Renal Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Curr Diab Rep. 2010 Aug;10(4):291-6. doi: 10.1007/s11892-010-0123-5.
The triad of diabetes mellitus, anemia, and chronic kidney disease (CKD) define a group of patients at high risk for death and cardiovascular complications. The approval of epoetin alfa in 1989 transformed the treatment of anemia in patients with CKD. However, evidence has emerged from randomized controlled trials that correcting anemia with erythropoiesis-stimulating agents in CKD patients is associated with increased risk. Most recently, the TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy) study of anemic type 2 diabetic patients with CKD reported that treatment with darbepoetin conferred no benefit in mortality or in attenuating cardiovascular or renal events. Instead, there was a twofold higher rate of stroke and thromboembolic complications and a higher rate of cancer deaths in patients randomized to treatment with darbepoetin. Furthermore, there was an inconsistent and modest improvement in health-related quality of life. TREAT raises questions about whether anemia in type 2 diabetic patients should be treated and under what circumstances.
糖尿病、贫血和慢性肾脏病（CKD）这三者定义了一组高死亡和心血管并发症风险的患者群体。1989 年，促红细胞生成素α的批准改变了 CKD 患者贫血的治疗方法。然而，随机对照试验的证据表明，用红细胞生成刺激剂纠正 CKD 患者的贫血与风险增加有关。最近，TREAT（用阿法达贝泊汀治疗减少心血管事件试验）研究了伴有 CKD 的 2 型糖尿病贫血患者，结果表明达贝泊汀治疗在死亡率或减缓心血管或肾脏事件方面没有益处。相反，接受达贝泊汀治疗的患者中风和血栓栓塞并发症的发生率增加了一倍，癌症死亡的发生率也更高。此外，健康相关生活质量的改善也不一致且轻微。TREAT 提出了关于是否应该治疗 2 型糖尿病患者的贫血以及在什么情况下应该治疗的问题。
