Diabetes, anemia and CKD: Why TREAT?

Area of Science:

• Nephrology
• Endocrinology
• Cardiology

Background:

• Anemia is common in patients with diabetes mellitus and chronic kidney disease (CKD), increasing mortality and cardiovascular risks.
• Epoetin alfa revolutionized anemia treatment in CKD, but newer studies question risks associated with erythropoiesis-stimulating agents.
• The TREAT study investigated darbepoetin's efficacy and safety in anemic type 2 diabetic patients with CKD.

Purpose of the Study:

• To evaluate the effect of darbepoetin alfa on mortality and cardiovascular events in anemic type 2 diabetic patients with CKD.
• To assess the impact of darbepoetin alfa on renal events, stroke, thromboembolic complications, and cancer deaths.
• To determine the effect on health-related quality of life.

Main Methods:

• Randomized controlled trial (TREAT study) involving type 2 diabetic patients with CKD and anemia.
• Patients were randomized to receive darbepoetin alfa or placebo.
• Outcomes included mortality, cardiovascular events, renal events, stroke, thromboembolic complications, cancer deaths, and quality of life.

Main Results:

• Darbepoetin alfa treatment did not reduce mortality or cardiovascular/renal events.
• A twofold higher rate of stroke and thromboembolic complications was observed in the darbepoetin group.
• Cancer deaths were higher, and quality of life improvements were modest and inconsistent.

Conclusions:

• Anemia treatment with darbepoetin alfa in type 2 diabetic patients with CKD offers no mortality or cardiovascular benefit.
• The risks of stroke, thromboembolism, and cancer deaths outweigh potential benefits.
• Current evidence questions the routine use of erythropoiesis-stimulating agents for anemia in this high-risk population.