RESUMEN
BACKGROUND: Renal anemia complicated with chronic kidney disease is usually treated with erythropoiesis-stimulating agents (ESAs). However, few studies have compared the early response of hemoglobin (Hb) to different kinds of ESAs. METHODS: The effects of three types of ESAs-epoetin alfa or beta (EPO), darbepoetin alfa (DPO), and epoetin beta pegol (EPObp)-on renal anemia were followed in 416 pre-dialysis chronic kidney disease (CKD) patients. After the initial 12-week administration of ESAs, ΔHb/ESA dose/kg was calculated as an index of efficacy of each ESA. Furthermore, independent variables associated with ΔHb/ESA dose/kg (dependent variable) were determined using multiple linear regression analysis. The ten independent variables selected for analysis were: presence of diabetic nephropathy, estimated glomerular filtration rate (eGFR), Hb, albumin, iron (Fe), transferrin saturation (TSAT), ferritin, phosphate (P), intact parathyroid hormone (iPTH), and C-reactive protein. RESULTS: The efficacy of DPO and EPObp were similar and higher than EPO. TSAT was most strongly correlated with ΔHb/EPO dose/kg in all three types of ESAs. Other significant independent factors were Hb, albumin, P, iPTH, and diabetic nephropathy in the EPO group, eGFR in the DPO group, and Fe in the EPObp group. The adjusted coefficient of determination (R (2)) ranged from 0.415 to 0.520 in the three ESA groups. CONCLUSIONS: The study results suggest that TSAT is the best predictor of the initial 12-week responsiveness to ESA, irrespective of the type. Variables not investigated in this study also affect responsiveness to ESA in Japanese pre-dialysis CKD patients.
Asunto(s)
Anemia/tratamiento farmacológico , Anemia/etiología , Eritropoyetina/uso terapéutico , Hematínicos/uso terapéutico , Insuficiencia Renal Crónica/complicaciones , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Almost all mammary lesions are detected by a mammography and an ultrasound. However, a small part of lesions cannot be shown by only a magnetic resonance imaging (MRI). MRI-guided vacuum-assisted breast biopsy is a very useful means for the pathological diagnosis of these lesions. We performed MRI-guided vacuum-assisted breast biopsy to 4 patients with the lesions seen only by MRI. Biopsies were safely and easily performed using biopsy software (syngo BreVis). These biopsied specimens resulted cancer in 1, adenoma in 1 and benign lesions in 2. With an increase of the opportunity of MRI for the mammary lesions, we expect these lesions become increasingly large. We believe that MRI-guided vacuum-assisted breast biopsy will be an important diagnostic modality.