Abaterusso Cataldo, Pertica Nicoletta, Lupo Antonio, Ortalda Vittorio, Gambaro Giovanni
Division of Nephrology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Verona, Italy.
Diabetes Obes Metab. 2008 Sep;10(10):843-9. doi: 10.1111/j.1463-1326.2007.00831.x. Epub 2007 Dec 17.
The mortality rate in diabetics with chronic kidney disease (CKD) is seven times higher than end-stage renal disease mainly because of cardiac causes. Anaemia may have a relevant role in the pathogenesis of cardiovascular (CV) disease in CKD. Anaemia occurs at an earlier stage of CKD in diabetic individuals than in those with other causes of CKD. Observational findings support the unfavourable influence of anaemia on mortality in CKD patients, and the combination of anaemia and CKD in diabetics identifies a group with a particularly high mortality risk. While the effect of erythropoietin on these patients' quality of life is known, its impact on mortality and CV risk is uncertain. The recent Anaemia Correction in Diabetes (ACORD) trial in diabetic CKD patients, which targeted haemoglobin levels of 13-15 mg/dl, disclosed no statistically significant favourable or adverse effects on mortality or morbidity over the 2-year follow-up, while other studies endeavouring to nearly normalize haemoglobin have reportedly proved risky. Even if anaemia is causally involved, the pathogenesis of CV disease in diabetics with CKD is so complex that addressing just one factor (anaemia) may not suffice to prevent CV risk, and normalizing haemoglobin levels may even be harmful.
患有慢性肾脏病（CKD）的糖尿病患者的死亡率比终末期肾病患者高出七倍，主要原因是心脏问题。贫血可能在CKD患者心血管（CV）疾病的发病机制中起相关作用。与其他病因导致的CKD患者相比，糖尿病患者的贫血在CKD的更早阶段出现。观察结果支持贫血对CKD患者死亡率有不利影响，而糖尿病患者中贫血与CKD并存确定了一个死亡率风险特别高的群体。虽然促红细胞生成素对这些患者生活质量的影响是已知的，但其对死亡率和CV风险的影响尚不确定。最近针对糖尿病CKD患者进行的血红蛋白水平目标为13 - 15mg/dl的糖尿病贫血纠正（ACORD）试验显示，在2年随访期间，对死亡率或发病率没有统计学上显著的有利或不利影响，而其他试图使血红蛋白接近正常水平的研究据报道已证明有风险。即使贫血有因果关系，患有CKD的糖尿病患者CV疾病的发病机制非常复杂，仅解决一个因素（贫血）可能不足以预防CV风险，使血红蛋白水平正常化甚至可能有害。
