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Latar Belakang: Salah satu faktor utama yang terlibat dalam gangguan mineral tulang dan muskuloskeletal pada pasien penyakit ginjal kronik (PGK) adalah Fibroblast Growth Factor-23 (FGF-23). Peningkatan kadar FGF-23 terjadi pada awal PGK dan semakin meningkat pada PGK tahap akhir terutama yang menjalani dialisis. FGF-23 mendapat perhatian khusus karena perannya terhadap otot skeletal pada pasien PGK yang menjalani hemodialisis belum diketahui secara pasti. 

Tujuan: Mengetahui korelasi antara kekuatan genggam tangan(KGT) dengan kadar FGF-23 pada pasien yang menjalani hemodialisis kronis.

Metode: Penelitianinimerupakanstudipotong lintang. Penelitian ini dilaksanakan di unit Hemodialisis Divisi Ginjal-Hipertensi Departemen Ilmu Penyakit Dalam RSCM Jakarta, pada 74 pasien dialisis 2 kali seminggu. Pengukuran FGF dengan pemeriksaan intactFibroblast Growth Factor-23 (iFGF-23) dan menilai KGT dengan dinamometer hidraulik tangan merek Jamar. Pemilihansubjekdilakukansecaraconsecutivesamplingsampaijumlah subyekyangdiperlukanterpenuhi.

Hasil: Subjek pada penelitian ini sebanyak 74 subjek dengan kadar pemeriksaan iFGF-23 pada laki-laki lebih tinggi dibandingkan dengan perempuan, (3276 [ min-maks; 41-6613]pg/ml dan1585 pg/ml, [min-maks; 21-4820])dan nilai KGT pasien laki-laki adalah 25 kg (min-maks; 11-48) dan perempuan adalah 20 kg (min-maks; 8-26). Setelah dilakukan penyesuaian dengan indeks komorbid charlson modifikasidan indeks massa tubuh, maka tidak didapatkan korelasi antara FGF-23 dengan KGT pada subjek laki-laki (r=-0.053, p=0.7) akan tetapi terdapat korelasi negatif bermakna pada subjek perempuan (r=-0.4, p=0.02). 

Kesimpulan: Kadar iFGF-23 memiliki korelasi negatif bermakna dengan KGT pada perempuan dan hal tersebut tidak ditemukan pada subjek penelitian laki-laki.

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Background: Patients with chronic kidney disease (CKD) face with muscle atrophy, low muscle strength, and low physical activity. One of the main factors involved in bone mineral and skeletal muscle dysfunction in patients with chronic kidney disease (CKD) is Fibroblast Growth Factor-23 (FGF-23). Despite FGF-23 associated left ventricular hypertrophy, there are no prior studies assessing whether FGF-23 level is associated with skeletal muscle strength in hemodialysis patient. 

Objective: To determine the correlation between hand-grip strength (HGS) and FGF-23 levels in patients undergoing twice-weekly hemodialysis patients.

Patient and Method: This is a cross-sectional study, which was conducted on 74 twice-weekly hemodialysis patient at the Hemodialysis Unit at Rumah Sakit Cipto Mangunkusumo, Jakarta. Before dialysis session, intact Fibroblast Growth Factor-23 (iFGF-23) were measured in singlicate from plasma samples and han-grip strength that measured by Jamar hydraulic hand dynamometer. Subject selection was done by consecutive sampling until the required number of subjects was fulfilled. 

Results: There were 74 subjects recruited in this study, which included 7 (18.9%) male and 3 (8.1%) female subject had body mass index (BMI) < 18.5 kg/m2. Level of iFGF23 were significantly higher in males than in females (3276 pg/ml [ min-max, 41-6613] and 1585 pg/ml, [min-max 21-4820], respectively). According to the Asian Working Group for Sarcopenia, the HGS value of male patients was lower than in females (25 kg [min-max; 11-48], (20 kg [min-max; 8-26], respectively). After adjusting to Modified Charlson Comorbidity index (mCCI) and BMI, we found a significant correlation iFGF-23 and HGS in the female subject (r = -0.4, p = 0.02 and no correlation between iFGF-23 and HGS in male subject (r = -0,053, p = 0.7). 

 

Conclusion: In twice-weekly hemodialysis patients, iFGF-23 has a significant correlation with HGS in women and this was not found in male subject.

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"Latar Belakang: Fibroblast Growth Factor-23 (FGF-23) merupakan penanda proses gangguan mineral tulang pada penyakit ginjal kronik dialisis. Peningkatan FGF-23 menyebabkan proses remodelling yang berkontribusi pada perkembangan hipertrofi ventrikel kiri (LVH) dan penurunan fraksi ejeksi ventrikel kiri (LVEF) secara langsung pada pasien hemodialisis masih kontroversi.Tujuan: Mengetahui hubungan kadar FGF-23 dalam serum dengan hipertrofiventrikel kiri dan fraksi ventrikel kiri pada pasien hemodialisis regular.Metode: Studi potong lintang terhadap 111 pasien hemodialisis regular dua kali seminggu di Rumah sakit Cipto Mangunkusumo Jakarta selama periode Juli sampai September 2023. Dilakukan Uji Mann Whitney dan Chi Square untuk menilai perbedaan serta hubungan kadar FGF-23 dengan hipertrofi ventrikel kiri (LVH) dan fraksi ejeksi ventrikel kiri (LVEF).Hasil: Dari 111 subjek yang diikutsertakan pada analisis didapatkan median usia subjek yaitu 51 (37-61) tahun, kadar rerata iFGF-23 536,2 pg/ml (min-max 1358-2180,1). Didapatkan hasil echocardiography gambaran LVH sebesar 84,68% dan LVEF yang turun 10,81% . Didapatkan perbedaan (terbalik) kadar FGF-23 antara LVH dengan Tidak LVH (p value 0,003). Didapatkan hubungan (terbalik) kadar FGF-23 dengan LVH p value 0,010 PR (95%IK) 0,792 (0,663-0946). Tidak didapatkan perbedaan kadar FGF-23 antara yang mengalami penurunan LVEF dengan LVEF normal.Kesimpulan: Terdapat perbedaan (terbalik) kadar FGF-23 antara hipertrofi ventrikel kiri dengan tidak hipertrofi ventrikel kiri namun tidak terdapat perbedaan kadar FGF-23 antara yang mengalami penurunan fraksi ejeksi ventrikel kiri dengan yang tidak mengalami penurunan fraksi ejeksi ventrikel kiri.

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Background: Fibroblast Growth Factor-23 (FGF-23) is a marker that indicate the process of bone mineral disorders in chronic kidney disease dialysis. An elevated FGF-23 causes a remodeling process that contributes to the development of left ventricle hypertrophy (LVH) and the still controversial direct decline of left ventricle ejection fraction (LVEF) among hemodialysis patients.

Objective: To seek out the connection between FGF-23 levels in serum with left ventricle hypertrophy and left ventricle ejection fraction among regular hemodialysis patients.

Methods: It is a cross-sectional study conducted to 111 regular hemodialysis patients for twice a week in Cipto Mangunkusumo Hospital in Jakarta from July to September 2023. The Mann Whitney and Chi Square tests were subsequently used to evaluate the difference as well as the connection between FGF-23 levels with left ventricle hypertrophy (LVH) and left ventricle ejection fraction (LVEF).

Results: Of the 111 subjects included in the analysis, the median age of the subject was 51 (37-61) years, show an average level of iFGF-23 value at 536.2 pg/ml (min-max 1358-2180.1). Results obtained from the echocardiography images show that 84,68% had LVH Meanwhile, LVEF results of decline was 10,81%. There is a difference (reverse) in FGF-23 levels between patients with LVH and patients without LVH (p value 0.003). Furthermore, there is a correlation (reverse) between FGF-23 levels with LVH p value 0.010 PR (CI 95%) 0.792 (0.663-0.946). Nonetheless, there is no difference between the levels of FGF-23 between subjects who experienced LVEF decline and those who did not experience LVEF normal.

Conclusion: There is a difference (reverse) in FGF-23 levels between subjects with LVH and those without LVH. However, there is no difference in FGF-23 levels among those who experienced left ventricle ejection fraction (LVEF) decline and those who did not experience LVEF decline."