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"Hipertensi adalah salah satu penyakit sistim kardiovaskuler dengan prevalensi tinggi di masyarakat dan dapat menimbulkan berbagai gangguan organ vital tubuh dengan akibat kelemahan fungsi organ, cacat maupun kematian. Banyak faktor yang mempengaruhi hipertensi tidak terkendali, namun demikian faktor mana yang paling dominan, berapa besar hubungannya belum terungkap sepenuhnya. Hal ini akan diungkapkan pada penelitian ini dengan menggunakan jenis disain kasus kontrol dimana kasus dan kontrol diambil dari pengunjung poliklinik Ginjal - Hipertensi RSUPNCM dengan besar sampel 200 untuk kasus dan 200 untuk kontrol. Sebelum dilakukan analisis ditentukan terlebih dahulu " Cut off Point " dari variabel independen. Pada analisis bivariat ternyata variabel yang menunjukkan hubungan bermakna dengan hipertensi tidak terkendali (HTT) adalah lntensitas Terapi (IT), usia dan Body Mass Index (BMI), sedangkan variabel yang menunjukkan hubungan tidak bermakna yaitu merokok dan jenis kelamin, selanjutnya dilakukan analisis multivariat untuk menentukan model, temyata variabel yang dapat dimasukkan kedalam model adalah IT, usia dan BMI. Untuk mengurangi risiko HTT, penderita hipertensi sebaiknya menjalani terapi nonfarmakologi (penurunan berat badan bila obesitas, latihan fisik secara teratur, mengurangi makan garam menjadi < 2,3 g Natrium atau < 6 g NaCL sehari, makan Ca, K dan Mg yang cukup dan diet, membatasi asupan alkohol , kafein, kopi, teh, berhenti merokok) dan terapi farmakologi dengan sebaik mungkin.

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Hypertension is a cardiovascular disease with high prevalence in the society. The disease is able to distress vital organ function even worst death. There are two kinds of hypertension; control and uncontrolled.

Uncontrolled hypertension is influenced by many factors but the significant factors and their relationship can't be determined yet. Through this research. I would try to reveal the significant factors and their relationship. The research is used the control case design with 400 sample; case and control are taken from the visitors at the Polyclinic Ginjal-Hipertensi Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo.

Cut off point is determined from independent variables before we do analysis. Based on bivariat analysis, Define Daily Doses (DDD), age, and Body Mass Index (BMI) are significant variables for uncontrolled hypertension. On the other hand, gender and smoking are insignificant variables. Furthermore, model is determined by doing multivariate analysis. DDD, age, and BMI are variables that in fact can be input to the model.

To reduce the risk of uncontrolled hypertension, nonpharmacology and pharmacology should be treated to patients simultaneously."

"Telah dilakukan penelitian secara before and after terhadap pasien HD kronik antara bulan Mei 1997 - Juli 1997 di Subbagian Ginjal Hipertensi, SMF llmu Penyakit Dalam FKUI / RSUPN Dr.Cipto Mangunkusumo. Penelitian ini bertujuan untuk mengetahui perubahan sistem koagulasi akibat hemodialisis. Setelah melalui proses eksklusi terhadap faktor-faktor yang dapat mempengaruhi sistem koagulasi, diteliti 30 subyek yang terdiri dari 20 laki-laki (66,6%) dan 10 perempuan (33,3%). Umur termuda 13 tahun dan tertua 71 tahun dengan rerata 45,5; 13,5 tahun.

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A before and after study has been conducted on chronic HD patients between May 1997 - July 1997 in the Hypertension Kidney Subdivision, SMF llmu Internal Medicine FKUI / Dr.Cipto Mangunkusumo Hospital. This study aims to determine the changes in the coagulation system as a result of hemodialysis. After going through the process of exclusion of factors that can affect the coagulation system, 30 subjects consisting of 20 male (66.6%) and 10 female (33.3%). The youngest age is 13 years old and the oldest is 71 years old with an average of 45.5; 13.5 years."

"Latar belakang. Penyakit Ginjal Kronik (PGK) stadium 3 merupakan faktor risiko tinggi terjadi Nefropati Akibat Kontras (NAK) setelah Percutaneous Coronary Intervention (PCI). Hidrasi merupakan salah satu modalitas mencegah NAK, demikian juga N-Acetyl Cysteine (NAC) walaupun efek proteksinya terhadap NAK masih kontroversial.Tujuan. Mengetahui apakah kombinasi hidrasi dan NAC dapat menurunkan risiko NAK pada pasien PGK stadium 3 setelah PCI pada pasien Pelayanan Jantung Terpadu (PJT) RSCM.Methoda penelitian. Studi kohort prospektif mengukur kreatinin plasma sebelum dan 48 jam sesudah PCI, sambil mencatat ada atau tidaknya perlakuan pemberian kombinasi hidrasi dan NAC pada pasien PGK stadium 3 tersebut.Hasil. Terdapat 38 pasien yang memenuhi kriteria penerimaan dan tidak mencakup kriteria penolakan serta menuntaskan penelitian dalam kurun waktu Agustus 2013 ? Januari 2014. Dua puluh tiga (43,4%) dari total 53 pasien PGK stadium 3 yang awalnya masuk studi ini diberikan perlakuan hidrasi dan NAC dan sisanya tidak mendapat perlakuan tersebut. Insidens kejadian NAK terdapat pada 2 dari 38 pasien yang menuntaskan studi (5.26%) yaitu pada kelompok yang tidak mendapat hidrasi dan NAC. Attributable Risk% sebesar 100%, kejadian NAK dapat dihilangkan 100% apabila diberikan hidrasi dan NAC.Simpulan. Kombinasi hidrasi dan NAC cenderung memproteksi kejadian NAKpada populasi PGK stadium 3 yang menjalani PCI

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Background. Stage 3 Chronic Kidney Disease (CKD) is known as a high risk factor for Contrast Induced Nephropathy (CIN) after Percutaneous Coronary Intervention (PCI). Hydration is a modality which is widely used to prevent CIN, and so is N-Acetyl Cysteine (NAC) eventhough there are controversial issues regarding their effectiveness to prevent CIN.

Aim. To know whether hydration and NAC combined has an effect of lowering CIN incidence in stage 3 CKD patients after PCI in Integrated Cardiac Services (ICS) in Cipto Mangunkusumo Hospital.

Methods. A prospective cohort is conducted examining plasma creatinine before and 48 hours after PCI in stage 3 CKD patients, meanwhile recording which patients are given combined hydration and NAC and which are not.

Results. Total 38 patients were collected whom fulfill the inclusion criteria and not meet the exclusion criteria and finished the study, from August 2013 until January 2014. Twenty-three (43,4%) of total 53 patients with stage 3 CKD whom enter the study at first were given hydration and NAC, and the did not received the combination. Incidence of CIN occurred in 2 of 38 patients whom finished this study (5.26%), all belonging to the non-hydration and NAC group. Attributable Risk% is 100%, means CIN can be 100% prevented if hydration and NAC is given.

Conclusion. Combination of Hydration and NAC is indicated to be protective against the risk of CIN in stage 3 CKD patients undergoing PCI."

"Latar belakang: Transplantasi ginjal dapat memperbaiki fungsi endotel. Berbagai penelitian membuktikan bahwa peningkatan kadar eritropoietin (Epo) dapat mengaktifasi dan memobilisasi Endothelial Progenitor Cell (EPC) sehingga mampu memperbaiki fungsi endotel melalui proses angiogenesis dan neovaskularisasi. Membaiknya fungsi endotel akan menurunkan angka kesakitan dan kematian akibat penyakit kardiovaskular pada penderita PGK. Tujuan: Untuk mengetahui hubungan peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel pada penderita gagal ginjal 3 bulan setelah transplantasi ginjal. Metode Penelitian: Potong lintang sebelum dengan 3 bulan setelah transplantasi ginjal pada penderita gagal ginjal yang menjalani transplantasi ginjal di RSCM. Jumlah subyek 21 orang yang dikumpulkan dalam kurun waktu Juli 2013 - Februari 2014. Pengambilan sampel darah untuk memeriksa kadar Epo, jumlah EPC CD34+ dan CD133+ dan kadar asimetrik dimetilarginin (ADMA) dilakukan sebelum dan 3 bulan setelah transplantasi ginjal. Analisis statistik dengan uji korelasi Pearson atau Spearman. Hasil: Penelitian ini menunjukkan adanya peningkatan kadar Epo tetapi tidak bermakna secara statistik (p>0.05), sedangkan jumlah EPC CD34+ dan CD133+ meningkat (p<0.05), serta kadar ADMA menurun yang bermakna secara statistik (p<0.05). Tiga bulan setelah transplantasi ada korelasi bermakna antara peningkatan kadar Epo dengan jumlah EPC CD34+ (r = 0.466 ; p < 0.05). Tidak ada hubungan peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel 3 bulan setelah transplantasi ginjal. Kesimpulan: Tiga bulan setelah transplantasi ginjal didapatkan adanya peningkatan kadar Epo, jumlah EPC CD34+ dan CD133+ serta penurunan kadar ADMA. Tetapi tidak ada korelasi peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel dalam rentang 3 bulan setelah transplantasi ginjal.

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Background: Kidney transplantation improved endothelial function. Various studies have shown that elevated level of erythropoietin (Epo) could activate and mobilize Endothelial Progenitor Cell (EPC), thus would improve endothelial function through the process of angiogenesis and neovascularization. The improvement of endothelial function will decrease morbidity and mortality from cardiovascular disease in patients with CKD.

Aim: To determine association between elevated level of Epo and the numbers of EPC CD34+ - CD133+ with the improvement of endothelial function in patients three months after kidney transplantation.

Methods: cross sectional study prior and 3 months after kidney transplantation in patients with renal failure who underwent kidney transplantation in RSCM. The study included 21 subjects who enrolled from July 2013 to February 2014. Blood samples prior and 3 months after kidney transplantation were collected to evaluate the level of Epo, numbers of EPC CD34+ and CD133+ and level of assymetric dimethylarginine (ADMA). Statistical analysis was performed using Pearson or Spearman correlation test.

Resulys: The results of the study showed that prior to kidney transplantation, level of Epo was increased but not statistically significant (p>0.05). The EPC numbers of CD34+ and CD133+ were significantly increased (p<0.05), whereas the ADMA level was significantly decreased (p<0.05). Three months after transplantation showed a significant association between elevated level of Epo and the numbers of EPC CD34+ (r = 0.466, p > 0.05). There was no association between the elevated level of Epo and the numbers of EPC CD34+ and CD133+ with the improvement of endothelial function three months after kidney transplantation.

Conclusion: Three months after kidney transplantation showed an elevated level of Epo, the numbers of EPC CD34+ and CD133+ and the decreased level of ADMA. However, there was no association between the elevated level of Epo and the numbers of EPC CD34+ and CD133+ with the improvement of endothelial function in patients 3 months after kidney transplantation."

"Latar Belakang: Reaktivasi CMV pasca transplantasi ginjal 3 bulan pertama 40-80% dan 20-50% menjadi penyakit CMV. Pencegahan pasca transplantasi dapat dilakukan dengan terapi preemptive saat terjadi reaktivasi CMV yang ditandai dengan DNA CMV >500 kopi/mL. Di Indonesia belum ada pemeriksaan DNA CMV, sebaliknya pemeriksaan IgG CMV tersedia di seluruh daerah, mudah dan murah. Tujuan: Untuk mengetahui insidens reaktivasi CMV pada resipien seropositif 3 bulan pertama pasca transplantasi ginjal, mengetahui korelasi antara DNA CMV dengan peningkatan titer IgG CMV, dan cutoff point titer IgG CMV saat reaktivasi. Metode: Penelitian ini kohort prospektif 3 bulan. Uji korelasi DNA CMV dengan peningkatan IgG CMV menggunakan uji korelasi Spearman’s rho. Penentuan cutoff point terbaik IgG CMV menggunakan kurva ROC dengan menilai AUC. Hasil: Jumlah subyek penelitian 23 resipien seropositif CMV. Reaktivasi pertama pada minggu ke-4 pasca transplantasi (2 orang), diikuti minggu ke-6 (4 orang) dan ke-10 (3 orang), sehingga keseluruhan 9 orang (39%). Dua (22,2%) orang meninggal karena penyakit CMV, dan 7 (77,8%) orang tanpa tanda/keluhan klinis CMV dengan kreatinin serum 1,19 (SB 0,29) mg/dL serta eGFR 69,99 (SB 19,92) mL/menit/1,73 m2. Korelasi positif antara DNA CMV dengan IgG CMV ditemukan bermakna mulai minggu ke-8 (r=0,70 p <0,001), minggu ke-10 (r=0,83 p <0,001) dan minggu ke-12 (r=0,72 p <0,001), dengan peningkatan minimal 2 kali. Cutoff point titer IgG CMV terbaik pada minggu ke-10, yaitu 401,4 AU/dL (sensitivitas 88,9 %, spesifisitas 92,9%), Pada minggu ke-8 dan ke-12 juga diperoleh AUC yang baik untuk ditetapkan nilai cutoff point titer IgG CMV, yaitu berturut-turut 502,7 AU/dL (sensitivitas 83,3 %, spesifisitas 94,1%) dan 679,35 AU/dL (sensitivitas 81,9 %, spesifisitas 90,8%). Kesimpulan: Insidens reaktivasi pada resipien seropositif pasca transplantasi ginjal 3 bulan pertama adalah 39%. Terdapat korelasi positif yang bermakna antara DNA CMV kuantitatif dengan peningkatan minimal 2 kali titer IgG CMV pada resipien seropositif mulai pada minggu ke-8 pasca transplantasi ginjal; dengan cutoff point terbaik titer IgG CMV pada minggu ke-10.

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Background: Reactivation of CMV in the first 3 month after kidney transplantation reached 40-80%, and 20-50% developed to CMV disease. CMV reactivation in seropositive recipients are prevented by pre-emptive therapy, when CMV DNA >500 copy/mL. Indonesia hasn’t performed CMV DNA real-time routinely, however do measuring CMV antibody-IgG because it is simple, cheap and available.

Objective: to determine the incidence of CMV reactivation in seropositive recipients, identify correlation between quantitative CMV DNA with increasing CMV antibody-IgG titre, and determine CMV antibody-IgG cutoff point when reactivation.

Methods: prospective cohort study for 3 months. Using Spearman‘s rho test to correlate CMV DNA and CMV antibody-IgG, and using ROC curve to identify AUC to decide the best cutoff point of CMV antibody-IgG.

Results: All of subject is 23 seropositive recipients. The first reactivation on 4th week after transplantation (2 persons), followed on 6th week (4 persons) and on 10th week (3 persons), so the total is 9 recipients (39%). Two (22,2%) recipients died due to sepsis, and 7 (77,8%) recipients is healthy without signs/symptoms of CMV infection. Their serum creatinin is 1,19 (SB 0,29) mg/dL and eGFR 69,99 (SB 19,92) mL/menit/1,73 m2. There was positive correlation between CMV DNA with CMV antibody-IgG on the 8th week (r=0,70 p <0,001), on the10th week (r=0,83 p <0,001) and on the 12th week (r=0,72 p <0,001), with double increasing of antibody IgG titre. The best of antibody IgG cutoff point was on the 10th week (401,4 AU/dL, sensitivity 88,9 %, specifity 92,9%). On 8th and 12th week was found a good antibody IgG cutoff point titre too, respectively 502,7 AU/dL (sensitivity 83,3 %, specifity 94,1%) and 679,35 AU/dL (sensitivity 81,9 %, specifity 90,8%).

Conclusion: Incidence of reactivation in seropositive recipients after kidney transplantation was 39%. There was positive correlation between quantitative CMV DNA with double increasing of CMV antibody-IgG titre started from 8th week after transplantation. The best cutoff point was on 10th week."

"Latar Belakang: Transplantasi ginjal adalah modalitas terapi pengganti ginjal yang paling baik bagi pasien dengan Penyakit Ginjal Tahap Akhir (PGTA). Saat ini di Indonesia transplantasi ginjal dengan donor hidup mulai semakin sering dilakukan, terutama di RSUPN Cipto Mangunkusumo, di mana dalam beberapa tahun terakhir lebih dari 50% kasus transplantasi ginjal di Indonesia dilakukan di rumah sakit ini. Walaupun demikian, data mengenai hasil transplantasi di Indonesia, baik kesintasan 1 tahun graft maupun pasien, serta faktor yang diduga mempengaruhinya masih belum ada. Diharapkan hasil transplantasi di rumah sakit ini dapat menggambarkan hasil secara keseluruhan di Indonesia. Metode: Studi kohort retrospektif pada resipien transplantasi ginjal di RSUPN-CM dari Januari 2010 hingga Mei 2014. Data didapatkan dari penelusuran rekam medis serta menghubungi pasien secara langsung. Masing-masing resipien diikuti sejak tanggal transplantasi hingga kematian atau Mei 2015. Proporsi kesintasan graft dan pasien pada 1 tahun post transplantasi dan pada akhir studi didokumentasikan. Kurva Kaplan-Meier digunakan untuk menggambarkan kesintasan pasien secara keseluruhan. Studi deskriptif dilakukan dengan melihat perbedaan proporsi variabel serta perbedaan rerata atau median pada pasien yang mengalami kegagalan graft 1 tahun serta tidak, serta pasien yang bertahan hidup atau meninggal. Hasil: Berdasarkan hasil consecutive total sampling didapatkan 157 resipien yang menjalani transplantasi ginjal di RSUPN-CM, 137 resipien di antaranya memenuhi kriteria penelitian, seluruhnya mendapatkan ginjal dari donor hidup. Usia resipien rata-rata adalah 47,9 ± 13,9 tahun, rerata IMT 22,8 ± 3,7 kg/m2, dan proporsi resipien dengan diabetes 35,8%. Didapatkan 7 pasien mengalami disfungsi graft primer (kegagalan transplantasi), sehingga 130 pasien diikuti untuk melihat kesintasan jangka panjang. Pada akhir tahun pertama, didapatkan angka death-censored graft survival adalah 95,4%, all-cause graft survival 85,4%, kesintasan pasien 88,5%, dan death with a functioning graft sebesar 10%. Pada akhir studi, didapatkan angka kesintasan tersebut berturut-turut adalah 94,6%, 80%, 82,3%, dan 14,6%, dengan median waktu pengamatan 24 bulan (1 ? 64 bulan). Kurva Kaplan Meier menunjukkan angka mortalitas tertinggi didapatkan pada bulan-bulan awal post transplantasi. Kegagalan graft dan kematian didapatkan lebih banyak pada resipien yang berusia lebih tua, mengidap diabetes melitus, serta memiliki indeks komorbiditas yang tinggi. Penyebab kematian utama adalah infeksi (11,5%) diikuti dengan kejadian kardiovaskular (3,8%). Simpulan: Death-censored graft survival 1 tahun resipien transplantasi ginjal di Indonesia sudah sangat memuaskan. Angka death with functioning graft masih cukup tinggi, sehingga menurunkan all-cause graft survival dan kesintasan pasien 1 tahun. Walaupun demikian, secara keseluruhan hasil ini masih sebanding dengan negara-negara berkembang lainnya.

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Background: Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia.

Methods: A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately.

Results: Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%).

Conclusions: The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries."

"Pendahuluan. Berbagai panduan menganjurkan hemodialisis HD tiga kali seminggu. Di Indonesia pasien dengan hemodialisis dua kali seminggu lebih banyak ditemukan. Perlu dilakukan penelitian untuk mengetahui gambaran klinis dan kualitas hidup pada pasien yang menjalani hemodialisis dua kali seminggu dibandingkan tiga kali seminggu. Metode. Merupakan studi potong lintang pada pasien yang menjalani HD dua dan tiga kali seminggu di RS Cipto Mangunkusumo dan beberapa RS swasta. Dilakukan pemeriksaan laboratorium dan penilaian kualitas hidup dengan menggunakan Kidney Disease Quality of Life KDQOL-SF 36. Hasil. Didapatkan 80 subjek dengan kelompok usia >50 tahun lebih banyak ditemukan. Secara bermakna lebih tinggi pada kelompok HD dua kali yaitu Interdialytic Weight Gain IDWG 4,91 SB 1,52 dan 3,82 SB 1,28 p=0,002. albumin 4,05 SB 0,26 dan 3,86 SB 0,48 p=0,027, saturasi transferin 25,5 12,0-274,0 dan 21,95 5,8-84,2 p=0,004, kadar fosfat 5,82 SB 1,68 dan 5,82 SB 1,68 p=0,026. Kadar TIBC 235,20 SB 55,72 dan 273,73 SB 58,29 p=0,004 pada kelompok tiga kali HD secara bermakna lebih tinggi. Pada kelompok HD dua kali seminggu 68 mencapai Kt/V>1,8, 93,3 yang HD tiga kali seminggu mencapai Kt/V>1,2. Kualitas hidup antara kedua kelompok tidak berbeda bermakna baik pada Physical Componet Score PCS p=0,227, Mental Component Score MCS p=0,247 dan Kidney Disease Component Score KDCS p=0,889. Simpulan. Didapatkan secara bermakna lebih tinggi pada kelompok HD dua kali seminggu pada pemeriksaan IDWG, albumin, saturasi transferin, fosfat, sedangkan TIBC lebih tinggi pada kelompok HD tiga kali seminggu. Kualitas hidup kedua kelompok tidak berbeda bermakna.

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Introduction. Many guidelines recommend hemodialysis HD three times a week. In Indonesia there are more patients undergoing hemodialysis twice a week. It is necessary to investigate the clinical features and the quality of life in patients undergoing hemodialysis twice a week.

Method. A cross sectional study in patients undergoing HD two and three times weekly at Cipto Mangunkusumo Hospital and some private hospitals. Laboratory examination and assessment of quality of life by using Kidney Disease Quality of Life KDQOL SF 36.

Results. There were 80 subjects with age group 50 years is more common. Significantly higher in group HD twice a week were Interdialytic Weight Gain IDWG 4.91 SB 1.52 and 3.82 SB 1.28 p 0.002. 4,05 albumin SB 0.26 and 3.86 SB 0.48 p 0.027, transferrin saturation 25.5 12.0 to 274.0 and 21.95 5.8 to 84.2 p 0.004, the phosphate level 5.82 SB 1.68 and 5.82 SB 1.68 p 0.026. The TIBC level 235.20 55.72 SB and 273.73 58.29 SB p 0.004 was significantly higher in group HD thrice a week. In twice a week HD group 68 reached Kt V 1.8, 93.3 of HD thrice a week achieved Kt V 1.2. Quality of life between the two groups was not significant either on Physical Componet Score PCS p 0.227, Mental Component Score MCS p 0.247 and Kidney Disease Component Score KDCS p 0.889.

Conclusion. There were significantly higher in group HD twice a week on examination IDWG, albumin, transferrin saturation and phosphate levels, whereas the TIBC was higher in group HD three times a week. Quality of life of the two groups was not significant difference."

"Pola sirkadian tekanan darah (TD) adalah gambaran TD 24 jam berupa kurva TD yang meningkat pada pagi hari, menurun pada siang / sore hari dan terendah pada malam hari / waktu tidur. 24 hours Ambulatory Blood Pressure Monitoring (24 hrs ABPM) merupakan alat pengukur TD yang lebih akurat dan dapat memperlihatkan pola sirkadian TD 24 jam. Turunnya TD 10 - 20% pada malam hari disebut dipper, jika turun < 10% disebut nondipper. Meningkatnya TD 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Faktor utama penyebab hipertensi pada PGK 5D adalah menurunnya Laju Filtrasi Glomerulus (LFG) dan meningkatnya cairan ekstraselular. Transplantasi ginjal akan memperbaiki TD dan nondipper dengan membaiknya LFG, meningkatnya produksi urin dan menurunnya cairan ekstraseluler. Namun demikian satu bulan Pasca Transplantasi Ginjal kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD. Tujuan : Mengetahui perbedaan pola sirkadian TD, data dipper / nondipper dan rerata TD 24 jam pada pasien PGK Pra dan satu bulan Pasca Transplantasi Ginjal. Metode Penelitian : Studi Pre experimental dengan before and after design. Subjek penelitian pasien PGK 5D / Pra Transplantasi Ginjal berusia 18 ? 60 tahun, dilakukan di RSCM pada bulan Oktober sampai dengan Desember 2014. Jumlah subjek sebanyak 15 orang. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG, pengukuran TD 24 jam dengan 24 hrs ABPM, Pra dan satu bulan Pasca Transplantasi Ginjal. Analisis statistik dengan uji McNemar dan uji t dependen. Hasil : Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan Pasca Transplantasi Ginjal seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan Pasca Transplantasi Ginjal nondipper (homogen). Terdapat penurunan rerata TD sistolik 24 jam pasien PGK satu bulan Pasca Transplantasi Ginjal yang tidak signifikan (p > 0,05) dan penurunan rerata TD diastolik 24 jam yang signifikan (p < 0,05). Simpulan : Belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal. Terdapat penurunan rerata TD sistolik 24 jam yang tidak signifikan dan penurunan rerata TD diastolik 24 jam yang signifikan pada pasien satu bulan Pasca Transplantasi Ginjal.

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The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP.

Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation.

Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis.

Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05).

Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation."

"Transplantasi ginjal dapat memperbaiki fungsi jantung Penelitianeksperimental pada binatang membuktikan bahwa peningkatan kadar hormoneritropoetin memperbaiki fungsi jantung namun secara klinis masih menjadi bahanperdebatan Tujuan: Untuk menilai hubungan peningkatan kadar eritropoetin dengan perbaikanfungsi jantung pada pasien gagal ginjal yang menjalani transplantasi Metoda: Penelitian Kohor prospektif pada pasien gagal ginjal yang menjalanitransplantasi di RSCM Jumlah subyek 21 orang yang dikumpulkan dalam kurunwaktu Maret September 2013 Pengambilan data ekokardiografi dan kadareritropoetin dilakukan sebelum dan 3 bulan sesudah transplantasi ginjal Analisisstatistik dengan uji korelasi Pearson atau Spearman Hasil: Penelitian ini menunjukkan peningkatan bermakna kadar eritropoetin 7 58 2 56 mlU ml menjadi 18 1 6 4 mlU ml Terdapat hubungan peningkatan kadareritropoetin dengan LVEDD r 0 56 p0 05 Kesimpulan: Terdapat hubungan peningkatan kadar eritropoetin dengan perbaikanLVH LVEDD pada pasien gagal ginjal yang menjalani transplantasi Tidak ada hubungan peningkatan kadar eritropoetin dengan perbaikan LVEF

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Kidney transplantation improved cardiac function Based on animaltrials elevated levels of erythropoietin hormone can improved cardiac function butin clinically still debate Aim: To determine association between elevated levels of erythropoietin andimprovement cardiac function on renal failure who underwent transplantation Methods: Prospective cohort study on renal failure who underwent kidneytransplantation at Cipto Mangunkusumo Hospital The study include 21 subjects whocollected it from Marct to September 2013 Data of echocardiography anderythropoietin level were collected at time prior to kidney transplantation and repeat 3months there after The association between elevated levels of erythropoietin andcardiac function was analyzed using Pearson correlation and Spearman test Results: The study showed a significantly elevated levels of erythropoietin from7 58 2 56 to 18 1 6 4 mlU ml There was statistically significant association between elevated levels of erythropoietin and LVEDD r 0 56 p Conclusions: There was association elevated levels of erythropoietin and improvement of LVH, LVEDD on renal failure who underwent transplantation, however, there was no association of elevated levels of erythropoietin level and improvement of LVEF."