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"Latar belakang: Hipertensi pulmonal (HP) telah banyak dilaporkan terjadi pada populasi hemodialisis (HD). Namun data mengenai insidensi HP serta bagaimana mekanisme terjadinya masih sangat sedikit. Beberapa faktor risiko dan protektif terjadinya HP telah diidentifikasi melalui studi-studi di mancanegara. Penelitian ini bertujuan untuk mengevaluasi hubungan penggunaan penghambat kanal kalsium dengan kejadian hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialisis. Metode: Penelitian potong lintang dilakukan terhadap 100 pasien HD rutin di unit HD RSCM yang sedang mengkonsumsi penghambat kanal kalsium jenis dihidropiridin (nifedipin, amlodipin, felodidpin) 1x sehari per oral selama minimal 1 tahun. Hipertensi pulmonal dinilai dengan menggunakan ekokardiografi doppler yang dilakukan 1 jam pasca HD oleh satu orang operator independen yang tidak mengetahui latar belakang klinis pasien. Selanjutnya dilakukan analisis uji statistik chi square dengan batas kemaknaan < 0.05, serta analisis multivariat dengan regresi logistik antara variabel penghambat kanal kalsium dengan hipertensi pulmonal untuk mendapatkan Crude OR, antara variabel perancu dengan hipertensi pulmonal untuk mendapatkan nilai P < 0.25, dan antara variabel penghambat kanal kalsium dengan variabel perancu untuk mendapatkan fully adjusted OR. Hasil: Dari 100 subyek penelitian, HP didapatkan pada 27 subjek (27%). Pada kelompok pasien HP, 21 subjek (29.2%) memiliki akses fistula AV di brakial, TAP rata-rata 36 ± 20.6 mmHg, curah jantung ³ 5 l/min sebanyak 13 subjek (28.8%) dengan fraksi ejeksi ³ 50% sebanyak 18 subjek (20.7%). Etiologi PGK terbanyak pada kelompok HP adalah nefropati DM dengan 10 subjek (37%). Setelah dilakukan adjustment dengan disfungsi diastolik ventrikel kiri, fraksi ejeksi dan diabetes melitus sebagai faktor perancu, penggunaan penghambat kanal kalsium berhubungan dengan penurunan risiko terjadinya hipertensi pulmonal (adjusted OR 0.258; IK 95% 0.085 – 0.783; nilai P 0.017). Kesimpulan: Penggunaan penghambat kanal kalsium berhubungan dengan penurunan risiko terjadinya hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialis.

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Background and Aim of Study: Pulmonary hypertension (PH) has been reported in hemodialysis (HD) patients. However data regarding its incidence and mechanism are scarce. Many published journal abroad had been identify the risk and protective factors in this syndrome. This study evaluated the use of Calcium Channel Blocker (CCB) on Pulmonary Hypertension at End-Stage Renal Disease (ESRD) patients who undergo hemodialysis.

Methods: A Cross – Sectional study conducted on hundreds HD patients in RSCM who consumed CCB for at least a year with oral single dose. PH was screened by Doppler echocardiography one hour following dialysis done by one independent operator without knowing clinical background of the patients. Furthermore, statistical analysis was done using chi square and define as significance if the value is <0.05. Moreover, multivariate analysis with logistic regression between CCB and PH variable in order to get Crude OR, between confounder variables and PH in order to get P value < 0.25, and between CCB and confounder variables in order to get fully adjusted OR.

Results: Out of 100 HD patients, PH was detected in 27 patients (27%). Of those with PH, brachial AV shunt was seen in 21 patients (29.2%), mean PAP was 36 ± 20.6 mmHg, and cardiac output ³ 5 l/min was seen in 13 patients (28.8%) with EF ³ 50% seen in 18 patients (20.7%). The common etiology of CKD in group of PH was diabetic nephropathy seen in 10 patients (37%). The used of CCB is associated with lower risk of PH (adjusted OR 0.258; 95% CI 0.085 – 0.783; P value 0.017) after adjusted with variable left ventricular diastolic dysfunction, ejection fraction, and diabetes melitus as confounders.

Conclusion: This study demonstrates that the use of CCB is associated with lower risk of PH in ESRD patients with hemodialysis."

"Latar Belakang: Kadar asam urat darah berhubungan dengan peningkatan risiko penyakit kardiovaskular (PKV) serta meningkatkan angka kematian terutama pada populasi hemodialisis (HD) dan dialisis peritoneal (CAPD). Symmetric Dimethylarginine (SDMA) sudah sering dipakai dan diperiksa sebagai penanda PKV pada studi epidemiologi terutama pada populasi HD maupun CAPD. Pada populasi umum dewasa sehat dan HD, telah didapatkan adanya hubungan peningkatan kadar asam urat darah dengan peningkatan kadar SDMA. Namun pada populasi CAPD, peningkatan kadar asam urat darah terhadap peningkatan risiko yang terjadi masih menjadi kontroversi. Tujuan: Studi ini bertujuan untuk melihat hubungan antara kadar asam urat darah dengan kadar SDMA pada pasien penyakit ginjal kronik yang menjalani CAPD.Metode: Penelitian dengan desain potong lintang yang dikerjakan pada bulan Juni 2021 sampai bulan Agustus 2021 pada pasien CAPD kronik > 3 bulan. Subjek dengan obat penurun asam urat, wanita hamil dan menyusui, dan pasien dengan riwayat keganasan tidak diikutsertakan pada penelitian ini. Kadar asam urat dan SDMA diambil saat pasien kontrol ke poli CAPD. Analisis bivariat dilakukan dengan analisis Mann – Whitney dan analisis multivariat dengan regresi logistik.Hasil: Total 55 subjek diikutsertakan pada penelitian ini. Didapatkan rerata kadar asam urat7.30 +1.59 mg/dl dan sebanyak 33 subjek (60%) dengan kadar asam urat > 7 mg/dl. Rerata kadar SDMA didapatkan sebesar 633.73 +231.54 ng/mL. Subjek dengan kadar asam urat > 7 mg/dl memiliki peningkatan kadar SDMA secara signifikan bila dibandingkan pada kelompok asam urat <7 mg/dl (721.58 + 220.57 vs 501.95 +182; P < 0.001). Didapatkan cut – off SDMA 536 ng/ml berdasarkan kurva ROC dengan Sensitivitas 81.8%, Spesifisitas 63.6%, PPV 77.78% dan NPV 73.68%. Setelah dilakukan adjustifikasi terhadap faktor perancu didapatkan bahwa DM (OR: 7.844; CI95%: 1.899 – 32.395: P value: 0.004) dan dyslipidemia (OR: 6.440; CI95%: 1.483 – 27.970; P value: 0.013) sebagai faktor risiko.Simpulan: Terdapat hubungan kadar asam urat darah > 7 mg/dl dengan peningkatan kadar SDMA pada pasien yang menjalani CAPD. Diabetes melitus dan dyslipidemia merupakan faktor risiko yang berhubungan dengan peningkatan kadar asam urat dengan peningkatan kadar SDMA.

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Background and Objectives: Uric Acid (UA) levels are associated with increased risk of cardiovascular events and mortality in hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. Symmetric dimethylarginine (SDMA) is a known marker of cardiovascular disease in a number of epidemiological studies, including in the HD and CAPD patient population. In a study with a population of healthy young adults and HD there was a correlation between high blood uric acid levels and blood SDMA level. However, in CAPD population, there are still conflicting data on the mechanism of increased risks related to uric acid levels. This study aimed to assess the association between uric acid levels and SDMA in the subjects undergoing CAPD.

Materials and Methods: This was a cross – sectional study conducted in all the adults who underwent CAPD for at least three months in tertiary hospital in Jakarta, Indonesia. Subjects already on uric lowering therapy, pregnant or lactating women, and those with a history of malignancy were excluded. Uric acid and SDMA level were measured at the same time patients controlled to outpatient clinic. Bivariate analysis was performed using the Mann – Whitney test and multivariate analysis performed using logistic regression test.

Results: A total of 55 subjects were included. The median level of UA was 7.30 +1.59 mg/dl and 33 subjects (60%) had UA levels of 7 mg/dl or higher. The median SDMA level was 633.73 +231.54 ng/mL. Subjects with UA levels > 7 mg/dl had significantly higher SDMA levels compared to subjects with UA levels <7 mg/dl (721.58 +220.57 vs 501.95 +182; P < 0.001). The cut – off value of SDMA 536 ng/mL was obtained from the receiver operating characteristic (ROC) curve with sensitivity 81.8%, specificity 63.6%, PPV 77.78% and NPV 73.68%. After fully adjusted with the confounders, the determinant factors in this study were diabetes mellitus (OR: 7.844; CI95%: 1.899 – 32.395: P value: 0.004) and dyslipidemia (OR: 6.440; CI95%: 1.483 – 27.970; P value: 0.013) as risk factors.

Conclusion: In CAPD patients, UA levels above 7 mg/dl were associated with increased SDMA levels. This study demonstrates the determinant factors regarding association between UA level and SDMA in CAPD patients were diabetes mellitus and dyslipidemia. The cut – off value of SDMA above 536 ng/mL were significant to increased risk of cardiovascular events."