Time to Reconsider Evidence for Anaemia Treatment (TREAT) = Essential Safety Arguments (ESA)

TREAT: A trial of darbepoietin alfa in type 2 diabetes and chronic kidney disease (ClinicalTrials.gov number NCT00093015), published recently by Marc Pfeffer and colleagues, may rank as one of the most important clinical trials in nephrology [1]. As well as being important, it was one of the largest, best conceived, designed, executed and expensive (a conservative estimate would be $300 000 000) trials in patients with chronic kidney disease. In this commentary, we will set out what we believe has now changed as a result of the TREAT and how we might have to adapt our thinking and our clinical practice in the future as a result. We believe that clinical nephrologists, anaemia coordinators, clinical practice and guideline setters, and patient registries, will need to re-address anaemia treatment paradigms and, in so doing, reappraise our clinical use of those expensive and powerful medications— erythropoiesis-stimulating agents (ESAs).