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"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. Prevalensi malnutrisi energi-protein (MEP) tinggi pada pasien penyakit ginjaI kronik yang menjalani hemodialisis (PGK-HD), dan MEP merupakan penyebab meningkatnya morbiditas dan mortalitas. Berbagai upaya telah dilakukan untuk mengatasi MEP pada pasien PGK-HD, antara lain dengan pemberian nutrisi parenteral intradialisis (IDPN). Dari beberapa penelitian yang telah dilakukan didapatkan basil yang masih kontroversial mengenai manfaat IDPN.Tujuan. Menilai efek IDPN terhadap konsentrasi albumin dan prealbumin serum selama prosedur HD; menilai efek IDPN terhadap indeks masa tubuh (IMT), konsentrasi albumin dan prealbumin serum setelah pemberian IDPN 2 kali seminggu selama 6 minggu, dan efek IDPN terhadap konsentrasi albumin dan prealbumin serum 3 minggu setelah pemberian IDPN dihentikan.Metodologi. Studi intervensional-prospektif selama 9 minggu dilakukan pada pasien PGK-HD usia 20-65 tahun yang telah menjalani HD minimal satu tahun, konsentrasi albumin serum < 3,5 g/dL, tidak menderita penyakit infeksi berat, keganasan, sirosis had, diabetes melitus tidak terkontrol, atau gagal jantung berat, di unit HD RS Ciptomangunkusumo, RS Islam Cempaka Putih, dan RS PGI Cikini Jakarta. Subyek penelitian diberikan IDPN 2 kali seminggu selama 6 minggu, dan diukur konsentrasi albumin, prealbumin, c-reactive protein (CRP) sebelum dan setelah HD+IDPN pertama dan HD+IDPN keduabelas. IMT diukur sebelum dan setelah 6 minggu pemberian IDPN. Konsentrasi albumin, prealbumin serum 3 diukur kembali 3 minggu setelah pemberian IDPN dihentikan. Dilakukan uji-t berpasangan atau uji Wilcoxon sesuai dengan tujuan penelitian.Hasil. Selma periode Februari 2005-Maret 2006 terkumpul 14 subyek, 1 subyek meninggal setelah mendapat IDPN selama 6 minggu. Didapatkan peningkatan tidak bermakna konsentrasi albumin serum (3,24 ± 0,38 menjadi 3,34 ± 0,56 g/dL, P 0,341-dan 3,26 ± 0,40 menjadi 3,47 ± 0,55, P = 0,053), dan peningkatan bermakna prealbumin (18,76 ± 7,92 menjadi 22,37 ± 10,24 mg/dL, P = 0,033 dan 16,94 ± 7,81 menjadi 23,16 + 17,21 mgldL, P = 0019), berturut-turut setelah HD+IDPN pertama dan keduabelas. Setelah HD+IDPN 2 kali seminggu selama 6 minggu, didapatkan peningkatan tidak bermakna IMT (21,75 + 2,98 menjadi 21,95 ± 3,27, P = 0,139), konsentrasi CRP serum (38,46 + 54,92 menjadi 60,04 ± 86,54 mg/L, P = 0,826), konsentrasi albumin serum, baik dibandingkan sebelum HD+IDPN pertama dengan keduabelas (3,24 ± 0,38 menjadi 3,26 ± 0,40 gldL, P = 0,795), maupun dibandingkan setelah HD+IDPN pertarna dengan keduabelas (3,34 ± 0,56 menjadi 3,47 ± 0,55 gldL), tetapi didapatkan penurunan tidak bermakna prealbumin jika dibandingkan sebelurn HD+IDPN pertarna dengan keduabelas (18,76 ± 7,92 menjadi 16,94 ± 7,81 mg/L, P = 0,109), dan peningkatan tidak bermakna jika dibandingkan setelah HD+IDPN pertama dengan keduabelas (22,37 + 10,24 menjadi 23,16 + 17,21 mgfL). Tiga minggu setelah IDPN dihentikan, didapatkan peningkatan tidak bermakna konsentrasi albumin serum (3,26 ± 0,40 menjadi 3,30 ± 0,31, P = 0,699), penurunan tidak bermakna prealbumin (16,94 ± 7,81 menjadi 16,65 ± 6,72, P = 0,552).KesimpuIan. Pemberian IDPN dapat meningkatkan konsentrasi prealbumin serum dan mencegah menurunnya albumin dalam setiap sesi HD. Pemberian IDPN 2 kali seminggu selama 6 minggu dapat menstabilkan kecenderungan menurunnya IMT dan konsentrasi albumin serum, tetapi tidak dapat menstabilkan prealbumin, dan konsentrasi albumin serum dapat bertahan selama 3 minggu setelah IDPN dihentikan.

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Backgrounds. In chronic kidney disease patients undergoing hemodialysis (CKDHD), prevalence of protein-energy malnutrition (PEM) is high, and it is associated with increased morbidity and mortality. Many interventions to improve PEM in CKD-HD patients have been conducted, one of them is intradialytic parenteral nutrition (IDPN). Data from many studies showed that beneficial effect of IDPN to improve PEM in CKD-HD patients is still controversial.Objectives. To assess effect of IDPN on serum albumin and prealbumin concentration during each HD procedure, effect of IDPN on body mass index (BMI), serum albumin and prealbumin concentration after administration twice a week for 6 weeks, and effect of IDPN on serum albumin and prealbumin concentration 3 weeks after IDPN was discontinued.Methods. Prospective-interventional study for 9 weeks was conducted in CKD patients undergoing maintenance HE) at least for 1 years, age 20-65 years old, not suffering severe infection disease, malignancy, cirrhosis hepatis, severe heart disease, acute coroner syndrome, and serum albumin concentration < 3.5 gldL, at HD unit Ciptomangunkusumo hospital, Islamic Cempaka Putih hospital, and PGI Cikini hospital, Jakarta. The subjects received IDPN consisting of 9% essential and non essential amino acids, 40% glucose, and 20% fat emulsion, twice a week for 6 weeks. Before and 2 hours after the HD+151 IDPN and HD+12th IDPN, serum albumin, prealbumin, c-reactive protein (CRP) concentration were measured. BMI was measured before and after subjects received IDPN for 6 weeks. Serum albumin, prealbumin were measured again 3 weeks after IDPN discontinued. Dependent sample t-test or Wilcoxon test was used to analyse the data.Results. During February 2005 - March 2006, 14 patients were included into subjects of this study. There were no significant increase in serum albumin concentration (3.24 ± 0.38 to 3.34 ± 0.56 g/dL, P = 0.341 and 3.26 + 0.40 to 3.47 ± 0.55, P = 0.053), and significant increase in prealbumin (18.76 + 7.92 to 22.37 + 10.24 mg/dL, P = 0.033 and 16.94 + 7.81 to 23.16 + 17.21 mgldL, P = 0.019), respectively after the HD+15tIDPN and HD+12thIDPN. After IDPN administration twice a week for 6 weeks, there were no significant increase in BMI (21.75 + 2.98 to 21.95 + 3.27, P = 0.139), serum CRP (38.46 + 54.92 to 60.04 + 86.54 mg/L, P = 0.826), and albumin concentration, when it was compared before the HD+15`IDPN and HD+12tIDPN (3.24 ± 0.38 to 3.26 + 0.40 gldL, P = 0.795), and when it was compared after the HD+1$`IDPN and HD+12thIDPN (3.34 ± 0,56 to 3.47 + 0.55 g/dL,), but there was no significant decrease in prealbumin when it was compared before the HD+15`IDPN and HD+12'hIDPN (18.76 + 7.92 to16.94 + 7.81, P = 0.109), and there was no significant increase when it was compared after the HD+15tIDPN and HD+12thIDPN (22,37 + 10,24 to 23,16 + 22,10 mg/L). Three weeks after IDPN discontinued, there were no significant increase in serum albumin concentration (3.26 + 0.40 to 3.30 + 0.31 gldL, P = 0.699), but no significant decrease in prealbumin (16.94 + 7.81 to 16.65 + 6.72 mgldL, P = 0.552).Conclusions. IDPN administration during each HD session could increase serum prealbumin concentration and prevent the decrease of albumin, whereas IDPN administration twice a week for 6 weeks could stabilize the downward trend in BM1 and serum albumin concentration, but couldn't stabilize prealbumin, the serum albumin concentration could be stabilized for 3 weeks after IDPN administration discontinued."

"Hemodialisis merupakan salah satu terapi pengganti ginjal yang paling banyak dipilih di Indonesia. Penelitian ini bertujuan untuk mendapatkan gambaran tentang pengalaman hidup klien dengan hemodialisis terhadap kualitas hidup dalam konteks asuhan keperawatan di RSUP Fatmawati. Penelitian ini menggunakan metode penelitiankualitatif dengan pendekatan fenomenologi. Data didapat dengan wawancara mendalam terhadap 6 partisipan yang terdiri dari 3 laki-laki dan 3 perempuan, usia 27 ? 60 tahun dengan lamanya menjalani hemodialisis 2 ? 10 tahun. Hasil wawancara di analisa dengan menggunakan metode Colaizzi.Hasil penelitian didapatkan 5 tema yaitu: perubahan pemenuhan kebutuhan dasar klien, kualitas spiritual meningkat, kualitas fisik dan psikologis menurun, puas akan pelayanan keperawatan, kebutuhan memperoleh dukungan sosial. Berdasarkan penelitian ini dapat disimpulkan bahwa klien hemodialisis mengalami perubahan terhadap kondisi fisik, psikologis, sosial, ekonomi dan spiritual. Namun sebagian besar klien sudah dapat beradaptasi dengan kondisi yang dihadapi.

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Hemodialysis is one of the most renal replacement therapy was choose in Indonesia. The purpose of the study was to explore the experiences of hemodialysis patients on quality of life in the on nursing care contex at Fatmawati Hospital Jakarta. This study used qualitative research methods with the approach of phenomenology. Data obtained with a dept interviews from 6 participants, they were 3 male and 3 famale, participants age ranged between 27 ? 60 years. Duration of received maintenance hemodialysis from 2 to 10 years.

The result was analyzed used Colaizzi method. The result obtained five themes : the change of basic human needs, the spiritual quality increases, the quality of physical and psycological decreases, satisfied with nursing service , the need for social support, Based on this research concluded that hemodialysis patients experiencing changed in physical, psycological, social, economic and spiritual, but most patients are able to adapted to the their conditions uncountered."

"ABSTRAK Latar Belakang: Skor kualitas hidup yang rendah pada pasien hemodialisis (HD) dikatakan berhubungan dengan peningkatan risiko mortalitas. Namun, belum ada penelitian yang melaporkan hubungan langsung antara laju aliran darah (Qb) dan skor kualitas hidup pada pasien HD dua kali seminggu.Tujuan: Mengetahui hubungan antara laju aliran darah (Qb) dengan skor kualitas hidup pada pasien-pasien yang menjalani hemodialisis kronik dua kali seminggu.Metode: Penelitian potong-lintang ini dilakukan di Unit Hemodialisis di Rumah Sakit Cipto Mangunkusumo, Jakarta. Pasien dengan gangguan fungsi luhur, chronic heart failure NYHA (New York Heart Association) kelas III-IV, buta, imobilisasi ketergantungan berat serta menolak ikut penelitian tidak diikutsertakan dalam penelitian. Pasien kemudian dibagi menjadi grup 1 (Qb > 250 ml/menit) dan grup 2 (Qb ≤ 250 ml/menit). Skor kualitas hidup dinilai menggunakan kuesioner KDQOL-SFTM, yang dibagi dalam skor fisik (PCS), mental (MCS) dan masalah terkait penyakit ginjal (KDCS). Hubungan antara Qb dan skor kualitas hidup dianalisis menggunakan metode chi-square serta regresi logistik untuk mendapatkan nilai rasio prevalensi (RP) yang adjusted.Hasil: Sebanyak 132 pasien dimasukkan kedalam analisis penelitian. Nilai Qb digrup 1 memiliki hubungan dengan skor PCS ≥ 44 (RP 1,86; IK 95% 1,15-2,99), serta skor KDCS ≥ 52 (RP 1,41; IK 95% 1,03-1,92). Setelah analisis multivariat, nilai Qb digrup 1 masih berhubungann dengan skor PCS ≥ 44 (RP adjusted 1,87; IK 95% 1,15-2,51) dan skor KDCS ≥ 52 (RP adjusted 1,31; IK 95% 1,004-1,50).Simpulan: Nilai Qb > 250 ml/menit memiliki hubungan yang signifikan dalam kualitas hidup fisik dan masalah terkait penyakit ginjal yang lebih baik pada pasien hemodialisis 2 kali seminggu.

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ABSTRACT

Background. A low quality of life (QoL) score in hemodialysis (HD) patients was related to increased risk of mortality. However, there was no study reported the direct relationship between BFR and QoL in twice-weekly HD patients.

Objectives. To determine the relationship between blood flow rate and quality of life in twice-weekly hemodialysis patients.

Methods. This cross-sectional study was conducted at the Hemodialysis Unit in Cipto Mangunkusumo Hospital, Jakarta. Patients with neurocognitive impairment, chronic heart failure NYHA (New York Heart Association) class III-IV, blindness, immobilization with severe dependence and refused to participate were excluded in the study. Patients were divided into group 1 (BFR > 250 ml/min) dan group 2 (BFR ≤ 250 ml/min). The QoL was assessed using KDQOL-SFTM questionnaire, which was divided in physical (PCS), mental (MCS) and kidney disease-related (KDCS) scores. Relationship between BFR and QoL scores were analyzed using chi-square and logistic regression methods in order to determine adjusted Prevalence Ratio (PR).

Results. A total of 132 patients were included in the analysis. The BFR in group 1 was associated with PCS scores ≥ 44 (PR 1.86; 95% CI 1.15-2.99), as well as KDCS scores ≥ 52 (PR 1.41; 95% CI 1.03-1.92). After multivariate analysis, BFR values ​​of patients in group 1 were still associated with PCS scores ≥ 44 (adjusted PR 1.87; 95% CI 1.15-2.51) and KDCS scores ≥ 52 (adjusted PR 1.31; 95% CI 1.004-1.50).

Conclusion. The BFR values > 250 ml/min had a significant relationship for better physical and kidney disease-related quality of life in twice-weekly HD patients."

"Introduction: Central venous stenosis (CVS) or occlusion is a severe complication in hemodialysis patients, which significantly decreases the patency of all vascular dialysis access components, including arteries and branches, AV anastomosis, peripheral veins, and central veins. The main etiology of CVS is mostly secondary to the placement of temporary or permanent dialysis catheters in the subclavian vein, internal jugular vein, and femoral vein. Standard endovascular therapy for central venous stenosis is conventional balloon angioplasty. Method: This is a retrospective study using medical records from June 2013 to August 2018. Patients who underwent plain old balloon angioplasty (POBA) procedures in the CVS condition due to the installation of hemodialysis catheter access were included in this study. The analysis was performed to assess the characteristics and data distribution of each variable. Results: Significant factors related to the success of endovascular procedure in patients with central venous stenosis with POBA were the onset of clinical symptoms (<3 months; p <0.001), duration of catheter placement (<2.5 months; p <0.001), history of previous catheter placement (no more than once, p <0.001), initial stenosis (<80; p <0.001), and diameter of POBA (≥ 10 mm; p <0.001). Conclusion: Some factors influenced the success of the POBA procedure for overcoming CVS. The need to understanding the use of hemodialysis catheter access according to the guideline is important."

"Pendahuluan: KDOQI menyebutkan infeksi adalah komplikasi utama terkait penggunaan kateter akses hemodialisis jangka panjang. KDOQI merekomendasikan pemasangan kateter vena tunneling (TCC) hemodialisis pada vena jugularis interna (VJI) kanan dengan posisi ujung TCC ditempatkan di atrium kanan dan bukaan lumen arteri menghadap ke mediastinum. Berdasarkan penelitian yang dilakukan angka catheter related bacteremia (CRB) sebesar 35% pada pemakaian 3 bulan dan 54% untuk pemakaian 6 bulan. Posisi ujung TCC akses hemodialisis VJI kiri mempunyai pengaruh terhadap kejadian disfungsi dan infeksi dibandingkan jika terpasang di sisi kanan.Metode: Dilakukan studi cross sectional dengan 62 subjek pasien hemodialisis menggunakan akses TCC VJI. Dicari hubungan antara posisi pemasangan TCC, posisi ujung TCC dan faktor risiko dengan kejadian terduga CRB menggunakan uji Chi Square dengan nilai p<0,05 dianggap bermakna secara statistik dan penghitungan odd ratio (OR) interval kepercayaan 95%. Diambil data posisi pemasangan TCC, posisi ujung TCC, terduga CRB serta karakteristik berupa usia, jenis kelamin serta status DM di RSCM Januari 2018 sampai Januari 2019.Hasil: Enam puluh dua subjek yang dilibatkan dalam penelitian ini 45 orang (72,6%) berusia 60 tahun kebawah. Empat puluh satu subjek (66,1%) berjenis kelamin pria. Lima belas subjek menderita DM (24,2%). Posisi ujung TCC yang didapatkan dari 62 subjek tersebut, 39 (62,9%) berada di VKS, 2 (3,2%) pada CAJdan 21 (33,9%) pada atrium kanan. Dari 62 subjek tersebut 22 (35,48%) diantaranya mengalami kejadian terduga CRB. Tidak didapatkan hubungan yang bermakna antara posisi ujung TCC VJI dengan kejadian terduga CRB (p = 0,92, OR 1,05 dengan IK 95% = 0,35 – 3,08). Usia, jenis kelamin, dan status DM tidak merupakan faktor risiko bermakna secara statistik berhubungan dengan kejadian terduga CRB.Kesimpulan: Studi ini mendapatkan hasil tidak ada hubungan kemaknaan posisi ujung TCC dan faktor risiko diteliti dengan kejadian terduga CRB.

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Introduction: KDOQI stated infection is the main complication of long-term catheter use as hemodialysis access. KDOQI recommends insertion of tunneling venous hemodialysis catheter in the right internal jugular vein (IJV) with the tip placed in the right atrium and the arterial lumen opening facing the mediastinum. Previous study stated that the number of catheter related bacteremia (CRB) is 35% at 3 months use and 54% at 6 months use. The TCC tip position as hemodialysis access in left IJV is correlated more to dysfunction and infection compared to the right IJV.

Method: A cross-sectional study was conducted with 62 subjects of hemodialysis patients using IJV TCC access. The correlation between TCC insertion location, TCC tip position, and risk factors with suspected CRB was analyzed using Chi Square Test. A p value <0.05 was considered statistically significant. The odds ratio (OR) with 95% confidence interval was analyzed. The data of TCC insertion location, TCC tip position, suspected CRB incidence, and subject’s characteristics including age, sex, and DM status were gathered in RSCM from January 2018 to January 2019.

Results: Within 62 subjects included in this study 45 (72,6%) were 60 y.o or less. Forty one (66,1%) subjects were male. Fifteen had DM as comorbid (24,2%). Thirty nine TCC tip position were in SVC (62,9%), 2 were in CAJ (3,2%) and 21 were in (33,9%)RA. Twenty two from 62 had suspected CRB (35,48%). There is no significant correlation between TCC tip position with suspected CRB incidence (p

= 0.92, OR 1,05, 95% CI = 0.35 – 3.08). Age, sex, and DM status were not statistically proven as risk factors of suspected CRB.

Conclusion: There is no significant correlation between TCC tip position and studied risk factors with suspected CRB."

"Anak dengan penyakit ginjal kronis memiliki ketergantungan yang tinggi terhadap pengasuhnya (caregiver). Caregiver pada anak yang menjalani hemodialisis rentan mengalami kelelahan fisik, psikologi, sosial serta finansial. Kebutuhan keterampilan tambahan dalam perawatan dibutuhkan untuk membangun adaptasi yang positif serta kemampuan koping caregiver. Teori model adaptasi Roy memberikan arahan dalam intervensi keperawatan pada caregiver melalui edukasi suportif. Karya ilmiah ini bertujuan untuk menganalisis penerapan model adaptasi Roy pada 5 kasus kelolaan sebagai upaya optimalisasi pemberian asuhan keperawatan pada anak yang menjalani hemodialisis rutin. Asuhan keperawatan dilakukan berdasarkan tahapan pengkajian (perilaku dan stimulus), merumuskan diagnosis keperawatan, penentuan tujuan, intervensi dan evaluasi. Model adaptasi Roy dapat diterapkan pada perawatan anak yang menjalani hemodialisis rutin. Proyek inovasi edukasi suportif yang diberikan kepada 19 caregiver anak yang menjalani hemodialisis signifikan menurunkan caregiver burden dan dapat diaplikasikan sebagai intervensi keperawatan non-invasif, non-farmakologi dalam mengurangi beban perawatan dan meningkatkan kemampuan adaptasi pasien terhadap penyakitnya.

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Children with chronic kidney disease have a high dependence on their caregivers. Caregivers in children undergoing hemodialysis are vulnerable to physical, psychological, social and financial exhaustion. The need for additional skills in care is needed to build positive adaptation and coping abilities of caregivers. Roy's adaptation model theory provides direction in nursing interventions to caregivers through supportive educative program. This scientific work aims to analyze the application of Roy's adaptation model in 5 managed cases as an effort to optimize the provision of nursing care to children undergoing routine hemodialysis. Nursing care is carried out based on the stages of assessment (behavior and stimulus), formulating nursing diagnoses, setting goals, interventions and evaluations. Roy's adaptation model can be applied to the care of children undergoing routine hemodialysis. The supportive educative program given to 19 caregivers of children undergoing hemodialysis significantly reduces the caregiver burden and can be applied as a non-invasive, non-pharmacological nursing intervention in reducing the burden of care and increasing the patient's ability to adapt to his illness."

"ABSTRAKPada pasien hemodialisis (HD), banyak penelitian di negara maju membuktikan hubungan yang erat antara inflamasi, komplikasi kardiovaskular, malnutrisi, dan mortalitas yang tinggi. Inflamasi yang ditandai dengan meningkatnya IL-6 dan CRP, serta berkurangnya sitokin anti-inflamasi IL-10, mempunyai peran utama dalam terjadinya berbagai komplikasi pada pasien HD di Indonesia, terdapat perbedaan pelaksanaan HD, yaitu HD yang lebih jarang (2 kali seminggu), banyak menggunakan dialiser selulosal diasetat, proses ulang, low flux, dan tanpa air yang sangat murni, yang kesemuanya menyebabkan risiko respons inflamasi yang tinggi. Pada kenyataannya, prevalensi inflamasi dan nilai rata-rata CRP di Indonesia lebih rendah. Polimorfisme gen IL-6-174G>C dan gen IL-10-1082G>A telah dibuktikan mempengaruhi tingkat produksi IL-6 dan CRP. Perbedaan proporsi alel G, C pada IL-6-174, dan alel G, A pada IL-1082, berbagai bangsa dan ras, mungkin menjadi penyebab perbedaan di atas. Sindrom inflamasi malnutrisi (SIM) pada pasien HD berbeda dengan malnutrisi pada populasi. Pada SIM, faktor inflamasi, uremia dan katabolisme protein lebih berperan. Hal ini memerlukan cara penilaian status malnutrisi yang berbeda. Penelitian ini dilakukan untuk mendapatkan frekuensi polimorfisme gen IL-6-174 dan IL-10-1082, mengetahui faktor yang berperan dalam SIM, mengetahui perbedaan prevalensi inflamasi pada pasien dengan malnutrisi dan sebagai validitas penilaian SGA.Telah dilakukan penelitian pada pasien yang menjalani HD 2 kali seminggu, 5 jam per kali HD, tanpa komplikasi penyakit lainnya, dan semua memakai dialiser selulosa diasetat yang diproses ulang. Dari 64 pasien yang diperiksa, didapatkan gen IL-6-74GG 95,31%, CC 3,13% dan GC 1,56%. Gen IL-1082AA 89,06%, GA 10,94%, dan GG tidak didapatkan. Proporsi alel ini hampir sama seperti yang didapatkan di Korea, Jepang dan Cina, berbeda dengan yang didapat di AS, ras Kaukasia, Amerika-Afrika, Hispanik dan Eropa (Kaukasia). Selain perbedaan pada proporsi gen, kami mendapatkan konsenlrasi CRP (6,23±5,57 mg/L), frekuensi malnutrisi (24,7%), dan skor MIS (6,7) yang lebih rendah dibanding dengan data dari AS dan Eropa. Mengingat sedikitnya alel C pada gen IL-6-174 dan alel G pada gen IL-10-1082, analisis statistik yang dilakukan tidak dapat memperlihatkan pengaruh perbedaan alel terhadap manifestasi klinik. Inflarnasi kronik mempengaruhi terjadinya malnutrisi (PR 3,03; 1K 95% 1,53-6,06; P = 0,012). Penilaian dengan skala SGA berkorelasi balk dengan parameter antropometri (IMT, LLA, LOLA, HGS), dan albumin serum. Albumin serum sebagai parameter inflamasi kronik berkorelasi balk dengan parameter nutrisi yang lain, sedangkan CRP tidak. Didapatkan kesan yang kuat bahwa pada pasien HD, gen IL-174GG bersifat protektif, sedangkan gen IL-1082AA tidak begitu berperan. Selain itu dibuktikan adanya pengaruh inflamasi terhadap malnutrisi dan SGA terbukti merupakan penilaian sindrom malnutrisi inflamasi yang cukup baik.

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ABSTRACT

Many studies on HD patients in developed countries have conferred strong evidence of closed correlation between inflammation, cardiovascular complication and high mortality rates. Inflammation, indicated by high levels of CRP and IL-6, has a major role in initiating and sustaining complications. Adapting to high cost, HD in Indonesia is conducted in a little different ways. Patients are dialyzed twice a week, 5 hours each, using reprocessed cellulose/diacetate membrane dialyzer, and without ultrapure water. All of these contribute to a high risk of inflammation, but in fact the prevalence of inflammation in Indonesia is relatively low. IL-6-174G>C and IL-10-1082G>A polymorphic gene have been proven to influence the production of IL-6 and CRP. The difference in the proportion of allele G, C in IL-6-174, allele G, A in IL-1082 in a variety of people's races might cause the difference in the prevalence and the level of inflammation. Malnutrition inflammation syndrome (MIS) on HD patients is different from malnutrition in general population. In MIS, the inflammatory factors, uremia, and protein catabolism of protein are more dominant. These matters probably require a different assessment method of malnutrition status. The purpose of this study was to obtain the frequency of polymorphic gene IL-6-174 and IL-10-1082 to find out the prominent factors in MIS, and to find out the difference in the inflammation prevalence in patients with malnutrition and to serve as validity of SGA assessment.

A study on patients who were on hemodialysis twice a week, 5 hours each session has been conducted. The subjects had no other co-morbidities and all of them used reprocessed diasetat cellulose dialyzers. Out of 64 patients examined, IL-6-174GG was obtained 95.31%, CC 3.13% and GC 1.56%, IL-1082AA 89.06%, GA 10.94%, but absence of GG genotype. The proportion of these alleles was almost similar to that obtained in Korea, Japan and China, but it was different from that obtained in the US for the Caucasian race, African Americans, Hispanic people, and the Caucasian people in Europe_ Besides the difference in gene proportion, it was obtained that CRP (6.23±5.57 mg/L), malnutrition (24.7%), and malnutrition inflammation score (6.7) were lower compared with the data from Europe and the United States. Considering the scanty amount of allele C in IL-6-174 gene and G allele in IL-10-1082 gene, based on the statistic analysis performed it did not revealed the influence of the difference in allele on the clinical manifestation. It was found that chronic inflammation influenced the occurrence of malnutrition (PR 3.03; CI 95% 1.53-6.06; P = 0,012). The scoring by the SGA scales correlated well with the anthropometric parameters (body mass indes, mid arm circumtance, midarm muscle circumference, hand grip strength and serum albumin. A very resolute impression was obtained in HD patients that IL-6-174GG gene was protective in nature whereas IL-10-1082 AA gene had a less considerable role. In addition to that, it was proven that there was influence of information on the occurence of malnutrition and SGA consitutes a good enough assessment for malnutrition inflammation syndrome."