SC, Bakris GL et al (2022) Effect of the glucagon-like peptide‑1 receptor agonists semaglutide and liraglutide on kidney outcomes in patients with type 2 diabetes: pooled analysis of SUSTAIN 6 and LEADER. Circulation 145:575–585PubMedCrossRef

69.

Shlipak MG, Tummalapalli SL, Boulware LE et al (2021) The case for early identification and intervention of chronic kidney disease: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference. Kidney Int 99:34–47PubMedCrossRef

70.

Stahl K, Duong M, Schwarz A et al (2017) Kinetics of rituximab excretion into urine and peritoneal fluid in two patients with nephrotic syndrome. Case Rep Nephrol 2017:1372859PubMedPubMedCentral

71.

Tokoroyama T, Ando M, Setoguchi K et al (2017) Prevalence, incidence and prognosis of chronic kidney disease classified according to current guidelines: a large retrospective cohort study of rheumatoid arthritis patients. Nephrol Dial Transplant 32:2035–2042PubMed

72.

Torres PU, Troya MI, Dauverge M et al (2022) Independent effects of parathyroid hormone and phosphate levels on hard outcomes in non-dialysis patients: food for thought. Nephrol Dial Transplant 37:613–616PubMedCrossRef

73.

Umezawa Y, Hayashi M, Kikuchi S et al (2015) Ustekinumab treatment in patients with psoriasis undergoing hemodialysis. J Dermatol 42:731–734PubMedCrossRef

74.

Vargas-Santos AB, Peloquin CE, Zhang Y et al (2018) Association of chronic kidney disease with allopurinol use in gout treatment. JAMA Intern Med 178:1526–1533PubMedPubMedCentralCrossRef

75.

Wan EYF, Yu EYT, Chan L et al (2021) Comparative risks of nonsteroidal anti-inflammatory drugs on CKD. Clin J Am Soc Nephrol 16:898–907PubMedPubMedCentralCrossRef

76.

Wanner C, Inzucchi SE, Lachin JM et al (2016) Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 375:323–334PubMedCrossRef

77.

Weckmann G, Chenot JF, Stracke S (2020) The management of non-dialysis-dependent chronic kidney disease in primary care. Dtsch Arztebl Int 117:745–751PubMedPubMedCentral

78.

Weiner SM, Bergner R (2015) Dosage and toxicity of antirheumatic drugs in renal insufficiency. Z Rheumatol 74:300–309PubMedCrossRef

79.

Weiner SM, Waldherr R (2020) Value of renal biopsy in lupus nephritis. Akt Rheumatol 45:319–327

80.

Wheeler DC, Stefánsson BV, Jongs N et al (2021) Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol 9:22–31PubMedCrossRef

81.

Whelton PK, Carey RM, Aronow WS et al (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. Hypertension 71:e13–e115PubMed

82.

Williams B, Mancia G, Spiering W et al (2018) 2018 practice guidelines for the management of arterial hypertension of the European society of hypertension and the European society of cardiology: ESH/ESC task force for the management of arterial hypertension. J Hypertens 36:2284–2309PubMedCrossRef

83.

Wright JT Jr., Williamson JD, Whelton PK et al (2015) A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373:2103–2116PubMedCrossRef

84.

Yamamoto J, Nakazawa D, Nishio S et al (2020) Impact of weekly teriparatide on the bone and mineral metabolism in hemodialysis patients with relatively low serum parathyroid hormone: a pilot study. Ther Apher Dial 24:146–153PubMedCrossRef

85.

Ytterberg SR, Bhatt DL, Mikuls TR et al (2022) Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis. N Engl J Med 386:316–326PubMedCrossRef

86.

Zewinger S, Rauen T, Rudnicki M et al (2018) Dickkopf‑3 (DKK3) in urine identifies patients with short-term risk of eGFR loss. J Am Soc Nephrol 29:2722–2733PubMedPubMedCentralCrossRef

87.

Zewinger S, Speer T, Kleber ME et al (2014) HDL cholesterol is not associated with lower mortality in patients with kidney dysfunction. J Am Soc Nephrol 25:1073–1082PubMedPubMedCentralCrossRef

88.

Zhang Y, Li JJ, Wang AJ et al (2021) Effects of intensive blood pressure control on mortality and cardiorenal function in chronic kidney disease patients. Ren Fail 43:811–820PubMedPubMedCentralCrossRef

Titel: Nephrologisches Management und Medikamentendosierung bei Rheumapatienten mit Niereninsuffizienz
verfasst von: Prof. Dr. med. Stefan M. Weiner
Publikationsdatum: 01.03.2023
Verlag: Springer Vienna
Erschienen in: Wiener klinisches Magazin
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI: https://doi.org/10.1007/s00740-023-00485-0