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"Glikosaminoglikan merupakan komponen penyusun glikokaliks yang berperan penting dalam per selektivitas muatan anionik kapiler glomerulus. Gangguan hemodinamik dan metabolik akibat hiperglikemia kronis menyebabkan peluruhan komponen glikokaliks endotel. Beberapa pedoman telah menyetujui keamanan tiap OAD berdasarkan fungsi ginjal. Tujuan penelitian adalah menilai keamanan penggunaan metformin (metformin dan metformin-glimepirid) berdasarkan fungsi ginjalnya serta menilai perbandingan kadar GAG urin pasien DMT 2 kelompok risiko rendah terhadap risiko sedang-tinggi PGK. Desain penelitian potong lintang dan metode consecutive di Puskesmas Depok Jaya dan Kecamatan Pasar Minggu. Sampel urin dan darah dikumpulkan untuk pengukuran eLFG, HbA1c, ACR, dan kadar GAG urin. Sebanyak 137 partisipan dinilai keamanan penggunaan metformin berdasarkan fungsi ginjalnya. Terdapat ketidaksesuaian pada 1 partisipan dalam penggunaan metformin (n=55) dan semua partisipan (n=82) sesuai dengan pedoman dalam penggunaan metformin-glimepirid. Hanya 121 partisipan yang dianalisis kadar GAG urin menggunakan 1,9-DMMB dan terdiri dari 4 yaitu kelompok risiko rendah PGK: G1-A1(eLFG ≥90ml/min/1,73m² - <30mg/g) (n=25) dan G2-A1(eLFG 60-89ml/min/1,73m² - <30mg/g) (n=45) serta risiko sedang-tinggi PGK: GI-A2(eLFG ≥ 90ml/menit/1,73m² - >30mg/g) (n=23) dan G2-A2(eLFG 60-89ml/menit/1,73m² - >30mg/g) (n=28). Tidak ada perbedaan bermakna (p<0,05) pada karakteristik dasar dan klinis keempat kelompok kecuali usia (p=0,006) dan HbA1c (p<0,001). Tidak terdapat perbedaan kadar GAG urin yang bermakna antara kelompok G1 dengan G2 (p=0,290) serta pada keempat kelompok (p=0,221). Terdapat perbedaan kadar GAG urin yang bermakna (p=0,034) pada kelompok normoalbuminuria dan albuminuria. Faktor lain seperti durasi DMT 2 >5 tahun dan komorbiditas dapat meningkatkan kadar GAG urin. Oleh karena itu, diperlukan studi lanjut mengenai potensi GAG urin pada awal perkembangan penyakit ginjal diabetes.

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Glycosaminoglycans are components of the glycocalyx which play an important role in the permeselectivity of the anionic charge of the glomerular capillaries. Hemodynamic and metabolic disturbances due to chronic hyperglycemia cause the breakdown of the glycocalyx component of the endothelium. Several guidelines have agreed on the safety of each OAD based on renal function. The aims of this study were to assess the safety of using metformin (metformin and metformin-glimepiride) based on kidney function and to evaluate the comparison of urinary GAG levels in patients with DMT 2 in low-risk groups to moderate-high risk of CKD. Cross-sectional research design and consecutive in Depok Jaya Public Health Center and Pasar Minggu District. Urine and blood samples were collected for measurement of eGFR, HbA1c, ACR, and urinary GAG levels. A total of 137 participants assessed the safety of using metformin based on their kidney function. There was a discrepancy in 1 participant in the use of metformin (n=55) and all participants (n=82) according to the guidelines for the use of metformin-glimepiride. Only 121 participants were analyzed for urine GAG ​​levels using 1,9-DMMB and consisted of 4 low risk groups for CKD: G1-A1(eGFR 90ml/min/1.73m² - <30mg/g) (n=25) and G2-A1(eGFR 60-89ml/min/1.73m² - <30mg/g) (n=45) and moderate-high risk of CKD: GI-A2(eGFR 90ml/min/1.73m² - >30mg/g) (n=23) and G2-A2(eLFG 60-89ml/min/1.73m² - >30mg/g) (n=28). There was no significant difference (p<0.05) in the baseline and clinical characteristics of the four groups except age (p=0.006) and HbA1c (p<0.001). There was no significant difference in urine GAG ​​levels between the groups G1 with G2 (p= 0.290) and in the four groups (p= 0.221). There was a significant difference in urine GAG ​​levels (p= 0.034) in the normoalbuminuria and albuminuria groups. Other factors such as duration of DMT 2 > 5 years and comorbidities can increase urinary GAG levels. Therefore, further studies are needed regarding the potential of urinary GAGs in the early development of diabetic kidney disease. "

"Glikokaliks endotel pada glomerulus membantu mempertahankan homeostasis vaskular. Perubahan hemodinamik ginjal yang disebabkan oleh hiperglikemia kronis meningkatkan tekanan hidrolik glomerulus yang berkontribusi terhadap peluruhan glikokaliks. Faktor ini berkontribusi terhadap inisiasi penyakit ginjal kronis. Penelitian ini bertujuan untuk mengetahui asosiasi antara degradasi glikokaliks urin dan penyakit ginjal diabetes yang dinilai dengan estimasi laju filtrasi glomerulus (eLFG) pada pasien diabetes melitus tipe 2. Penelitian dilakukan dengan desain potong lintang dan teknik pengambilan sampel consecutive di Puskesmas Kecamatan Pasar Minggu. Sampel darah dan urin partisipan dikumpulkan untuk pengukuran eLFG, HbA1c, perbandingan albumin-kreatinin urin, dan degradasi glikokaliks. Degradasi glikokaliks urin diukur menggunakan 1,9- dimetilmetilen biru (GAG-DMMB). Total 75 partisipan dibagi menjadi dua kelompok menurut eLFG, ≥ 90 ml/min per 1,73 m2 (n = 33) (kelompok G1) dan 60-89 ml/min per 1,73 m2 (n = 42) (kelompok G2). Tidak ada perbedaan bermakna secara statistik (p<0,05) pada karakteristik dasar dan klinis kedua kelompok kecuali usia (p<0,001) dan HbA1c (p=0,039). Lebih lanjut, degradasi glikokaliks urin (mg/g kreatinin) lebih rendah pada kelompok G1 (median (min-max): 1,50 (0,00-16,59)) dibandingkan dengan kelompok G2 (2,04 (0,00-17,00)), namun tidak bermakna secara statistik. Tidak terdapat korelasi antara eLFG dengan degradasi glikokaliks urin (r=-0,11; p=0.33). Peningkatan degradasi glikokaliks urin tidak berhubungan terhadap tahap awal penyakit ginjal diabetes.

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Endothelial glycocalyx in the glomeruli helps maintain vascular homeostasis. Renal hemodynamic alterations caused by chronic hyperglycemia increase glomerular hydraulic pressure that contributes to the shedding of glycocalyx. This factor predisposes to the initiation of chronic kidney disease. This study aimed to investigate the association between endothelial glycocalyx breakdown and diabetic kidney disease assessed by the estimated glomerular filtration rate (eGFR) among type 2 diabetes mellitus patients. This cross-sectional study used consecutive sampling method and was conducted in Pasar Minggu Primary Health Center. Participants’ blood and urine samples were collected for measurement of eGFR, HbA1c, urine albumin-to-creatinine ratio (UACR), and glycocalyx degradation. Urinary glycocalyx breakdown was measured in the form of glycosaminoglycan and was assayed with 1,9-dimethylmethylene blue (GAG-DMMB). A total of 75 participants were divided into two groups according to the eGFR, ≥ 90 ml/minute per 1.73 m2 (n = 33) (G1 group) and 60-89 ml/minute per 1.73 m2 (n = 42) (G2 group). There were no statistically significant differences (p<0.05) in baseline and clinical characteristics among groups except for age (p<0.001) and HbA1c level (p=0.039). Furthermore, there was a decrease in urinary glycocalyx degradation product (mg/g creatinine) in G1 group (median (min-max): 1.50 (0.00-16.59)) compared to G2 group (2.04 (0.00-17.00)) with no statistically significant difference. There was no correlation between eGFR and urinary glycocalyx degradation product (r=-0,11; p=0.33). Increased urinary glycocalyx degradation was not associated with early phase of diabetic kidney disease."