Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar Belakang: Penyakit ginjal kronik (PGK) dilaporkan berhubungan dengan peningkatan risiko kejadian ulkus pedis dan amputasi pada diabetes melitus (DM). Namun, data mengenai hal tersebut masih terbatas termasuk di Indonesia. Tujuan penelitian ini adalah untuk mengetahui pengaruh PGK terhadap kejadian ulkus pedis dan amputasi ekstremitas bawah dalam 3 tahun. Metode: Penelitian ini merupakan studi kohort retrospektif pada DM berusia >18 tahun dengan menggunakan data sekunder di RSUP Fatmawati pada periode Januari – Desember 2016. Kesintasan terhadap ulkus pedis dan amputasi ekstremitas bawah berdasarkan LFG dihitung dan dianalisis melalui kurva Kaplan Meier. Adjusted hazard ratio (aHR) dinilai dengan menggunakan analisis multivariate Cox proportional hazards. Hasil: Dari 204 subjek penelitian, 108 orang (52,9%) memiliki LFG > 60, 54 orang (26,5%) memiliki LFG 30-59, dan 42 orang (20,6%) memiliki LFG <30 ml/menit/1,73 m2. Kesintasan ulkus pedis dalam 3 tahun adalah 75,7% untuk LFG <30; 86,4% untuk LFG 30-59; dan 94,1% untuk LFG > 60 ml/menit/1,73 m2. Laju insidens ulkus pedis per 1000 orang per bulan adalah 7,98 untuk LFG <30; 4,08 untuk LFG 30-59; dan 1,61 untuk LFG >60 ml/menit/1,73m2. Pasien dengan LFG 30-59 dan LFG <30 ml/menit/1,73 m2 memiliki adjusted HR 1,36 (IK 95% 0,39-4,66) dan 4,39 (IK 95% 1,18-16,4) terhadap ulkus pedis dibandingkan dengan LFG > 60 ml/menit/1,73 m2. Tidak dilakukan analisis lebih lanjut pada luaran amputasi ekstremitas bawah karena tidak ada pasien yang mengalami luaran pada kelompok LFG >60 ml/menit/1,73 m2 Kesimpulan: PGK mempengaruhi kejadian ulkus pedis dalam 3 tahun pada pasien DM dan risiko ulkus pedis dalam 3 tahun semakin meningkat seiring dengan semakin berat derajat PGK. Pengaruh PGK terhadap kejadian amputasi ekstremitas bawah masih belum dapat disimpulkan pada penelitian ini. ......Background: Chronic kidney disease (CKD) has been reported associated with poor prognoses in foot ulcers and lower extremity amputation (LEA) in patients with diabetes melitus (DM). However, the study is still limited and never been done in Indonesia. The objective of this study is to evaluate the impact of CKD on foot ulcers and LEA in patients with diabetes. Methods: This was a retrospective cohort study in Internal Medicine out-patient clinic in Fatmawati General Hospital. All subjects were enrolled between January-December 2016 who had history of DM, age >18 years old and had a history of DM. Foot ulcer-free and amputation-free survival for estimated glomerular filtration rate (eGFR) >60, 30-59, and <30 ml/min/1,73 m2 were calculated and analyzed by Kaplan-Meier curves. Adjusted hazard ratio (HR) was analalyzed using multivariate Cox proportional hazards. multivariate model. Results: A total of 204 individuals were included: 108 (52,9%) in eGFR >60, 54 in eGFR 30-59, and 42 in eGFR <30 ml/min/1,73 m2. Foot ulcer free survival for patient with eGFR <30, 30-59, >60 ml/min/1.73 m2 were 75,7%; 86,4%; and 94,1% respectively. Unadjusted foot ulcer incidence rates per 1000 patients per month were 7,98 for eGFR <30; 4,08 for eGFR 30-59; and 1,61 for eGFR >60 ml/menit/1.73m2. For the development of foot ulcer compared with eGFR > 60 ml/min/ 1.73 m2, adjusted HR for patient with eGFR 30-59 ml/min/1.73 m2 was 1,36 (CI 95% 0,39-4,66) and for eGFR < 30 ml/min/1.73 m2 was 4,39 (CI 95% 1,18-16,4). HR for LEA could not be analyzed because there were no patient who had been amputated after 3 years follow up in group eGFR >60 ml/min/1.73 m2. Conclusion: CKD increased the risk of foot ulcer in 3 years among DM patients. The risk was increased concomitant with the severity of CKD. The impact of CKD on LEA could not be concluded in this study.

Abstrak :
Komplikasi penyakit ginjal pada pasien diabetes melitus ditandai oleh eksresi albumin secara progresif melalui urin dan penurunan laju filtrasi glomerulus. Komplikasi tersebut dapat dicegah atau diperlambat progresivitasnya dengan pemberian terapi antidiabetes. Metformin dan kombinasi metformin-sulfonilurea adalah antidiabetes yang sering diberikan kepada pasien diabetes melitus tipe 2, terutama di puskesmas. Penelitian ini bertujuan membandingkan urine albumine-to-creatinine ratio UACR dan estimation of glomerular filtration rate eGFR sebagai parameter fungsi ginjal antara dua kelompok pengobatan pada pasien diabetes melitus tipe 2. Desain penelitian yang digunakan adalah potong lintang dengan tehnik consecutive sampling. Sebanyak 88 sampel pasien diabetes melitus tipe 2 yang menggunakan metformin n=37 atau kombinasi metformin-sulfonilurea n=51 minimal selama satu tahun berpuasa selama 8 jam sebelum pengambilan urin dan darah untuk analisis UACR dan eGFR. Nilai UACR diperoleh dari perbandingan kadar albumin urin dengan kreatinin urin. Nilai eGFR diperoleh dengan menggunakan persamaan The Chronic Kidney Disease Epidemiology Collaboration CKD-EPI. Kreatinin serum dan kreatinin urin diukur secara kolorimetri enzimatik sedangkan albumin urin diukur secara imunoturbidimetri. Hasil menunjukan bahwa rata-rata nilai eGFR kelompok metformin dan kelompok kombinasi metformin-sulfonilurea berada pada kategori yang sama yaitu 60-89 mL/menit/1,73 m2 meskipun rata-rata nilai eGFR pada kelompok metformin lebih rendah daripada kelompok kombinasi metformin-sulfonilurea. Nilai UACR pada kelompok metformin lebih rendah daripada kelompok kombinasi metformin-sulfonilurea tetapi tidak menunjukan adanya perbedaan bermakna p>0,05. ...... Complication of renal disease in diabetes melitus patient is characterized by progressive urinary albumin excretion and decreased glomerular filtration. The complication could be prevented or slowed down by theraphy antidiabetic. Metformin and sulphonylurea is the most comonly drugs prescribed as antidiabetic theraphy especially at public health centre. This study aimed to comparing urine albumin to creatinine ratio UACR and estimation of glomerular filtration rate eGFR as paramter of renal function between two type of theraphy on diabetes mellitus type 2 patient Design of this study was cross sectional and consecutive sampling method. A total of 88 samples of diabetes mellitus type 2 patient who was enrolled had taken metformin n 37 or combination of metformin sulphonylurea n 51 for at least one year fasted for 8 hours prior to urine and blood collection for UACR and eGFR analysis. UACR value was obtained from comparison of urine albumin with urine creatinine concentration. The value of eGFR was obtained using The Chronic Kidney Disease Epidemiology Collaboration CKD EPI equation. Serum creatinine and urine creatinine was measured by colorimetric enzymatic assay meanwhile urine albumin was measured by immunoturbidimetry. The result showed the average eGFR value in two groups were in the same category 60 89 mL menit 1,73 m2 although eGFR value average in metformin group lower than combination metformin sulphonylurea group. UACR in metformin group was lower than combination metformin sulphonylurea group but didn rsquo t show a significant different p 0,05.

Abstrak :
Latar Belakang: Gagal jantung merupakan salah satu penyebab kematian utama di Indonesia. Jantung dan ginjal berhubungan dengan erat yang dapat dijelaskan oleh sindrom kardiorenal. Saat ini, ada kekurangan data di rumah sakit tersier di Indonesia mengenai hubungan Ejection Fraction (EF) dengan fungsi ginjal. Metode: Penelitian ini merupakan penelitian cross-sectional yang mengikutsertakan pasien gagal jantung di RSUP Dr. Cipto Mangunkusomo tahun 2018 – 2020 sebagai populasi sasaran. Uji Chi-squared digunakan untuk menganalisis korelasi antar variabel. Izin etik diperoleh karena penelitian ini menggunakan manusia sebagai subjeknya. Hasil: Sebanyak 158 subjek diikutsertakan dalam penelitian ini setelah menerapkan kriteria inklusi dan eksklusi. Terdapat 37 (36,6%) pasien HF pada kelompok HFrEF yang memiliki eGFR stadium 3, 4, atau 5. Sedangkan di kelompok HFmrEF atau HFpEF, terdapat 29 (50,9%) dengan eGFR stadium 3, 4 , atau 5 (p-value = 0,115, RR = 0,72). Pasien gagal jantung dengan eGFR stadium 3, 4, atau 5 (n = 8;12,1%) dan eGFR stadium 1 atau 2 (n = 4; 4,3%) termasuk dalam kelompok NYHA kelas III atau IV (p-value = 0,125, RR = 2,79). Kesimpulan: Tidak ada perbedaan proporsi pasien HFrEF dengan HFpEF untuk memiliki eGFR stadium 3, 4, atau 5 serta proporsi pasien HF yang eGFR stadium 3,4 atau 5 dengan eGFR stadium 1 atau 2 untuk dimasukkan pada kelompok NYHA kelas III atau IV. ......Background: Heart failure is considered one of leading cause of death In Indonesia. The heart and kidneys are tightly related which can be explained by the cardiorenal syndrome. There is a paucity of current data in a tertiary hospital in Indonesia regarding the association of Ejection Fraction (EF) with kidney function. Method: This is a cross-sectional study that includes heart failure patients in Dr. Cipto Mangunkusomo Hospital year 2018 – 2020 as the target population. The Chi-squared test is used to analyse the association between the variables. Ethical permission was obtained since this research used humans as the subject. Results: A total of 158 subjects were included in this study after applying the inclusion and exclusion criteria. There were 37 (36,6%) HF patients in the HFrEF group had eGFR stage 3, 4, or 5. Meanwhile, among HFmreEF or HFpEF group, there were 29 (50,9%) with eGFR stage 3, 4, or 5 (p-value = 0,115, RR = 0,72). HF patients in both eGFR stage 3, 4, or 5 (n = 8;12,1%) and eGFR stage 1 or 2 (n = 4; 4,3%) were included in the NYHA class III or IV group (p-value = 0,125, RR = 2,79). Conclusion: There are no differences in the proportion of HFrEF patients with HFpEF to have eGFR stage 3, 4, or 5 as well as in the proportion of HF patients whose eGFR stages 3,4 or 5 with eGFR stages 1 or 2 to be included in the NYHA class III or IV group.

Abstrak :
Latar belakang: Dislipidemia merupakan keadaan kadar profil lipid tidak dalam rentang optimal yang saat ini banyak ditemukan pada masyarakat di Indonesia. Dislipidemia dipengaruhi oleh faktor genetik, pola hidup, atau penyakit lain yang sudah ada. Status sosioekonomi juga dapat mempengaruhi kesadaran dalam mengontrol dislipidemia. Hal ini dapat ditemukan pada masyarakat kampung kota yang cenderung rendah pengetahuan dan kesadarannya akan dislipidemia. Dislipidemia yang tidak ditangani berpotensi mengakibatkan kerusakan ginjal, sebagaimana yang disebutkan beberapa studi terdahulu bahwa adanya hubungan dislipidemia dengan penurunan fungsi ginjal. Oleh karena itu, penelitian ini dilakukan dengan tujuan meneliti hubungan dislipidemia dengan penanda fungsi ginjal subjek dewasa yang tinggal di kawasan kampung kota Jakarta dan Tangerang. Metode: Studi dilakukan dengan metode potong lintang pada subjek dewasa yang tinggal di kawasan kampung kota Jakarta dan Tangerang. Studi menggunakan data sekunder yang diambil pada September 2019-Maret 2020. Data subjek diseleksi berdasarkan kriteria inklusi dan eksklusi yang telah ditentukan. Hasil: Dari 215 subjek yang dianalisis, didapatkan peningkatan kolesterol total sebanyak 43,7%; peningkatan trigliserida (TG) sebanyak 28,4%; penurunan high-density lipoproteins (HDL) sebanyak 15,3%; peningkatan low-density lipoproteins (LDL) sebanyak 64,7%; dan penurunan estimated glomerular filtration rate (eGFR) sebanyak 4,7% subjek. Hasil analisis menggunakan uji Fisher menemukan adanya hubungan antara peningkatan kolesterol total dengan penurunan eGFR (p=0,023). Kesimpulan: Terdapat hubungan antara dislipidemia berdasarkan peningkatan kolesterol total dan penurunan fungsi ginjal pada masyarakat yang tinggal di kampung kota Jakarta dan Tangerang, sedangkan TG, HDL, dan LDL tidak berhubungan dengan penurunan fungsi ginjal. ......Introduction: Dyslipidemia is the state of the lipid profile that is not in the optimal range which is currently found in many people in Indonesia. Dyslipidemia is affected by genetics, lifestyle, or certain comorbidities. Low socioeconomic status also could influence awareness in controlling dyslipidemia. It could be found in kampung kota people which have relatively low knowledge and awareness of dyslipidemia. Untreated dyslipidemia could potentially causes kidney damage, as mentioned by previous studies that dyslipidemia is correlated with decreased kidney function. Therefore, this research is conducted to examine the relationship between dyslipidemia and kidney function markers in adults who live in kampung kota in Jakarta and Tangerang. Method: This study use cross-sectional design on adult subjects who live in kampung kota in Jakarta and Tangerang. This study used secondary data taken in September 2019-March 2020. Subjects’ data were selected based on defined inclusion and exclusion criteria. Result: From the 215 subjects analyzed, there were found increased total cholesterol in 43.7%; increased triglycerides (TG) in 28.4%; decreased high-density lipoproteins (HDL) in 15.3%; increased low-density lipoproteins (LDL) in 64.7%; and decreased estimated glomerular filtration rate (eGFR) in 4.7% subjects. Analysis using Fisher’s test found an association between increased total cholesterol and decreased eGFR (p=0.023). Conclusion: There is an association between dyslipidemia, based on increased total cholesterol, and decreased kidney function in people who live in kampung kota in Jakarta and Tangerang, meanwhile TG, HDL, and LDL are not associated with decreased kidney function.

Abstrak :
Renal dysfunction which frequently occurs in type 2 diabetes mellitus patients caused by oxidative stress. The effectiveness of the type 2 diabetes mellitus treatment to renal dysfunction is unknown. This study compare and analyze the correlation between urinary hydrogen peroxide which is a product of oxidative stress and estimated glomerular filtration rate (eGFR) in the treatment groups of sulfonylurea and combination biguanide-sulfonylurea. This study used a retrospective cohort study design with 50 sampels that was taken in Dr. Sitanala Tangerang hospital with total sampling technique. Estimated GFR value obtained based on serum creatinine values were measured using a kinetic Jaffe method, while the urinary hydrogen peroxide using FOX 1 (Ferrous ion Oxidation Xylenol Orange1). Value of urinary hydrogen peroxide in the two treatment groups did not have significant difference (p = 0.69), while the eGFR value of two groups did not have significant differences with the Cockroft Gault is p = 0.884; MDRD p = 0.886; and CKDEPI p = 0.490. Correlation analysis of urinary hydrogen peroxide and eGFR based on the MDRD equation and CKDEPI generate significant positive correlation (r = 0.326; p = 0.021) and (r = 0.282; p = 0.047). There is no antioxidant activity in the treatment groups. Urinary hydrogen peroxide may play a role in the pathophysiologic significance of diabetic nephropathy.

Abstrak :
Gangguan fungsi ginjal merupakan salah satu komplikasi yang sering terjadi pada pasien diabetes melitus tipe 2. Pendeteksian dini dengan menggunakan senyawa 8-iso-Prostaglandin F2α dan KIM-1 diperlukan untuk mencegah progresifitasnya. Dalam penelitian ini dilakukan analisis hubungan antara kadar 8-iso-Prostaglandin F2α dan KIM-1 urin dengan estimasi laju filtrasi glomerulus (eLFG). Sampel yang dianalisis adalah 40 orang pasien diabetes melitus tipe 2 di Puskesmas Pasar Minggu, dengan teknik total sampling. Nilai eLFG diperoleh berdasarkan nilai kreatinin serum yang diukur menggunakan metode kinetik Jaffe, sedangkan kadar 8-iso-Prostaglandin F2α dan KIM-1 diukur dengan menggunakan metode ELISA (Enzyme Linked Immunosorbent Assay). Kadar 8-iso-Prostaglandin F2α diperoleh 6633,87 ± 1292,62 pg/mg kreatinin, kadar KIM-1 diperoleh 8,23 ± 3,23 ng/mL dan nilai eLFG diperoleh 99,65 ± 41,12 (Cockroft-Gault); 96,59 ± 41,90 (MDRD study); dan 100,79 ± 40,07 (CKD-EPI). Hubungan antara kadar 8-iso-Prostaglandin F2α dengan nilai eLFG berdasarkan persamaan Cockroft-Gault (r = 0,520; p = 0,001), MDRD (r = 0,477; p = 0,004) dan CKD-EPI (r = 0,403; p = 0,013), serta setelah perokok dieksklusi, berdasarkan ketiga persamaan, yaitu Cockroft-Gault (r = 0,595; p = 0,001), MDRD (r = 0,554; p = 0,003) dan CKD-EPI (r = 0,559; p = 0,003). Hubungan antara kadar KIM-1 dengan nilai eLFG berdasarkan persamaan Cockroft-Gault (r = -0,155; p = 0,339), MDRD (r = -0,173; p =0,285) dan CKD-EPI (r = -0,024; p = 0,883). Sehingga diketahui terdapat hubungan yang bermakna antara kadar 8-iso-Prostaglandin F2α dengan nilai eLFG dan tidak terdapat hubungan yang bermakna antara KIM-1 dengan nilai eLFG.

---

Renal dysfunction is one of complication that most common in type 2 diabetes mellitus patients. The earlier detection is needed to prevent its progression with 8-iso-Prostaglandin F2α and KIM-1. The aim of this study was to analyze concentration of 8-iso-Prostaglandin F2α and KIM-1urine and its correlation with estimated glomerular filtration rate (eGFR). Samples analyzed were 40 type 2 diabetes mellitus patients at Pasar Minggu Local Government Clinic, used total sampling method. eGFR was obtained based on the measurement of serum creatinine on kinetic Jaffe method, 8-iso-Prostaglandin F2α and KIM-1 was measured by ELISA (Enzyme Linked Immunosorbent Assay) method. Concentration of 8-iso-Prostaglandin F2α was 6633,87 ± 1292,62 pg/mg creatinine, concentration of KIM-1 was 8,23 ± 3,23 ng/mL and the eGFR values were 99,65 ± 41,12 (Cockroft-Gault); 96,59 ± 41,90 (MDRD study); and 100,79 ± 40,07 (CKD-EPI). The correlation between 8-iso-Prostaglandin F2α concentration and eGFR is based on Cockroft-Gault (r = 0,520; p = 0,001), MDRD (r = 0,477; p = 0,004) and CKD-EPI (r = 0,403; p = 0,013), and the correlation between 8-iso-Prostaglandin F2α concentration after smoker exclution and eGFR based on Cockroft-Gault (r = 0,595; p = 0,001), MDRD (r = 0,554; p = 0,003) and CKD-EPI (r = 0,559; p = 0,003). But the correlation between KIM-1 concentration and eGFR based on Cockroft-Gault (r = -0,155; p = 0,339), MDRD (r = -0,173; p =0,285) and CKD-EPI (r = -0,024; p = 0,883). So there was a significant correlation between 8-iso-Prostaglandin F2α concentration and eGFR, and also there were no significant correlation between KIM-1 concentration and eGFR.

Abstrak :
[ABSTRAK Gangguan fungsi ginjal yang sering terjadi pada pasien diabetes melitus tipe 2 diperankan oleh stres oksidatif. Belum diketahui efektivitas pengobatan diabetes melitus tipe 2 terhadap gangguan fungsi ginjal. Penelitian ini membandingkan dan menganalisis hubungan hidrogen peroksida urin yang merupakan produk stress oksidatif dan estimasi Laju Filtrasi Glomerulus (eLFG) pada kelompok pengobatan sulfonilurea dan kombinasi biguanid-sulfonilurea. Penelitian ini menggunakan desain penelitian kohort retrospektif dengan jumlah sampel 50 orang yang diambil di RSK Dr. Sitanala Tangerang dengan teknik total sampling. Nilai eLFG diperoleh berdasarkan nilai kreatinin serum yang diukur menggunakan metode kinetik Jaffe, sedangkan hidrogen peroksida urin menggunakan metode FOX (Ferrous ion Oxidation Xylenol Orange) 1. Nilai hidrogen peroksida urin pada dua kelompok pengobatan tidak memiliki perbedaan yang bermakna (p = 0,69). Sedangkan nilai eLFG pada dua kelompok juga tidak memiliki memiliki perbedaan yang bermakna dengan Cockroft Gault adalah p = 0,884; MDRD p = 0,886; dan CKDEP p= 0,490. Analisis hubungan hidrogen peroksida urin dengan eLFG berdasarkan persamaan MDRD dan CKDEPI menghasilkan hubungan positif bermakna (r = 0,326; p = 0,021) dan (r = 0,282; p = 0,047).

---

ABSTRACT , Renal dysfunction which frequently occurs in type 2 diabetes mellitus patients caused by oxidative stress. The effectiveness of the type 2 diabetes mellitus treatment to renal dysfunction is unknown. This study compare and analyze the correlation between urinary hydrogen peroxide which is a product of oxidative stress and estimated glomerular filtration rate (eGFR) in the treatment groups of sulfonylurea and combination biguanide-sulfonylurea. This study used a retrospective cohort study design with 50 sampels that was taken in Dr. Sitanala Tangerang hospital with total sampling technique. Estimated GFR value obtained based on serum creatinine values were measured using a kinetic Jaffe method, while the urinary hydrogen peroxide using FOX (Ferrous ion Oxidation Xylenol Orange) 1. Value of urinary hydrogen peroxide in the two treatment groups did not have significant difference (p = 0.69) , While the value eGFR the two groups did not have significant differences with the Cockroft Gault is p = 0.884; MDRD p = 0.886; and CKDEP p = 0.490. Analysis of urinary hydrogen peroxide and eGFR based on the MDRD equation and CKDEPI generate significant positive correlation (r = 0.326; p = 0.021) and (r = 0.282; p = 0.047). ]