Sclerostin is a glycoprotein expressed by osteocytes and plays a role in bone turnover in themetabolism of the bone. Sclerostin blocks the formation of a ligand with its receptor on theWnt/β-catenin pathway, and influences the activity of osteoblasts. Sclerostin also influencesmineral and bone disturbances in CKD via the interaction between kidney, bone and vascularaxis. The concentration of sclerostin will rise especially in patients with ESRD undergoingdialysis. Concentration of sclerostin has not been reported yet in non-dialysis CKD patientstage 3-5 and the aim of this study is to see sclerostin concentration on those population. Methods This is a descriptive and cross-sectional study designed to measure sclerostinconcentration in non dialysis patients with CKD stage 3-5. The sclerostin concentration ismeasured using an enzyme-linked immunosorbent assay kit. CKD stages are diagnosed usingthe KDIGO-2012 criteria which measures the estimated GFR (eGFR) with the formulation of EPICKD. Fifty six patients with CKD stage 3-5 were enrolled in this study and one way ANOVA comparative test followed with a post hoc analysis using Benferroni test to analysethe data. Results The mean concentration level of serum sclerostin in this population is (79.7+ 41.2) pmol/L, and in patients with CKD stage 3, CKD stage 4, and CKD stage 5 are (59.6 +28.5) pmol/L, (71.9 + 42.2) pmol/L and (96.7 + 39.8) pmol/L respectively. The comparativetest of mean concentrations of the serum sclerostin between stages of CKD are statisticallysignificant with a p=0.022. The post hoc analysis of serum sclerostin concentration betweenCKD stage 3 and CKD stage 5 have a significant difference with a mean of 37 pmol/L andp=0.037. Conclusion, The serum sclerostin concentration rise in accordance with the declineof kidney function in patients with pre-dialysis CKD stage 3-5.
ABSTRAK Hipertensi merupakan penyebab gangguan ginjal kronik melalui suatu proses yang mengakibatkan hilangnya sejumlah besar nefron fungsional yang progresif dan irreversible. The Kidney Disease Outcome Quality Initiative (K/DOQI) of the national kidney foundation (NKF) merekomendasikan target tekanan darah pada pasien gangguan ginjal kronik < 140/90 mmHg sehingga dapat mengurangi risiko terjadinya penyakit kardiovaskular. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian obat antihipertensi terhadap kualitas hidup pasien GGK yang menjalani hemodialisis di RSUP DR.Hasan Sadikin Bandung. Penelitian menggunakan desain cross sectional observational konkuren dengan mengkaji data rekam medis dan status harian pasien selama periode Desember 2015-Febuari 2016 dan hasil pengisian kuisioner Kidney Disease and Quality of Life (KDQOLTM-36). Subyek penelitian merupakan pasien GGK yang menjalani hemodialisis dan mendapatkan terapi obat antihipertensi (OAH), laki-laki dan perempuan, usia lebih dari 18 tahun. Terdapat perbedaan bermakna penurunan tekanan darah sistolik(p=0,011) dan diastolik (p=0,023) untuk setiap terapi OAH, kombinasi 2 OAH memberikan efek penurunan tekanan darah sistolik dan diastolik yang paling baik dan berbeda bermakna (p=0,001). Pengobatan tunggal dan kombinasi dua obat antihipertensi memberikan efek penurunan tekanan darah yang paling baik.Setiap jenis terapi obat antihipertensi tidak memberikan perbedaan bermakna terhadap kualitas hidup kecuali domain aspek efek penyakit (p=0,041). Kata kunci : Hipertensi, gagal ginjal kronik, hemodialisis, antihipertensi, KDQOL, kualitas hidup. 40 ABSTRACT Background: Hypertension is the leading cause of chronic kidney disease (CKD) through a process that resulted in loss of a large number of functional nephron on progressive and irreversible. The Kidney Disease Outcome Quality Initiative (K/DOQI) of The National Kidney Foundation (NKF) recommends a target blood pressure values of < 130/80 mmHg in CKD patients, it can reduce the risk of cardiovascular disease. Objective : The purpose of this study is to understand the antihypertension medication effects to the quality of life of hemodialysis patients in RSUP DR.Hasan Sadikin Bandung. Methods : The design of study is cross sectional observational with concurrent medical record with patients daily status analyses during December 2015 - February 2016 with questionnaire by the Kidney Disease and Quality of Life (KDQOL-36. Results : The analysis result shows significant differences in the reduction of systolic (p=0, 011) and diastolic (p=0, 023) blood pressure in each group of antihypertension therapy. Furthermore, 2 combination of antihypertension therapy gives the most significant different in reduction of systolic and diastolic blood pressure (p=0, 001). Conclusions : Second combination of antihypertension therapy can be reduce of blood pressure better than other therapy. Second combinations of antihypertension therapy is best for decrease of blood pressure and creatinin serum. In all domain of quality of lifes, symptom/problems have a highest score, and burden of kidney disease have a lowest score of quality of life. Keywords : chronic kidney disease, hemodialysis, antihypertension, KDQOL, quality of life.
Absolute Iron Deficiency Anemia (IDA) is one of the complications in the End State Renal Disease (ESRD) patients undergoingmaintenance hemodalysis, with an incidence of 76.4%. If this condition is not properly addressed, it can lead to impaired cardiac functionand increased mortality. The incidence of this case is between 30−45%. The determination of the iron status in ESRD patients wqs setby the Perhimpunan Nefrologi Indonesia 2011 using serum ferritin and transferrin saturation, but they do not provide a meaningfulchange in the value of the initial state of the iron deficiency. This condition should be examined with other parameters combination aswell as those influenced by diurnal variation and infection-inflammation condition. Reticulocyte hemoglobin (Ret-He) parameter canbe used as a marker of bone marrow iron availability because these reticulocytes are young erythrocytes released from the bone marrowinto the circulation. These conditions were circulated only within a short time about 1-2 days before becoming mature erythrocytes. Theaim of this study was to determine the Ret-He level diferentiation between absolute IDA and non absolute IDA states in ESRD patientswhom underwent maintenance hemodialysis. This research was conducted in the Laboratory of Clinical Pathology-RSHS-Bandung fromSeptember 2012 to June 2013. The study design was cross-sectional. All subjects were ESRD patients undergoing hemodialysis maintenancefor at least three (3) months and consisted of absolute IDA and non-absolute IDA based on the results of the ferritin and transferrinsaturation calculations according to the criteria of Pernefri 2011 Reticulocyte hemoglobin levels were checked using a fluorescenceflowcitometry principle in the automated hematology analyzer. In this study it was found that the Ret-He mean in the absolute IDA was26.1 pg/cell and 35.9 pg/cell in non absolute IDA. Statistical analysis was performed using Independent T-test. A total of 61 undergoingmaintenance hemodialysis subjects participating in this study comprised patients with absolute IDA and non-absolute IDA who met theinclusion and exclusion criteria. It can be concluded that the Ret-He level in statistical analysis showed absolute IDA which was meaningfullower than nonabsolute IDA in ESRD patients undergoing maintenance hemodialysis (p<0.001).
Objective: To determine the relative change in endothelin-1 (ET-1) during hemodialysis procedure in Stage Five Dialysis-Dependent Chronic Kidney Disease (CKD-5D)patients with and without intradialytic hypertension (IDH). Methods: This was a cross-sectional, observational study involving 40 CKD-5D patients who received two hemodialysis per week for at least three months at the dialysis unit of Dr. Hasan Sadikin Hospital General Bandung, Indonesia during September 2016. Subjects were divided two groups: with IDH (n=20) and without IDH (n=20). Plasma ET-1 level was examined before and after hemodialysis. Results: There was a significant elevation of ET-1 level (mean±SD pg/mL) between pre- and post-dialysis state in patients with IDH (3.33±1.28 vs. 3.84±1.75; relative changes: 15.32%, p=0.013). No change was observed in patients without IDH (3.99±2.30 vs. 4.38±1.81; relative changes: 9.77% p=0.083). The post-dialysis absolute ET-1 level was significantly lower in CKD-5D patients with IDH (3.84±1.75 vs. 4.38±1.81; p=0.024). Conclusion: There was a significant elevation of ET-1 level in CKD-5D patients with IDH during hemodialysis procedure at the dialysis unit of Dr. Hasan Sadikin General Hospital Bandung.
Gangguan ginjal akut (GgGA) merupakan penurunan fungsi ginjal secara mendadak yang ditandai dengan peningkatan kreatinin serum ≥0,3 mg/dL atau meningkat >1,5 kali dari kadar sebelumnya atau penurunan urine output (UO) <0,5 mL per jam selama >6 jam. Sepsis merupakan penyebab tersering GgGA dengan angka kejadian berkisar 20-50% dan angka kematian mendekati 70%. Kadar neutrophil gelatinase associated lipocalin (NGAL) urine penderita GgGA dapat meningkat secara cepat dan lebih awal dibandingkan dengan kadar kreatinin serum sehingga NGAL dapat dijadikan penanda diagnosis GgGA. Penelitian bertujuan mengetahui validitas NGAL urine sebagai penanda diagnosis GgGA pada penderita sepsis. Sebanyak 50 sampel urine diambil dari penderita sepsis di Unit Gawat Darurat (UGD), Intensive Care Unit (ICU), dan Medical Intermediate Care (MIC) di Rumah Sakit Dr. Hasan Sadikin Bandung selama Februari sampai Mei 2010 dan dilakukan pemeriksaan kadar NGAL urine dengan metode enzyme linked immunosorbent assay (ELISA). Data yang diperoleh dianalisis dengan uji nonparametrik Mann-Whitney, kurva receiver operating characteristic (ROC), dan uji validitas. Hasil penelitian didapatkan kadar NGAL urine penderita sepsis dengan GgGA lebih tinggi secara bermakna dibandingkan dengan penderita sepsis tanpa GgGA (3.380 ng/mL berbanding 116 ng/mL; p<0,001). Pada cutoff point 107 ng/mL, NGAL urine memiliki sensitivitas 100%, spesifisitas 36%, positive predictive value (PPV) 60,9%, negative predictive value (NPV) 100%, dan akurasi 68%. Simpulan, kadar NGAL urine memiliki validitas yang baik dan dapat dijadikan sebagai penanda diagnosis terjadinya GgGA pada penderita sepsis. [MKB. 2012;44(2):121-6].
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