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"Latar Belakang: Penyakit ginjal diabetik (PGD) merupakan komplikasi mikrovaskular yang paling sering terjadi pada diabetes melitus. Podositopati merupakan kunci utama dari kerusakan glomerular pada PGD. miRNA-21 merupakan regulator epigenetik yang mempunyai peran dalam kerusakan podosit pada PGD, namun hasil dari penelitian yang sudah ada sebelumnya masih menyisakan kontroversi tentang peran miRNA-21 pada patogenesis PGD. Tujuan: Mengetahui korelasi antara kadar miRNA-21 dengan kadar nefrin urin, podosin urin, dan rasio albumin kreatinin urin pada pasien PGD. Metode: Studi potong lintang terhadap 42  pasien PGD di RSUPN Cipto Mangunkusumo Jakarta selama periode April sampai Juli 2023. Uji korelasi dilakukan untuk menilai hubungan miRNA-21 dengan nefrin, podosin, dan rasio albumin kreatinin urin. Regresi linier dilakukan untuk menilai variabel perancu terhadap hubungan tersebut. Hasil: Didapatkan hasil rerata ekspresi relatif miRNA-21 0,069 (0,024) , median nefrin 35,5 (15,75 – 51,25)ng/ml, median podosin 0,501 (0,442– 0,545) ng/mL, dan rasio albumin kreatinin urin 150 (94,56 – 335,75) ng/ml.Ditemukan korelasi antara miRNA-21 dengan nefrin (r = 0,598; p = <0,0001). Ditemukan korelasi antara miRNA-21 dengan rasio albumin kreatinin urin (r = 0,604; p = <0,0001). Tidak didapatkan korelasi antara miRNA-21 dengan podosin. Simpulan: Terdapat korelasi positif antara miRNA-21 dengan nefrin dan rasio albumin kreatinin urin namun tidak didapatkan korelasi yang bermakna antara miRNA-21 dengan podosin urin.

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Diabetic kidney disease (DKD) is the most common microvascular complication in diabetes mellitus. Podocytopathy is a key component of glomerular damage in DKD. miRNA-21 is an epigenetic regulator that plays a role in podocyte damage in DKD, however, the results of previous studies have not resolved the controversy about the role of miRNA-21 in the pathogenesis of DKD. Objective: The aim is to investigate the correlation between miRNA-21 levels and the urinary nephrin, urinary podosin, and urinary albumin-creatinine ratio (uACR) in patients with DKD.  Methods: A cross-sectional study of 42 patients with DKD was conducted at Cipto Mangunkusumo Hospital Jakarta from April to June 2023. A correlation test was performed to assess the association of miRNA-21 with the nephrin, podosin, and uACR. A linear regression test was performed to assess the confounding variables in these relationships. Results: The mean relative expression of miRNA-21 was 0.069 (0.024), the median nephrin was 35.5 (15.75 - 51.25) ng/ml, the median podocin was 0.516 (0.047 - 0.620) ng/ml, and the uACR was 150 (94.56 - 335.75) ng/ml. There was a correlation between miRNA-21 and nephrin (r = 0.598; p = <0.0001). There was a correlation between miRNA-21 and the uACR (r = 0.604; p = <0.0001). No correlation was found between miRNA-21 and podocin. Conclusions: There was a positive correlation between miRNA-21 and nephrin and urinary albumin-creatinine ratio, but no significant correlation between miRNA-21 and urinary podocin."

"Latar Belakang: Penyakit ginjal diabetik (PGD) merupakan salah satu penyebab terbanyak penyakit ginjal kronik tahap akhir. Podositopati sebagai gambaran dini PGD dapat ditandai oleh adanya protein spesifik podosit (nefrin dan podosin) di urin. Asymmetric dimethylarginine (ADMA) merupakan penanda disfungsi endotel yang diketahui meningkat pada hiperglikemia serta berhubungan dengan albuminuria dan progresivitas kerusakan ginjal. Mekanisme terjadinya gangguan ginjal akibat disfungsi endotel belum sepenuhnya diketahui. Tujuan: Penelitian ini bertujuan untuk mengetahui korelasi ADMA plasma dengan kadar nefrin, podosin, dan rasio podosin nefrin (RPN) urin pada pasien PGD. Metode: Studi potong lintang dilakukan terhadap pasien PGD pada dua rumah sakit di Jakarta sepanjang periode April sampai Juni 2023. Dilakukan pengumpulan data karakteristik subjek, riwayat penyakit dan pengobatan, serta data laboratorium yang relevan. Pemeriksaan ADMA dilakukan dengan metode liquid chromatography dari darah, sedangkan nefrin dan podosin dilakukan dengan metode ELISA dari urin. Uji korelasi dilakukan untuk menilai hubungan ADMA dengan nefrin, podosin, dan RPN. Regresi linier dilakukan untuk menilai pengaruh variabel perancu terhadap hubungan tersebut. Hasil: Dari data 41 subjek yang dianalisis ditemukan rerata ADMA 70,2 (SD 17,2) ng/mL, median nefrin 65 (RIK 20-283) ng/mL, dan median podosin 0,505 (RIK 0,433-0,622) ng/mL. Ditemukan korelasi bermakna antara ADMA dengan nefrin (r=0,353; p=0,024) dan korelasi bermakna antara ADMA dengan RPN (r=–0,360; p=0,021). Tidak ditemukan korelasi bermakna antara ADMA dengan podosin (r=0,133; p=0,409). Analisis multivariat menunjukkan indeks massa tubuh sebagai faktor perancu. Simpulan: Terdapat korelasi positif lemah antara ADMA dengan nefrin urin dan korelasi negatif lemah antara ADMA dengan RPN urin pada pasien PGD. Tidak ditemukan korelasi antara ADMA dengan podosin urin.

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Background: Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease, and podocytopathy is an early manifestation of DKD characterized by the urinary excretion of podocyte-specific proteins, such as nephrin and podocin. Asymmetric dimethylarginine (ADMA), a biomarker of endothelial dysfunction, is associated with progressive kidney dysfunction. However, the mechanism of endothelial dysfunction in DKD progression is unclear. Objectives: The aim of this study was to investigate the correlations of ADMA levels with nephrin, podocin, and the podocin nephrin ratio (PNR) in DKD patients. Methods: A cross-sectional study of 41 DKD outpatients was performed in two hospitals in Jakarta from April to June 2023. The collected data included the subjects’ characteristics, histories of disease and medication, and relevant laboratory data. Serum ADMA was measured using liquid chromatography, while urinary podocin and nephrin were measured using the enzyme-linked immunosorbent assay (ELISA) method. A correlation analysis was performed to evaluate the correlation of ADMA with nephrin, podocin, and PNR. Regression analysis was performed to determine confounding factors. Results: The mean value of ADMA was 70.2 (SD 17.2) ng/mL, the median for nephrin was 65 (20-283 ng/mL), and the median of podocin was 0.505 (0.433-0.622) ng/mL. ADMA correlated significantly with nephrin (r = 0.353, p = 0.024) and PNR (r = -0.360, p = 0.021), but no correlation was found between ADMA and podocin (r = 0.133, p = 0.409). The multivariate analysis showed that body mass index was a confounding factor. Conclusion: This study revealed weak positive correlations between ADMA and urinary nephrin, and weak negative correlations between ADMA and PNR in DKD patients. No correlation was found between ADMA and urinary podocin.

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"Background: Diabetic kidney disease (DKD), as a common cause of end-stage renal disease (ESRD), is a chronic complication of diabetes mellitus (DM). It has been established that vitamin D deficiency is one of DKD risk factors, which may be related to vitamin D receptor (VDR) polymorphisms. This study aimed to analyze the association between VDR polymorphisms and DKD in Indonesian population, also risk factors that influence it. Methods: a cross-sectional study was conducted in Type 2 DM patients who visited internal medicine outpatient clinic at Dr. Cipto Mangunkusumo Hospital, Jakarta, from November 2014 until March 2015. Data collection includes characteristics of subjects and laboratory examination, including BsmI polymorphisms in the vitamin D receptor gene. Patients with acute and severe disease were excluded from the study. Bivariate and multivariate analyses were done. Results: of 93 DM subjects, 42 (45.2%) subjects were without DKD and 51 (54.8%) subjects had DKD. Most of the subjects had the Bb genotype (89.2%), with no subject having the BB genotype. The proportions of the B and b alleles were 44.6% and 55.4%, respectively. There is no association between BsmI polymorphisms in the vitamin D receptor gene and DKD (OR = 1.243; CI 95% 0.334-4.621; p value = 0.751). Conclusion: the profile of BsmI polymorphisms in the vitamin D receptor gene in the Indonesian population were genotypes Bb (89.2%) and bb (10.8%). There was no association between BsmI polymorphisms in the vitamin D receptor gene and DKD. Duration of DM more than five years influenced the association between those variables."

"ABSTRAKPemilihan obat antidiabetik oral (OAD) pada pasien diabetes melitus tipe 2 (DMT2) dengan penyakit ginjal kronik (PGK) sangatlah penting karena sebagian besar OAD diekskresikan melalui ginjal sehingga diperlukan penyesuaian dosis. Di Indonesia, sulfonilurea (SU) kerja pendek umum dipakai untuk pengelolaan DMT2 dengan PGK. Tinjauan pustaka ini membahas perbandingan efektivitas dan keamanan beberapa jenis SU dengan OAD lainnya pada pasien DMT2 dengan PGK. Golongan obat yang dievaluasi adalah SU, tiazolidindion (TZD), penghambat DPP-IV, dan penghambat SGLT-2. Sulfonilurea kerja pendek (gliklazid dan glipizid) dan penghambat SGLT-2 (empaglifozin dan canaglifozin) dapat menghambat progresi PGK pada DMT2. Pioglitazon dan sitagliptin dikaitkan dengan progresi PGK yang lebih tinggi, sementara linagliptin berefek netral terhadap perburukan PGK. Namun, sitagliptin dan linagliptin memiliki risiko lebih rendah dalam menyebabkan hipoglikemia dibandingkan SU kerja pendek. Dengan demikian, dapat disimpulkan OAD golongan SU kerja pendek, seperti gliklazid dan glipizid masih dapat menjadi pilihan utama untuk pengelolaan glukosa darah pada pasien DMT2 dengan PGK di Indonesia."

"Hiperglikemia pada pasien diabetes melitus dapat menyebabkan kerusakan selular dan komplikasi. Salah satu komplikasi yang muncul yaitu pada jaringan mikrovaskular dan menyebabkan nefropati diabetik. Nefropati diabetik secara klinis diawali dengan kondisi albuminuria. Selain albuminuria, produksi spesies oksigen reaktif ROS berlebihan melalui NADPH oksidase juga merupakan salah satu patogenesis dari nefropati diabetik. Penelitian ini bertujuan untuk menganalisis aktivitas NADPH Oksidase yang diukur melalui rasio NADP /NADPH serum, dan hubungannya terhadap rasio albumin kreatinin urin. Penelitian dilakukan dengan studi cross sectional dan menggunakan teknik consecutive sampling. Populasi sampel pada penelitian ini adalah 89 orang pasien diabetes melitus tipe 2 usia 39-75 tahun di Puskesmas Kecamatan Pasar Minggu. Sampel penelitian dibagi menjadi 3 kelompok, yaitu kelompok subjek non DM sebagai kontrol n=10 , kelompok normoalbuminuria n=62 dan kelompok albuminuria n=27 . Rasio NADP /NADPH serum dan konsentrasi kreatinin urin diukur menggunakan metode kolorimetri, sedangkan albumin urin diukur dengan metode immunoturbidimetri. Hasil uji beda rata-rata menunjukkan terdapat perbedaan rasio NADP /NADPH serum pada ketiga kelompok.

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Hyperglycemic condition on diabetes mellitus patient can cause a cellular injury and complication. One of those was microvascular complication which lead to diabetic nephropathy. Diabeteic nephropathy defined by proteinuria that preceded by lower degrees of proteinuria or albuminuria condition. Reactive oxygen species derived from NADPH Oxidase also play an important roles in the pathogenesis of diabetic nephropathy. Our study aimed to analyzed the activity of NADPH Oxidase by measuing the NADP NADPH serum ratio, and to find out if there any correlation with the normoalbuminuria and albuminuria condition.

Consecutive method is used in this cross sectional study. Population of this study are 89 type 2 diabetes mellitus patient from ages 39 75 years at Pasar Minggu Community Health Center and 10 non diabetes volunteers served as control. For this purpose we divided the samples into three groups,a group of 10 healthy volunteers, normoalbuminuria group n 62 and and albuminuria group n 27. NADP NADPH serum ratio was analyzed by colorimetric method. Urine albumin creatinine ratio was measured by immunoturbidimetri and enzymatic colorimetric. The NADP NADPH serum ratio and urine albumin creatinine ratio were lower in control subject than in type 2 diabetes melitus patient."

"Latar Belakang: Pruritus menjadi salah satu gejala yang dialami oleh pasien dengan penyakit ginjal kronik (PGK). Pruritus yang berasosiasi dengan PGK mayoritas terjadi pada pasien yang menjalani hemodialisis (HD) dan dapat terjadi pada resipien transplantasi ginjal (RTG). Gejala pruritus yang tidak ditangani dengan baik dapat memberikan dampak terhadap kualitas hidup. Belum terdapat penelitian yang membandingkan proporsi derajat keparahan pruritus, kualitas hidup, dan korelasi berbagai faktor biokimia antara pasien HD dengan RTG di Indonesia. Tujuan: Membandingkan derajat keparahan pruritus, kualitas hidup, serta korelasi kadar hs-CRP, kalsium, fosfat, dan e-GFR antara pasien PGK yang menjalani HD dengan RTG. Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang. Setiap SP dilakukan anamnesis, pemeriksaan fisis, dan pemeriksaan laboratorium. Skala gatal 5 dimensi (5-D) digunakan untuk evaluasi derajat keparahan pruritus dan Indeks Kualitas Hidup Dermatologi (IKHD) digunakan dalam menilai kualitas hidup. Analisis statistik yang sesuai dilakukan untuk membuktikan hipotesis penelitian dengan nilai kemaknaan yang digunakan adalah p <0,05. Hasil: Dari 30 SP di masing-masing kelompok, proporsi pruritus derajat sedang-berat sebesar 76,7% pada kelompok HD sedangkan pada kelompok RTG sebanyak 83,3% mengalami pruritus derajat ringan (RR = 4,6; IK 95% = 2,02–10,5; p <0,001). Median skor IKHD pada kelompok HD adalah sebesar 5 (3–6) sedangkan pada kelompok RTG sebesar 3 (2–4) (p <0,001). Terdapat korelasi positif yang bermakna antara hs-CRP dengan skor skala gatal 5-D pada kelompok HD (r = 0,443; p <0,05). Terdapat korelasi negatif yang bermakna antara e-GFR dengan skor skala gatal 5-D pada RTG (r = -0,424; p <0,05). Tidak terdapat korelasi yang bermakna secara statistik antara kadar kalsium dan fosfat dengan skor skala gatal 5-D pada kedua kelompok. Kesimpulan: Pasien HD lebih banyak mengalami pruritus derajat sedang-berat dibandingkan pada RTG. Pruritus pada kelompok HD berdampak ringan hingga sedang terhadap kualitas hidup sedangkan pada kelompok RTG pruritus berpengaruh ringan terhadap kualitas hidup. Pada pasien HD, semakin tinggi kadar hs-CRP maka semakin meningkat skor skala gatal 5-D. Pada pasien RTG, semakin menurun nilai e-GFR maka semakin meningkat skor skala gatal 5-D.

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Background: Pruritus is one of the symptoms experienced by patients with chronic kidney disease (CKD). Most patients with chronic kidney disease-associated pruritus (CKD-aP) occur in dialysis patients and could also happen in kidney transplant (KT) recipients. Inappropriate management of pruritus could impact the quality of life (QoL). No studies have compared the severity of pruritus, QoL, and the correlation of various biochemical factors between hemodialysis (HD) and KT recipients in Indonesia. Objective: To compare the severity of pruritus, QoL, and the correlation of hs-CRP, calcium, phosphate, and e-GFR levels between HD and KT recipients. Methods: This is a cross-sectional analytic observational study. Medical history, physical examination, and laboratory examination were conducted on each subject. The 5-dimensional (5-D) itch scale was used to evaluate the severity of pruritus. Dermatology Life Quality Index (DLQI) was used to assess the QoL. Appropriate statistical analysis was conducted to prove the research hypothesis with a significance value of p <0.05. Results: Out of 30 subjects in each group, the proportion of moderate to severe pruritus was 76.7% in the HD group. In the KT group, 83.3% experienced mild pruritus (RR = 4.6; CI 95% = 2.02– 10.5; p <0.001). The median DLQI score in the HD group was 5 (3–6), while in the KT group was 3 (2–4) (p <0.001). There was a significant positive correlation between hs-CRP and the 5-D itch scale in the HD group (r = 0.443; p <0.05). The KT group had a significant negative correlation between e-GFR and the 5-D itch scale (r = -0.424; p <0.05). Both groups had no statistically significant correlation between calcium and phosphate levels and the 5-D itch scale. Conclusion: Moderate-to-severe pruritus was more common in HD patients than in KT recipients. Pruritus in HD patients had a mild to moderate effect on QoL, whereas pruritus in KT recipients had a mild impact on QoL. A higher level of hs-CRP in HD patients results in a higher 5-D itch scale. In KT recipients, the lower the e-GFR value, the higher the 5-D itch scale."

"Penyakit Ginjal Diabetes (PGD) dapat menyebabkan albuminuria, yang berkembang menjadi insufisiensi ginjal. Namun, sekitar 20-40% kasus PGD merupakan PGD normoalbuminuria, yaitu gangguan fungsi ginjal dengan kadar albumin normal. Penelitian ini untuk membandingkan metabolit urin pada pasien penyakit ginjal diabetes dengan normoalbuminuria dan albuminuria yang mengonsumsi metformin-glimepirid. Desain penelitian potong lintang dengan metode consecutive sampling di Puskesmas Kecamatan Pasar Minggu dan RSUD Jati Padang. Sampel urin dan darah dikumpulkan untuk pengukuran HbA1c, UACR, dan analisis metabolit urin. Sebanyak masing-masing 16 pasien dibagi menjadi kelompok PGD normoalbuminuria dan PGD albuminuria, serta dianalisis metabolit urinnya menggunakan metabolomik tidak tertarget dengan Quadruple Time of Flight Liquid Chromatography-Mass Spectrometry. Metabolit yang berbeda signifikan divisualisasi dengan Projections to Latent Structures Discriminant Analysis (PLS-DA). Lalu, dianalisis nilai Variable Importance for the Projection (VIP) > 1.0; Fold Change (FC) >1,2 (p<0,05); dan Area Under the Receiver Operating Characteristic Curve (AUROC). Metabolit dengan nilai Area Under Curve (AUC) > 0,65 dinilai sebagai biomarker potensial. Tidak ada perbedaan bermakna pada karakteristik dasar dan klinis pada kedua kelompok, kecuali HbA1c (p<0,001). Terdapat 20 metabolit urin yang berbeda signifikan pada kelompok PGD normoalbuminuria dan albuminuria. Dari analisis jalur metabolisme pada metabolit tersebut ditemukan empat jalur metabolisme, yaitu metabolisme gliserofosfolipid, eter lipid, fenilalanin, dan triptofan. Dari keempat jalur metabolisme tersebut, ditemukan tiga metabolit biomarker potensial, yaitu glycerophosphocholine, hippuric acid, dan 2-aminobenzoic acid. Ketiga metabolit tersebut berkurang secara signifikan dari kondisi normoalbuminuria ke albuminuria. Oleh karena itu, diperlukan studi lanjut mengenai ketiga metabolit tersebut pada perkembangan PGD normoalbuminuria dan albuminuria.

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Diabetic Kidney Disease (DKD) leads to albuminuria and gradually progresses to renal insufficiency. However, about 20-40% of DKD are normoalbuminuric DKD, which has impaired kidney function with normal albumin levels. This study compared urine metabolites in patients consuming metformin-glimepiride with normoalbuminuric and albuminuria DKD. The research design was cross-sectional with consecutive sampling method at Pasar Minggu District Public Health Centre and Jati Padang Hospital. Urine and blood samples were collected for measurement of HbA1c, UACR, and metabolite analysis. There were each 16 samples divided into normoalbuminuric DKD group and albuminuria DKD group. All subjects were analysed using non-targeted metabolomics with Quadruple Time of Flight Liquid Chromatography-Mass Spectrometry. The signature metabolites were determined by Projections to Latent Structures Discriminant Analysis (PLS-DA) with Variable Importance for the Projection (VIP) > 1.0; Fold Change (FC) >1.2 (p<0.05); and Area Under the Receiver Operating Characteristic Curve (AUROC). Metabolites with an Area Under Curve (AUC) value > 0.65 are considered potential biomarkers. There were no significant differences in baseline and clinical characteristics of two groups, except for HbA1c (p<0.001). There were 20 metabolites identified between two groups. The metabolic pathway analysis of these metabolites found that four metabolic pathways were glycerophospholipid, ether lipid, phenylalanine, and tryptophan metabolism. There were three potential biomarkers, glycerophosphocholine, hippuric acid, and 2-aminobenzoic acid, enriched in these four metabolic pathways. Compared between normoalbuminuric and albuminuria groups these three metabolites were significantly reduced. Therefore, further studies are needed regarding these three metabolites in the development of normoalbuminuric and albuminuria DKD."

"ABSTRAKLatar belakang: Sepsis merupakan masalah kesehatan penting yang dapat menyebabkan insidens kematian sampai 50% pada pasien dengan sepsis berat. Antibiotik aminoglikosidaterutama amikasin semakin banyak digunakan untuk mengobati infeksi kuman Gram negatif pada pasien sepsis di ICU, meskipun penggunaan obat tersebut pada dosisterapi dapat meningkatkan risiko kerusakan ginjal sekitar 10-25%. Pemantauan kadar lembah amikasin serta biomarker dini diperlukan untuk mencegah kerusakan ginjal pada pasien sepsis yang dirawat di ICU. Penelitian ini dilakukan untuk mengetahui hubungan kadar lembah amikasin pada pasien ICU dewasa yang dirawat di Rumah Sakit Cipto Mangunkusumo yang diberikan amikasin 1000 mg/hari denganpeningkatan kadar KIM-1 normalisasi dalam urin yang merupakan biomarker dini nefrotoksisitas.Metode:Penelitian ini merupakan penelitian pendahuluan yang dilakukan pada 12 pasien sepsis dewasa yang dirawat di ICU RSCM dan diberikan amikasin 1000 mg/hari pada bulan Mei-September 2015. Kadar lembah amikasin dosis ketiga dihubungkan dengan peningkatan kadar KIM-1 normalisasi yang diukur melalui urin 24 jam setelah pemberian amikasin dosis pertama/kedua dan dosis ketiga.Hasil:Dari 12 subyek penelitian, didapatkan 3 subyek penelitian dengan kadar lembah amikasin di atas 10 g/mL, sedangkan 9 subyek penelitian kadar lembahnya ada dalam batas aman (di bawah 10 g/mL). Delapan dari 12 subyek penelitian (66,7%) mengalami peningkatan kadar KIM-1 normalisasi dalam urin hari ketiga dibandingkan hari pertama. Tidak ada hubungan antara kadar lembah amikasin dengan peningkatan kadar KIM-1 normalisasi dalam urin (p=0,16; r=0,43).Kesimpulan:Pasien sepsis yang mendapat amikasin 1000 mg/hari di ICU RSCM selama 3 hari memperlihatkan kadar lembah amikasin plasma dalam batas aman untuk ginjal.

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ABSTRACT

Background: Sepsis is a common caused of mortality which may account for up to 50% death rate in patients with severe sepsis. Aminoglycoside antibiotics, especially amikacin, are the most commonly used antibiotics in the septic patients with Gram-negative bacterial infections, despite these drugs may induce nephrotoxicity in 10-25%

patients. Hence, it is essential to monitor amikacin trough plasma concentration and to detect nephrotoxicity as early as possible. The aim of this study is to find out the correlation between amikacin trough plasma concentration with normalized KIM-1 concentration in the urine as a sensitive and specific biomarker.

Methods:

This is a pilot study conducted in 12 septic patients treated with amikacin 1000 mg/day from May, 2015 to September, 2015. The correlation between amikacin

trough plasma concentrations measured at the third doses with the elevation of urine normalized KIM-1 concentrations measured at the first/second and the third doses were evaluated.

Results:

We observed 3 patients with amikacin trough plasma concentration above the safe level (>10 g/mL), while 9 patients had amikacin concentrations within the safe

plasma level (<10 g/mL). Furthermore, we observed 8 out of 12 patients with higher normalized KIM-1 concentrations measured at third doses compared to normalized KIM-1 concentrations measured at first/second doses. There was no correlation between amikacin trough concentration with elevated urine normalized KIM-1

concentration (p=0,16; r=0,43).

Conclusion:

Septic patients treated with amikacin 1000 mg/day hospitalized in ICU RSCM for 3 days have amikacin safe trough plasma concentration."

"Morbiditas pasien penyakit ginjal kronis memengaruhi jenis dan jumlah terapi obat yang potensial dapat menimbulkan beragam masalah terkait obat. Salah satu peran Apoteker adalah mengidentifikasi dan mencegah terjadinya masalah terkait obat. Penelitian ini bertujuan untuk mengetahui hubungan antara polifarmasi dan masalah terkait obat serta mengevaluasi jenis dan jumlah masalah terkait obat pada pasien ginjal kronis di ruang rawat inap RS PMI Bogor. Penelitian ini menggunakan rancangan studi potong lintang. Data primer adalah data masalah terkait obat. Data sekunder dari formulir pemantauan terapi obat oleh farmasi klinik. Penelitian dilakukan di ruang instalasi farmasi RS PMI Bogor periode 28 September?05 Desember 2015. Analisis univariat dilakukan untuk memperoleh gambaran distribusi frekuensi serta proporsi dari variabel yang diteliti. Analisis multivariat uji regresi logistik menguji hubungan variabel bebas, perancu, dan masalah terkait obat. Evaluasi dilakukan terhadap 682 terapi obat dari 92 orang pasien penyakit ginjal kronik. Persentase pasien dengan polifarmasi sebesar 83,7% dan pasien dengan masalah terkait obat sebesar 73,9%. Jumlah obat penyebab masalah terkait obat sebanyak 73 obat (55,3%). Jumlah masalah terkait obat dalam kategori masalah obat sebesar 207 masalah dengan persentase efek pengobatan yang tidak optimal sebesar 67,6%. Ada hubungan bermakna antara pasien yang mendapat obat polifarmasi dan kejadian masalah terkait obat (p=0,000). Pasien penyakit ginjal kronis dengan polifarmasi berisiko 21,67 kali mengalami kejadian masalah terkait obat.

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Morbidity in patients with chronic kidney disease affects variety of types and number of drug treatment, then it is potential to cause variety of types and number of drug-related problems. Pharmacists play a role in identifying and preventing drug-related problems. This study aimed to determine the relationship between polypharmacy and drug-related problems, as well as evaluating the type and number of drug-related problems in chronic kidney disease inpatient in Indonesian Red Cross Bogor hospital. This study was retrospective cross sectional study design. The primary data was obtained by identifying drug related problems. The secondary data was taken from drug therapy monitoring form by the clinical pharmacy. The study was conducted at the hospital pharmacy at PMI Bogor hospital during 28 September to 5 December 2015. Univariate analysis was performed to get the distribution frequency and proportion of the variables, such as the characteristics of the patient and drug therapy, as well as the number and types of drug-related problems with the classification of Pharmaceutical Care Network Europe (PCNE). Multivariate logistic regression analysis was conducted to test whether there was a relationship between the confounding variable with drug-related problems. An evaluation was taken on 682 drug treatment of 92 chronic kidney disease patients. The number of patients who experience polypharmacy was 83.7%. The number of patients experiencing drug-related problems was 73.9%. The number of problem in drug-related problems classification was 207 problems, with the nonoptimal treatment effect (67.6%). There was a significant association between patients who received polypharmacy and the incidence of drug-related problems (p=0.000). Chronic kidney disease patients who received polypharmacy had the risk of 21,667 times to experience drug-related problems."

"ABSTRAKTujuan penelitian ini adalah untuk mengembangkan model perilaku adaptasi pasien penyakit ginjal kronis pre dialisis serta mengidentifikasi efektifitas model terhadap respon adaptasi fisiologi, perilaku adaptasi psikologi, pengetahuan dan sikap. Penelitian ini merupakan riset development yang dilakukan dalam dua tahap. Tahap satu mengidentifikasi masalah melalui penelitian kualitatif dengan pendekatan fenomenologi deskriptif tentang pengalaman hidup pasien dengan penyakit ginjal kronis pre dialisis, dilanjutkan membuat solusi dengan mengembangkan model perilaku adaptasi pasien penyakit ginjal kronis pre dialisis. Penelitian tahap dua quasi eksperimen dengan desain pre-test-post-test with control group untuk melihat efektifitas model pada 70 pasien penyakit ginjal kronis pre dialisis 38 orang kelompok intervensi dan 32 orang kelompok kontrol . Hasil penelitian tahap satu berupa buku model dan panduan implementasi, materi pembelajaran perilaku adaptasi untuk perawat pelaksana, serta booklet perilaku adaptasi untuk pasien penyakit ginjal kronis pre dialisis. Hasil penelitian tahap dua membuktikan kelompok intervensi memiliki respon adaptasi fisiologi, perilaku adaptasi psikologi, serta pengetahuan dan sikap yang lebih baik dibanding kelompok kontrol. Kesimpulan hasil penelitian ini adalah model perilaku adaptasi pasien penyakit ginjal kronis pre dialisis efektif terhadap respon adaptasi fisiologi, perilaku adaptasi psikologi, pengetahuan dan sikap. Saran melakukan sosialisasi model, advokasi ke unit terkait, aplikasi dalam asuhan keperawatan pada pasien penyakit ginjal kronis pre dialisis. Kata kunci: model perilaku adaptasi, respon adaptasi fisiologi, perilaku adaptasi psikologi, penyakit ginjal kronis pre dialisis

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ABSTRACTThe purpose of this study is to develop a model of adaptation behaviors for patients with chronic kidney disease pre dialysis and identify the effectiveness of the model towards physiological adaptation response, psychological adaptation behavior, knowledge and attitude of the patients. The study is a development research done in two stages. Stage one is identification of the issues through qualitative study according to descriptive phenomenology approach related to patients rsquo life experiences with chronic kidney disease pre dialysis, continued by the development of a model of adaptation behaviors for patients with chronic kidney disease pre dialysis as a solution to the issue. Stage two is a quasi experiment according to pre test post test with control group design to observe the effectiveness of the model in 70 patients with chronic kidney disease pre dialysis 38 subjects in the intervention group and 32 subjects in control group . The result of stage one study is a model book and implementation guideline, adaptation behaviors learning material for caregiver nurse and basic adaptation behaviors booklet for patients with chronic kidney disease pre dialysis. The result of stage two study proved that the intervention group has a physiological adaptation response, psychological adaptation behavior, knowledge and attitude better than the control group. In conclusion, the constructed model of adaptation behaviors for patients with chronic kidney disease pre dialysis is effective towards physiological adaptation response, psychological adaptation behavior, knowledge and attitude of the patients. Suggestions for model dissemination, advocacy to related units, application in nursing care in patients with chronic kidney disease pre dialysis. Keywords Model of adaptation behaviors, physiological adaptation response, psychological adaptation behavior, chronic kidney disease pre dialysis"