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Today, type 2 diabetes (T2D) affects more than 23 million people in the United States1 and roughly 250 million people worldwide2. For patients with diabetes, existing drugs now allow them to manage glucose levels to some extent: not so for associated macrovascular complications including cardiac, cerebrovascular and peripheral vascular complications.
Research in T2D is moving away from the traditional view of diabetes as a disease involving decreased insulin secretion, reduced glucose uptake in the muscle and increased hepatic glucose production, to a much more complex condition involving numerous factors that give rise to hyperglycaemia, lipid modulation and subsequent complications.
So how do we transfer our scientific knowledge into novel, differentiated drugs offering patients new and better treatment options?
We provide an integrated network of science and technology to support pathway analysis, target assessment, biomarker discovery and validation.
At Roche, we leverage external expertise, act as a preferred partner throughout the value chain and aim for the best-in-disease treatment programmes. In early development, we are working at the biological core of disease, with diabetes programmes in discovery using translational approaches, examining pathophysiology and working in experimental medicine. There is no question that diabetes will be one of the most challenging health problems of the 21st century.
From pancreas, muscle and liver to a picture also encompassing brain, adipose tissue, kidneys and the digestive System.
The chronic symptoms of diabetes are related to the nerves, blood vessels, and organs that are damaged or destroyed by chronically elevated blood sugars. The destruction of large blood vessels, such as the coronary arteries, renal arteries, or arteries leading to the brain, can cause heart attack, stroke, and direct kidney damage or increased blood pressure. The destruction of small blood vessels decreases blood flow to all of the organs in your body.
Nerves throughout the body are also affected both by chronically increased blood sugars and by decreased blood flow (yes, there are thousands of small blood vessels that supply nerves with essential blood flow). What Causes Diabetes The Causes of Diabetes Answering the question of what causes diabetes is not as simple and straightforward as most people think. The number of cases of diabetes and prediabetes among Americans of all ages and ethnicities continues to increase, according to the National Diabetes Statistics Report, 2014 (based on health data from 2012), released today by the Centers for Disease Control and Prevention. People with diabetes often use a blood glucose monitoring device to help them maintain healthy glucose levels.
Senior man using glucometer: Maintaining a healthy blood glucose level helps people with diabetes stay healthy. Biographya€?These new numbers are alarming and underscore the need for an increased focus on reducing the burden of diabetes in our country. Biographya€?If we want to reduce the overall burden of diabetes in our nation, we have to focus on preventing diabetes in the first place."a€?The number of people affected by diabetes and prediabetes has increased across all age groups and ethnicities. Science, Technology and Medicine open access publisher.Publish, read and share novel research.
Anemia of Chronic Kidney Disease — A Modifiable Risk Factor in a Growing High Cardiovascular Risk PopulationNadine Montemarano1, Jennifer Guttman1 and Samy I. Based on reference 3 Beutler et al.Multiple risk factors increase the risk of developing anemia. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification Andrew S. National Kidney Foundation: KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease.
Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States : Results From the National Health and Nutrition Examination Survey, 1999 -2000. Writing Group Members for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Zoccali C, Bode-Boger S, Mallamaci F, Benedetto F, Tripepi G, Malatino L, Cataliotti A, Bellanuova I, Fermo I, Frolich J, Boger R. This entry was posted in Cartoon Publishing, Cartoon Services, Cartooning, cartoons, comics, funny, funny cartoons, glasbergen cartoons, Graphics, humor, Illustrations, News, newsletter content, Newspaper Content, Publishing Resources, Publishing Services, web comics and tagged cartoon resource for food cartoons, cartoon stock about food, cartoons about bakery food, cartoons about breakfast, cartoons about convenience foods, cartoons about cooking, cartoons about diners, cartoons about eating, cartoons about eating food, cartoons about family meals, cartoons about fast food, cartoons about fast food burgers, cartoons about feeding, cartoons about feeding kids, cartoons about food, cartoons about food choices, cartoons about food menus, cartoons about food pyramid, cartoons about food recipes, cartoons about groceries, cartoons about health food, cartoons about junk food, cartoons about lunch. Diet, Health, Fitness and Medical Cartoons by Randy Glasbergen My Health, Fitness and Medical Cartoons are available at budget-friendly rates for magazines, newspapers, books, presentations, newsletters, websites, social media, greeting cards, advertising, calendars, textbooks, any kind of print or electronic media. To use a cartoon from my website,  please contact me for more information and a rate quote.
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Search Can Stock Photo for royalty free illustration, royalty free clipart, digital artwork, EPS vector clip art, stock illustrations, stock images, logo icon graphics, and cheap EPS format line art drawings. As the obesity pandemic grows, the incidence of this chronic disease continues to soar and experts project that during the next 25 years, the number of North Americans with diagnosed and undiagnosed diabetes will increase to 44.1 million2 and up to 380 million people globally3. Each year more than 3.8 million people die from diabetes-related causes, one death every 10 seconds. However, in recent years, we have seen eight new classes of drugs approved for the management of T2D: metformin, glucosidase inhibitors, thiazolidinediones, glinides, glucagon-like peptide analogues, amylin analogues, dipeptidyl peptidase IV inhibitors and bile-acid sequestrants. There is uncertainty about the place of improved glycaemic control in the prevention of macrovascular disease in patients with diabetes mellitus. The pancreas, liver and muscle are involved but in the evolving view of T2D the brain, adipose tissue, kidneys and digestive system also play a part. Through our collaborations, we gain first-hand access to academic information on new preclinical and clinical data on potential targets, pathways and new drug candidates as well as new technologies, biomarkers, diagnostic tools and applications. At Roche, we believe our approaches will help us to find the best treatments to fit the individual patient so that, in the future, T2D and its associated complications become more manageable.
High blood sugars damage or destroy both small and large blood vessels, damage nerves, and suppress the immune system.
With decreased blood flow, these organs receive progressively less of the essential oxygen that they need to function properly. This, in turn, decreases the immune system’s ability to respond to external insults and threats. People with diabetes are at increased risk of serious health complications including blindness, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. Among multiple factors, individuals with CVD, DM and CKD, HTN(HTN) and of African American race are at significantly high risk than the general population [4,5,6]. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Prevalence and associations of anemia of CKD: Kidney Early Evaluation Program (KEEP) and National Health Nutrition Examination Survey(NHANES)1999-2004. Cardiovascular disease associated with anemia in diabetic patients with chronic kidney disease.
Hematologic differences between African-Americans and whites: the roles of iron deficiency and alpha-thalassemia on hemoglobin levels and mean corpuscular volume. Bethesda, MD, The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2006. The intensity of hemodialysis and the response to erythropoietin in patients with end-stage renal dis- ease. Abnormal membrane fluidity and acetylcholinesterase activity in erythrocytes from insulin-dependent diabetic patients. Membrane lipid alteration and Na-pumping activity in erythrocytes from IDDM and NIDDM subjects.
Changes in fluidity and composition of erythrocyte membranes and in composition of plasma lipids in type I diabetes. In vitro effects of high glucose concentrations on membrane protein oxidation, G- actin and deformability of human erythrocytes. Transferrinuria in type 2 diabetic patients with early nephropathy and tubulointerstitial injury. Left ventricular mass index increase in early renal disease: impact of decline in haemoglobin. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Ethnic Disparities in Cardiovascular Risk Factors and Coronary Disease Prevalence among Individuals with Chronic Kidney Disease: Findings from the Third National Health and Nutrition Examination Survey. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. Biomarkers of inflammation and thrombosis as predictors of near-term mortality in patients with peripheral arterial disease: a cohort study.
Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: A pooled analysis of community-based studies. Target level for hemoglobin correction in patients with diabetes and CKD: primary results of the Anemia Correction in Diabetes (ACORD) Study. TREAT Investigators: A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. Predictors of fatal and nonfatal cardiovascular events in patients with type 2 diabetes mellitus, chronic kidney disease, and anemia: an analysis of the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin-alfa) Therapy (TREAT).
USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.
Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: A prospective study. Reducing the burden of cardiovascular calcification in patients with chronic kidney disease. New insights into the pathophysiology of diabetic nephropathy: from hemodynamics to molecular pathology. Case for intrarenal hypertension in initiation and progression of diabetic and other glomerulopathies.


My food cartoons are available at budget-friendly rates for newsletters, magazines, newspapers, cookbooks, presentations, nutrition seminars, any type of print or electronic media. Can Stock Photo has the royalty free illustration, line art drawing, EPS vector graphic, or stock clipart icon that you need. The development of such complications is an important concern considering that most deaths in diabetes are related to cardiovascular disease5. By nurturing a culture that has science at its core, we aim to keep our Vascular and Metabolic Disease Discovery and Translational Medicine teams in Basel, Switzerland, and Nutley, New Jersey, USA, energised and engaged.
Taspoglutide, aleglitazar and dalcetrapib are potential first- or best-in-class compounds being developed to reduce cardiovascular morbidity and mortality and reduce complications in high-risk patients. The organs become damaged, and their function slowly decreases to the point where they eventually do not work at all. Ita€™s urgent that we take swift action to effectively treat and prevent this serious disease."a€?Now is the time to take action. IntroductionDiabetes Mellitus (DM) has become a modern day epidemic, affecting millions of people around the globe. Our designers and illustrators provide royalty free stock images, clip art, clipart graphics, and pictures for as little as 1 dollar. Patients with T2D are two to three times more likely to develop a serious cardiovascular outcome compared to those without diabetes6,7. We strive to generate a deep knowledge and understanding of biological pathways and pathophysiology of disease.
The organs where this is most prominently related to symptoms include the kidneys (decreased renal function), the eyes (decreased vision), and (most importantly to many of us) the penis (erectile dysfunction). Additionally, diabetics have a much more difficult time fighting off infections that are already present. If these numbers continue to rise, 1 in 5 people could have diabetes by the year 2025, and it could be 1 in 3 people by the year 2050. It has grown parallel to the rising epidemic of obesity, leading to increased cardiovascular disease (CVD) morbidity and mortality.
Postulated mechanisms of anemia in CKD, CVD and DMCKD, CVD and DM are intricately interconnected with one another. Despite risk-reduction strategies that include lowering of cholesterol and blood pressure, and smoking cessation, the majority of those with diabetes continue to die from cardiovascular causes8.
Identifying the best targets and informative biomarkers allows us to stratify patients so they can best benefit from our potential treatments. We simply cana€™t sustain this trajectory a€“ the implications are far too great a€“ for our families, our healthcare system, our workforce, our nation."a€?We know today that adopting a healthier lifestyle is the most effective way to prevent type 2 diabetes and improve health for people already diagnosed with diabetes. Currently, DM is the most common cause of chronic kidney disease (CKD) and subsequent end stage renal disease (ESRD) requiring renal replacement therapy. Although statistics indicate a leveling off in the incidence of ESRD among diabetics, these statistics do not hold true for some of the most vulnerable populations such as minority populations.CVD is the primary cause of death in people with DM who also possess traditional risk factors such as hypertension (HTN), obesity (particularly central obesity), dyslipidemia (decreased HDL, and elevated triglycerides), increased age, sedentary lifestyle and smoking. According to the Center for Disease Control (CDC), more than 35% of people aged 20 years or older with DM have CKD and more than 20% of people aged 20 years or older with HTN have CKD [9]. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy.
Nontraditional risk factors for CVD include increased inflammation, stimulation of the renin-angiotensin-aldosterone system (RAAS), increased fibrinogen, increased platelet activator inhibitor factor -1 (PAI-1) among others. Regardless of the level of estimated glomerular filtration rate (e-GFR), anemia is both more frequent and more severe in diabetics compared to non-diabetic patients [10].
The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. Diabetic kidney disease (DKD) is a well established cause of CVD and currently, it is considered a cardiovascular equivalent. Diabetes types 1 and 2, are the leading cause of CKD in the western world, accounting for approximately 30-40% of cases.
Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence.
The exact cause of increased CVD risk in CKD is likely multifactorial but is largely unknown.
A number of mechanisms contribute to the development of anemia in diabetics with CKD such as decreased red blood cell (RBC) life span, iron deficiency, nutritional folate deficiency, occult blood loss, systemic inflammation and what appears to be the most dominant causal factor, erythropoietin deficiency [11].
Anemia has been shown to increase cardiovascular risk in this vulnerable population and prior studies have demonstrated that treatment of anemia reduces this risk and improves quality of life [5].
Renal anemia is associated with a reduction in the number of RBCs and with an increase in oxidative stress to RBCs [23]. Type 2 diabetes, which was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, may account for about 90% to 95% of all diagnosed cases.
Prevention efforts nationwide are crucial to combat serious health risks.Individuals can learn more about diabetes and prediabetes by talking to a healthcare provider about the risk to them and their families. On the other hand, recent trials have shown an increased risk of CVD in those with higher hemoglobin values being treated with ESA [56]. Learn more about diabetes and CDCa€™s evidence-based and cost-effective interventions through our National Diabetes Prevention Program. It is unclear whether the ESA in large doses confers this harm or whether the correction of anemia to high hemoglobin levels is responsible.
While this phenomenon has been recognized for over 50 years, the mechanism is not completely understood [12].
These uncertainties explain why many clinicians prefer transfusion therapy over the use of ESA. Some studies show that the decrease in RBC half life is partially caused by the uremic environment present in CKD patients.
Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over. Several questions remain unanswered including the mechanisms by which anemia confers increased cardiovascular risk in CKD and dialysis patients.
Another important issue surrounded by controversy is the degree to which anemia should be corrected with erythropoietic stimulating agents (ESA). Studies have also shown that the RBCs in diabetics have multiple metabolic and functional abnormalities [17,18].
In this chapter, we discuss the relationship between DM and CKD and the associated CVD risk factors, highlighting the pathophysiologic mechanisms that link anemia and CVD. We also explore the therapeutic rationale behind the current guidelines provided by the National Kidney Foundation for the management of anemia.
Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes.
These guidelines are constantly updated as new randomized controlled trials continuue to emerge.
According to Manodori et al, as a result of these changes, RBC life span in diabetic patients is decreased compared to nondiabetic patients with similar degrees of renal impairment [22]. Transferrin is a protein that captures iron that has been absorbed from the GI tract and that has been released from macrophages and delivers it to maturing RBCs. Blood glucose levels must be closely monitored through frequent blood glucose testing.Healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. Newer research differentiates anemia cutoffs based on both race and age in addition to sex. Table 1 lists proposed lower limits of normal for hemoglobin concentration based on Scripps-Kaiser data for the 5th percentiles and the NHANES data published in 2006 [2]. As uremia leads to platelet dysfunction, CKD patients are at increased risk for bleeding and iron loss [24]. Hemodialysis patients are at particular risk because of the chance for blood loss during dialysis [25].
Diabetics with nephropathy are at an added risk for iron loss by urinary excretion as their proteinuria progresses [26]. Systemic Inflammation is one of the leading features of diabetics with CKD that appears to contribute to anemia.
This inflammatory response is secondary to a variety of factors including elevated levels of inflammatory cytokines, volume overload and oxidative stress.
Increased level of cytokines impair bone marrow function and significantly alter iron metabolism. All three approaches are actively being pursued by the US Department of Health and Human Services.Both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) are involved in prevention activities. Erythropoietin (EPO) is a glycoprotein growth factor that is produced by the peritubular interstitial fibroblasts of the renal cortex and outer medulla [27]. The NIH is involved in research to cure both type 1 and type 2 diabetes, especially type 1. The release of EPO is regulated by a complex feedback mechanism at the level of the kidney. CDC focuses most of its programs on making sure that the proven science to prevent complications is put into daily practice for people with diabetes. If you have any concerns about your own health or the health of your family please contact Camelback Health Care. Camelback Health Care is a family medical practice providing pro-active health care for the entire family, allergy testing and treatment, cosmetic skin and laser services, medically managed weight loss, and bio-identical hormone replacement therapy. In this group, EPO deficiency is regarded as functional as it stems from a failure to increase EPO levels in response to a falling hemoglobin level, even though the absolute value of EPO may be within normal limits.


Conveniently located on Camelback Road, Camelback Health Care is easily accessible from Phoenix, Paradise Valley, Scottsdale, and Tempe. EPO deficiency appears to contribute largely to the development of anemia in patients with diabetic nephropathy and CKD [28, 29].
Multiple explanations have been postulated to account for the EPO deficiency in this patient population including microvascular damage, chronic hypoxia, oxidative stress, and autonomic neuropathy.
Damage to the tubulointerstitial cells has been observed in the early stages of diabetic nephropathy resulting in impairment of the signaling cascade that triggers transcription and release of EPO [29]. Unregulated activation of the Renin-Angiotensin-Aldosterone System (RAAS) in diabetics may also contribute to impaired erythropoietin release. Similarly, experimental models have illustrated that autonomic dysfunction, as seen in diabetics who tend to develop splanchnic nerve dysfunction, have impaired production of EPO [30]. Many of the same risk factors that contribute to DM, CKD and CVD, both independently and synergistically.
Some of the traditional risk factors include obesity, hypertension, dyslipidemia and smoking. Among the non traditional risk factors are anemia, chronic systemic inflammation, oxidative stress, hyperparathyroidism, hyperhomocysteinemia, endothelial dysfunction and prothrombin states [34].
Diabetic kidney disease, also known as diabetic nephropathy, is one of the major complications of type 2 diabetes. The increased intracellular glucose leads to increased production of glucose intermediaries cycling through multiple metabolic pathways. This leads to the production of advanced glycation products (AGEs), activation of protein kinase C (PKC), increased expression of transforming growth factor-beta (TGF-beta), GTP-binding proteins, and the formation of reactive oxygen species (ROS) [64].
In addition to these metabolic events, there is also a hemodynamic component to diabetic kidney disease. Hyperglycemia impairs glomerular circulation, mainly dilation of the afferent arteriole, which subsequently leads to increased glomerular capillary pressure [67, 68].
The culmination of these hyperglycemia induced metabolic and hemodynamic derangements sets off a cascade of aberrant cell growth, angiogenesis, extracellular matrix abnormalities, hyalinization of arterioles, proteinuria, and hyperfiltration, ultimately resulting in diabetic kidney injury [64]. Type 2 diabetes is the most common cause of CKD among the US adult population and both DM and CKD can cause anemia.
The decreased oxygen carrying capacity associated with anemia may aggravate myocardial hypoxia, increase cardiac output, cause volume overload, increase heart rate, stimulate the RAAS, and can lead to left ventricular hypertrophy (LVH). The damage caused as a result produces myocyte loss, progressive fibrosis, coronary heart disease (CHD) and heart failure [32,33]. Type 2 diabetes increases the risk of CHD events by at least by two- to three fold compared with non-diabetics [31]. EpidemiologyGiven the constant influx of immigrants to the western world, addressing the medical issues facing minorities holds critical relevance. Approximately one third of American population currently identifies as minority, including Hispanics, African Americans, Asians, and Native Americans [35]. Between 2010 and 2050, this population is expected to grow geometrically, most markedly in the Asian and Hispanic American populations, which are both anticipated to double during this period [36].
Ethnic differences in CKDESRD is much more common among ethnic minorities with rates per million as high as 925 among blacks, 501 among Hispanics, and 465 among Native Americans compared with 276 among NHWs.
ESRD as caused by HTN, the second leading cause, is also much more common in minorities with a nearly 11 times greater prevalence among blacks than whites [48].
On top of that, in patients with ESRD, the prevalence of HTN is greater in both Hispanic and NHBs compared with NHWs.
Levels of C-reactive protein (CRP) and white blood cells are highest among blacks in this population, suggesting a role for inflammation in disease progression [49]. Elevated levels of CRP are associated with the development of Type 2 diabetes [50], an increased risk for coronary events [51] and symptomatic PAD [52] and may help to explain the increased prevalence of CKD in the black population.CKD puts patients at greater risk for MI, stroke and death, with approximately 6 million Americans suffering from both CVD and CKD. According to NHANES, the prevalence of CVD is 63 percent in those with CKD stages 3–5, compared with 5.8 percent in those without kidney disease [48]. The risk for these cardiovascular endpoints is even higher among African Americans with CKD.
Ethnic differences in diabetic CKDDM is significantly more prevalent among Non Hispanic Blacks (NHB) than among non-Hispanic whites (NHW). Because of the increased risk of Type 2 diabetes among blacks and among other ethnic minorities [38], the number of Americans with DM is expected to triple from 20 million [37] to more than 60 million over the next forty years [39]. Among those aged 30–39, the rate of ESRD in diabetics has risen by 69 percent between 2000 and 2010 whereas it has dropped by one percent in age matched whites. Similarly, Native Americans in this age group have seen an increase of ESRD by 30.1 percent during this period. This contrasts with rates of ESRD in diabetics older than sixty where ESRD has dropped more dramatically among ethnic minorities than among whites. Ethnic differences in CKD as one of diabetic CVD complicationsDM is also linked with a greatly increased risk of CVD. The rise in prevalence of both coronary heart disease (CHD) and peripheral arterial disease (PAD) ranges between double and quadruple the risk of the general population [40].
The risk of PAD increases by 28 percent with each one percent increase in glycosylated hemoglobin, a marker for blood glucose levels [41].Furthermore, NHBs are at significantly greater risk of both PAD and CVD than NHWs [39]. Based on the third National Health and Nutrition Examination Survey (NHANES III), 5 million US adults above age 40 have PAD. According to the NAACP, NHB males have a 30 percent greater chance of dying from heart disease than NHW males [44].The development and the worsening of CKD as a complication of diabetic CVD is the result of a number of interacting pathways. These include enhanced levels of oxidative stress, inflammation, endothelial dysfunction, and RAAS activation [48]. In addition, hypertriglyceridemia, associated with CVD, promotes lipid accumulation in renal cells and consequent dysfunction [49]. Furthermore, vascular calcification in CVD is commonplace among the renal vessels, fostering CKD progression [63]. Thus, ethnic minorities are more likely to develop these conditions both independently and as part of cardiorenal syndrome. Part of the racial discrepancy in CKD, diabetic CKD and the associated complications may be explained by an increase in metabolic risk factors among minorities. Based on a three-year, cross-sectional sample of 15,826 patients with Type 2 diabetes, both Hispanics and NHBs were found to have higher body mass index, HbA1c, and LDL values in comparison with NHWs. Moreover, ethnic minorities are both less physically active and have worse dietary behaviors compared to NHWs [46]. Minorities are also less likely to have health insurance coverage or to have a regular doctor [44].
As a result of the lower levels of glycemic control and the higher prevalence of both vascular disease and metabolic risk factors, rates of mortality from DM are persistently higher among NHBs than among NHWs [47].
The difference in the prevalence of cardiovascular disease in those with DM and CKD among different ethnicities is striking. As health disparities continue to grow, a closer investigation into the root of these ethnic differences will help clinicians to create a more targeted approach.3.
Therapeutic rationale Anemia is a risk factor for cardiovascular morbidity and mortality that is reversible [54]. There are currently two Food and Drug Administration (FDA) approved ESAs in the United States, Epoetin alfa (Epogen, Procrit) and Darbepoetin alfa (Aranesp). According to the Kidney Foundation Guidelines, all patients with CKD should be screened at least annually for anemia with a set of labs that include a complete blood count (CBC), a hemoglobin concentration (MCHC), iron studies, folate and Vitamin B12.
Patients found to be iron deficient need to be started on iron supplementation, especially hemodialysis patients who may lose up to 3-5g of iron per year. During this three year study complete correction of anemia did not affect the likelihood of a first cardiac death. The Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) trial in 2009 is randomized, double blind placebo controlled trial that was conducted to evaluate whether increasing the hemoglobin level with the use of darbepoetin would lower the rate of death, cardiovascular events or end stage renal disease in patients with type 2 diabetes and CKD. Darbepoetin did not reduce the primary endpoints of death, cardiovascular events or ESRD in patients with DM and CKD.
Their findings brought to light several important ways to improve CVD risk stratification [57]. A 2012 update to the National Kidney Foundation clinical practice guidelines for DM and CKD was recently published to address new evidence that has emerged since the release of the 2007 guidelines.
If the anemia is addressed in its early stages, the risk of complications can be significantly reduced, especially those related to cardiovascular morbidity and mortality among the diabetic population. In addition, appropriate and timely treatment can improve the quality of life for these patients. It is important that physicians screen patients who are at risk for developing anemia as per accepted guidelines.
This is especially important given that based on data collected from 1998-2008, NHANES found that the prevalence of DKD has steadily been increasing.
The latest United States Renal Data System (USRDS) reported a 30 percent increase in the incidence of ESRD in diabetics in the United States between 1992 and 2008 [59, 60].
These figures indicate that anemia as caused by CKD in diabetics is an ongoing and ever-increasing problem in which all of the risk factors involved need to be addressed as part of regular preventative health measures.
The risk of developing CVD is significantly increased in diabetics with CKD compared with non-diabetics with CKD.



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