Ritz Eberhard
University of Heidelberg, Heidelberg, Germany.
Nephrol Dial Transplant. 2005 Jun;20 Suppl 6:vi21-5. doi: 10.1093/ndt/gfh1093.
The combination of diabetes and chronic kidney disease is associated with increased mortality and reduced quality of life. Recent studies have shown that, in general, late referral of patients to the renal unit increases mortality, and that patients with diabetes who are referred late have a particularly poor prognosis. Several co-morbid conditions have been shown to contribute to poor patient outcomes, including both cardiovascular disease and anaemia. In patients with diabetic nephropathy, anaemia is more severe and is seen earlier than in patients with non-diabetic renal disease. Although the treatment of anaemia with recombinant human erythropoietin (rhEPO; epoetin) is well established, the only data currently available concerning the effects of early intervention in patients with diabetic nephropathy are from small-scale studies. Therefore, two large-scale studies have been designed to provide information on the efficacy of epoetin treatment and on how current management strategies might be improved. The Anaemia CORrection in Diabetes (ACORD) study will provide information on the potential cardiac benefits of early anaemia management in patients with early, type 2 diabetic nephropathy. The Individualised Risk-profiling In DIabEtes Mellitus (IRIDIEM) study will provide evidence-based guidance in risk factor management, by assessing the efficacy of individualized interventions.
糖尿病与慢性肾脏病并存会导致死亡率上升和生活质量下降。最近的研究表明，一般而言，患者延迟转诊至肾脏科会增加死亡率，而延迟转诊的糖尿病患者预后尤其不佳。已证实多种合并症会导致患者预后不良，包括心血管疾病和贫血。在糖尿病肾病患者中，贫血更为严重，且比非糖尿病肾病患者出现得更早。尽管使用重组人促红细胞生成素（rhEPO；依泊汀）治疗贫血已得到充分确立，但目前关于早期干预对糖尿病肾病患者影响的唯一数据来自小规模研究。因此，已设计两项大规模研究，以提供依泊汀治疗效果以及如何改进当前管理策略的相关信息。糖尿病贫血纠正（ACORD）研究将提供有关早期贫血管理对早期2型糖尿病肾病患者潜在心脏益处的信息。糖尿病个体化风险评估（IRIDIEM）研究将通过评估个体化干预的效果，为风险因素管理提供循证指导。
