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"Latar Belakang: Penyakit Ginjal Kronis (PGK) merupakan penurunan fungsi ginjal secara progresif, komplikasi yang umum ditemukan pada PGK adalah anemia defisiensi besi. Untuk menanganinya, salah satu tatalaksana yang tersedia adalah epoetin alfa, sebuah agen rekombinan eritropoietin manusia. Studi ini spesifik melihat pengaruh dosis epoetin alfa pada pasien anemia dengan penyakit ginjal kronis yang menjalani hemodialisis.Metode: Desain studi kohort retrospektif dengan melibatkan 240 pasien yang menjalani hemodialisis. Pengumpulan data primer diambil pada Juni 2022 dari rekam medis. Analisis uji beda proporsi akan dilakukan dengan uji Chi-Square alternatif Fisher dengan signifikansi p<0.05. Analisis multivariat dilakukan menggunakan Cox-Reggresion.Hasil: Kelompok dengan dosis epoetin alfa 3000IU memiliki kemungkinan lebih kecil untuk mengalami peningkatan nilai Hb [RR: 0.789 (95% CI 0.696-0.895) dibandingkan dengan dosis epoetin alfa >3000IU. Status Gizi dan Jenis kelamin merupakan confounding yang paling berpengaruh dengan ∆RR >10%.Kesimpulan: Pasien yang menerima dosis epoetin alfa >3000 IU memiliki kemungkinan meningkatnya nilai Hb 3.458 kali lebih tinggi dibandingkan dosis 3000 IU (95% CI 1.745 - 6.855)......Background: Chronic Kidney Disease (CKD) is a progressive loss of kidney function, a common complication found in CKD is iron deficiency anemia. To treat it, one of the available treatments is epoetin alfa, a recombinant human erythropoietin agent. This study specifically looked at the effect of epoetin alfa dose in anemic patients with chronic kidney disease undergoing hemodialysis.Methods: Retrospective cohort study design involving 240 patients undergoing hemodialysis. Primary data collection was taken in June 2022 from medical records. The analysis of the different proportions test will be carried out using the Chi-Square Fisher alternative test with a significance of p<0.05. Multivariate analysis was performed using Cox-ReggressionResults: The group with 3000IU of epoetin alfa had a lower chance of increasing Hb values ​​[RR: 0.789 (95% CI 0.696-0.895) compared to >3000IU of epoetin alfa. Nutritional Status and Gender were the most influential confounding with RR >10%.Conclusion: Patients with dose of epoetin alfa >3000 IU had the possibility of increasing the Hb value 3,458 times higher than the dose of 3000 IU (95% CI 1,745 - 6,855"

"Latar Belakang: Penyakit Ginjal Kronik PGK merupakan masalah kesehatan di seluruh penjuru dunia. PGK menjadi penyebab menurunnya kualitas hidup penderitanya sekaligus meningkatkan risiko kematian. Penyakit Ginjal Kronik ditandai dengan terjadinya kerusakan ginjal dalam waktu lama dan progresif. Gangguan pada PGK berkaitan dengan kejadian stres oksidatif, yaitu keadaan di mana Reactive Oxygen Species ROS terbentuk melebihi pertahanan antioksidan. Kuersetin sebagai bagian keluarga flavonoid diketahui memiliki aktivitas antioksidan. Penelitian sebelumnya mendapatkan bahwa pemberian kuersetin mampu meningkatkan ekspresi protein Nuclear factor related erythroid factor 2 Nrf2 di dalam nukleus pada tikus yang mengalami PGK. Penelitian ini merupakan penelitian lanjutan untuk mengkonfirmasi apakah peningkatan ekspresi protein Nrf2 di dalam nukleus terjadi pada tahap transkripsi.Metode: Jaringan ginjal tikus Sprague-Dawley dari penelitian terdahulu yang tersimpan pada suhu -80oC, diukur ekspresi mRNA Nrf2, Keap1dan HO1menggunakan qRT PCR. Terdapat 4 kelompok penelitian yaitu kelompok kontrol normal, kelompok dengan nefrektomi 5/6 berturut-turut diberi CMC 0,5 , kaptopril 10 mg/kgBB, dan kuersetin 100 mg/kgBB. Ekspresi mRNA Nrf2, Keap1 dan HO1dianalisis statistik menggunakan uji ANOVA yang dilanjutkan dengan multiple comparison post hoc dengan LSD, Kruskal-Wallis untuk data yang tidak memenuhi syarat uji ANOVA dimana perbedaan dianggap bermakna secara statistik bila p.

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Background Chronic Kidney Disease CKD has been a problem all around the world as it causes the decrease of life quality and also raises the risk of death. Chronic kidney disease characterized with long time and progressively kidney failure. The alteration of CKD correlated to oxidative stress, a condition when Reactive oxygen species ROS produced more than antioxidant defense. Quercetin as a part of flavonoid, has been known to have an antioxidant activity. It has been showed in the previous study that quercetin increased intra nuclear Nuclear factor related erythroid factor 2 Nrf2 . This study proposed to confirm whether the increase of nuclear NRF2 is happened in transcription event.Method Kidney tissue of Sprague Dawley rat from previous study which had been saved in 80oC had measured the expression of Nrf2, Keap1 and HO1 mRNA by qRT PCR. There were 4 groups as the previous study, normal control group, 5 6 nephrectomy plus consecutively 0,5 CMC, 10 mg kgBW captopril, and 100 mg kgBW quercetin. Expression of Nrf2, Keap1 and HO1 mRNA had been analyzed statistically with ANOVA test and LSD multiple comparison post hoc. For data that are not fit to analyzed with ANOVA would be analyzed with Kruskal Wallis and Mann Whitney. The data considered as significantly different by p."

"Efektivitas HD dapat dicapai jika dosis HD mencapai adekuat serta hemodinamik pasien baik saat menjalani HD. Penelitian ini bertujuan untuk mengetahui hubungan dosis HD dengan adekuasi pada pasien penyakit ginjal kronis (PGK) on HD di unit RSUP Fatmawati. Penelitian ini menggunakan desain deskriptif analitik dengan pendekatan Cross Sectional, melibatkan sampel 60 orang yang dipilih dengan teknik total sampling.Hasil penelitian mencakup adekuasi responden rata rata URR 65,8%, dan rata rata Kt/V 1,37. Penelitian ini menunjukkan ada hubungan antara frekuensi HD dan adekuasi, Seluruh responden menjalani HD dengan durasi empat jam, faktor perancu terhadap adekuasi adalah berat badan dan diameter dialiser.Kesimpulan penelitian ini adekuasi ada hubungan dengan frekuensi, berat badan dan jenis dialiser.

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The effectiveness of HD can be achieved if HD dose adequate and patient good hemodynamics while the patient undergoing HD. This study aimed to determine the correlation between HD dose and adequacy in patients with chronic kidney disease (CKD) on HD in the unit Fatmawati Hospital. This research used descriptive analytical approach to the design of Cross Sectional, number of samples 60 respondents.The results showed that the mean URR respondents 65,8%, and mean Kt/V 1.37. This research showed there was correlation between frequency and adequacy, All respondents four hours of HD duration. Body weight, clearance dializer as confounding factor of adequacy.The conclusion this research the frequency, weight and type of dialiser had correlation to adequacy."

"World Health Organization (WHO) mendeklarasikan corona virus disease 19 (COVID-19) sebagai pandemi. Penyakit Ginjal kronis (PGK) muncul sebagai faktor risiko paling umum COVID-19 dengan manifestasi klinis yang parah dan mengkhawatirkan. Penyakit Ginjal kronis (PGK) dikaitkan dengan peningkatan tingkat rawat inap pasien dengan COVID-19, dan tingkat kematian tampaknya 14 - 16 kali lebih tinggi daripada populasi umum. RS UI merupakan rumah sakit rujukan COVID-19 di Kota Depok. Studi kasus kontrol dilakukan dengan memanfaatkan data rekam medis pasien COVID-19 terkonfirmasi yang dirawat inap di RS UI periode September 2020 – Agustus 2022 dengan jumlah sampel pada kelompok kasus 121 responden dan kelompok kontrol 242 responden. Hasil penelitian ini menunjukkan ada hubungan dan bermakna secara statistik antara Penyakit Ginjal Kronis dengan kematian pasien COVID-19 (OR 6,67; 95% CI 3,48–12,77; pvalue <0,001). Demikian, secara statistik hubungan antara Penyakit Ginjal Kronis dengan kematian pasien COVID-19 setelah dikontrol variabel kovariat yaitu : hipertensi, ARDS, ruang perawatan, obesitas dan umur. Jadi, pasien COVID-19 dengan Penyakit Ginjal Kronis memiliki resiko 3,65 kali lebih besar secara bermakna untuk meninggal dibanding pasien COVID19 tanpa Penyakit Ginjal kronis.......The World Health Organization (WHO) declared the corona virus disease 19 (COVID-19) a pandemic. Chronic Kidney Disease (CKD) is emerging as the most common risk factor for COVID-19 with severe clinical manifestations and deficiencies. Chronic Kidney Disease (CKD) is associated with increased hospitalization rates of patients with COVID-19, and death rates are roughly 14 – 16 times higher than the general population. UI Hospital is a COVID-19 referral hospital in Depok City. A case-control study was carried out by utilizing the medical record data of confirmed COVID-19 patients who were hospitalized at UI Hospital for the period September 2020 – August 2022 with a sample size of 121 respondents in the case group and 242 respondents in the control group. The results of this study showed that there was a statistically significant relationship between Chronic Kidney Disease and the death of COVID-19 patients (OR 6.67; 95% CI 3.48–12.77; pvalue <0.001). Thus, statistically the relationship between Chronic Kidney Disease and the death of COVID-19 patients after controlling for covariate variables, namely: hypertension, ARDS, treatment room, obesity and age. So, COVID19 patients with Chronic Kidney Disease have a significantly greater risk of dying 3.65 times than COVID-19 patients without Chronic Kidney Disease."

"Latar belakang: Tromboemboli vena (TEV) dapat bermanifestasi sebagai trombosis vena dalam (TVD) ataupun emboli paru (EP). EP sebagai komplikasi TVD dapat berakibat fatal. TVD umumnya terjadi disebabkan multipel faktor risiko seperti penyakit penyerta (komorbid), faktor provokasi, gangguan hemostasis dll. Gangguan fungsi hemostasis berupa keadaan protrombotik sudah dimulai dari awal stadium penyakit ginjal kronik (PGK). Menurunnya laju filtrasi glomerulus berkolerasi dengan peningkatan TEV. Mekanisme pasti bagaimana terjadinya TVD pada penderita PGK sampai saat ini masih belum jelas. Tujuan: Untuk mengetahui profil hemostasis dan faktor risiko yang berhubungan dengan TVD pada pasien PGK. Metode : Penelitian potong lintang retospektif dengan memakai data sekunder pada pasien PGK stadium 3-5 yang dirawat inap selama 1.5 tahun antara Oktober 2011- April 2013. Faktor risiko TVD yang diteliti meliputi DM, CHF, stroke iskemik, faktor provokasi, usia lanjut dan penurunan LFG. Analisis bivariat dan multivariat dilakukan dengan regresi logistik untuk mendapatkan faktor risiko yang paling berhubungan dengan terjadinya TVD pada pasien PGK. Adanya perbedaan proporsi pada kedua kelompok dinilai dengan analisis bivariat. Hasil: Proporsi TVD kasus baru yang telah dikonfirmasi dengan USG Doppler ditemukan sebesar 8% (91 dari 1115 pasien). Subyek penelitian sebanyak 160 pasien terdiri atas kelompok TVD 75 orang dan kelompok Non TVD 85 orang, subyek juga terbagi dalam kelompok Dialisis 77 orang dan Non Dialisis 83 orang. Pada pemeriksaan hemostasis ditemukan persentase rasio APTT <0.8 (1.9%), rasio PT <0.8 (0%), INR <0.8 (0%), fibrinogen >400 mg/dl (56.2%) dan D-Dimer >500 μg/l (87.5%) pada keseluruhan pasien PGK. Kadar fibrinogen lebih tinggi pada kelompok TVD daripada Non TVD. Tidak ada perbedaan hemostasis antara kelompok Dialisis dan Non Dialisis. Dari beberapa faktor risiko TVD yang diteliti, DM merupakan faktor risiko yang bermakna sesuai p <0.001, OR 4.5 (95% KI 2.3-8.8). Kesimpulan: Sebagian besar pasien PGK cenderung mengalami hiperkoagulasi. Pasien PGK dengan DM berisiko untuk mengalami TVD. DM bersama faktor risiko lain dapat menjadi predisposisi terjadinya TVD pada PGK. ......Background: Venous thromboembolism (VTE) may manifest as deep vein thrombosis (DVT) or pulmonary embolism (PE). PE as a major complication of DVT and can lead to potentially fatal. DVT can occur as the result of multiple risk factors such as comorbidities, provoked factors, abnormal hemostasis functions and others. Chronic kidney disease (CKD) is typically associated with a prothrombotic tendency in the early stages of the disease. The declining of glomerular filtration rate (GFR) is correlated with increasing of VTE. The exact mechanism of how DVT develops in CKD patients remains unclear. Aim: To determine the hemostasis profiles and risk factors associated with DVT in CKD patients. Methods: Retrospective cross sectional study was hold by review the medical records from stage 3-5 CKD patients that hospitalized during 1.5 years (October 2011 - April 2013). Multiple risk factors for TVD such as CHF, stroke ischemic, provoked factors, elderly and decreasing of eGFR were examined. Bivariate and multivariate analysis with logistic regression performed to obtain the most risk factors associated with the occurrence of TVD in CKD patients. The differences of proportion between both groups were assessed by bivariate analysis. Results: The proportion of first DVT confirmed by doppler ultrasound was 8% (91 of 1115 patients). 160 patients were divided into groups. 75 and 85 patients comprised the group with DVT-Non DVT as well as 77 and 83 patients comprised the group with Dialysis-Non Dialysis. We found the APTT ratio <0.8 (1.9 %), PT ratio <0.8 (0 %), INR <0.8 (0 %), fibrinogen level >400 mg/dl (56.2 %) and DDimer level >500 μg/l (87.5 %) in all CKD patients. The level of fibrinogen was higher when DVT group compared to Non DVT group. There was no significant differences of hemostasis functions between Dialysis and Non Dialysis group. Multivariate analysis demonstrated that diabetes mellitus (p<0.001, OR: 4.5; 95% CI: 2.3 to 8.8) was associated with DVT in CKD patients among all risk factors. Conclusion: Most CKD patients tend to have hypercoagulation. Diabetes was associated with DVT risk in CKD patients. Diabetes with other risk factors could be as predispotition factors for DVT in CKD in this study."

"[ABSTRAKPola sirkadian tekanan darah (TD) adalah gambaran TD 24 jam berupa kurva TD yang meningkat pada pagi hari, menurun pada siang / sore hari dan terendah pada malam hari / waktu tidur. 24 hours Ambulatory Blood Pressure Monitoring (24 hrs ABPM) merupakan alat pengukur TD yang lebih akurat dan dapat memperlihatkan pola sirkadian TD 24 jam. Turunnya TD 10 - 20% pada malam hari disebut dipper, jika turun < 10% disebut nondipper. Meningkatnya TD 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Faktor utama penyebab hipertensi pada PGK 5D adalah menurunnya Laju Filtrasi Glomerulus (LFG) dan meningkatnya cairan ekstraselular. Transplantasi ginjal akan memperbaiki TD dan nondipper dengan membaiknya LFG, meningkatnya produksi urin dan menurunnya cairan ekstraseluler. Namun demikian satu bulan Pasca Transplantasi Ginjal kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD.Tujuan : Mengetahui perbedaan pola sirkadian TD, data dipper / nondipper dan rerata TD 24 jam pada pasien PGK Pra dan satu bulan Pasca Transplantasi Ginjal. Metode Penelitian : Studi Pre experimental dengan before and after design. Subjek penelitian pasien PGK 5D / Pra Transplantasi Ginjal berusia 18 ? 60 tahun, dilakukan di RSCM pada bulan Oktober sampai dengan Desember 2014. Jumlah subjek sebanyak 15 orang. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG, pengukuran TD 24 jam dengan 24 hrs ABPM, Pra dan satu bulan Pasca Transplantasi Ginjal. Analisis statistik dengan uji McNemar dan uji t dependen.Hasil : Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan Pasca Transplantasi Ginjal seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan Pasca Transplantasi Ginjal nondipper (homogen). Terdapat penurunan rerata TD sistolik 24 jam pasien PGK satu bulan Pasca Transplantasi Ginjal yang tidak signifikan (p > 0,05) dan penurunan rerata TD diastolik 24 jam yang signifikan (p < 0,05).Simpulan : Belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal. Terdapat penurunan rerata TD sistolik 24 jam yang tidak signifikan dan penurunan rerata TD diastolik 24 jam yang signifikan pada pasien satu bulan Pasca Transplantasi Ginjal.

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ABSTRACTThe circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation., Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.]"

"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. ......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. "

"Penyakit ginjal kronik (PGK) sudah menjadi masalah kesehatan global dengan prevalensi dan insidensi gagal ginjal yang meningkat dan memberikan prognosis buruk. Salah satu penyebab beratnya morbiditas pada PGK adalah terjadinya disbiosis mikroflora usus yaitu peningkatan flora patogen dibandingkan dengan flora normal pada pasien PGK dengan hemodialisis (PGK-HD). Studi ini bertujuan untuk mendapatkan pola mikrobiota usus pada pasien PGK dengan hemodialisis dengan metode kuantitatif PCR dengan pendekatan analisis ΔCt. Desain penelitian potong lintang dengan 71 subjek pasien PGK usia >18 tahun dengan hemodialisis rutin di RS. Umum Pusat Nasional Dr. Cipto Mangukusumo. Sampel berupa feses yang disimpan di suhu -20oC selama kurang dari setahun. Ekstraksi dan purifikasi DNA dengan teknik pengikatan silika dan metode buffer kit Exgene Stool DNA, Bioneer. Pengukuran konsentrasi DNA dengan spektrofotometer NanoVue dilanjutkan dengan standarisasi konsentrasi DNA dengan pengenceran sampel berdasarkan konsentrasi DNA terkecil. Pemeriksaan real-time q-PCR mesin Bioneer ExicyclerTM 96 dengan menggunakan 13 macam primer yaitu E.coli, Parasuterella excrementihominis, Prevotella, Bacteroides, Bifidobacterium, L.casei, L.acidophillus, Enterococcus faecalis, Enterococcus faecium, Clostridium difficile, Clostridium cocoides, Akkermansia muciniphila dan Beta-actin sebagai housekeeping gene (HKG). Hasil penelitian didapatkan dominasi mikrobiota usus E. coli dan rasio F/B pasien PGK-HD 2,76. Terdapat hubungan bermakna antara hipertensi dengan rasio F/B 9,35 4,0. Penelitian ini merupakan penelitian pertama tentang disbiosis mikrobiota usus pada pasien PGK dengan hemodialisis di Indonesia dengan menggunakan sampel feses dengan metode PCR kuantitatif pendekatan analisis ΔCt. Dengan diketahui profil mikrobiota usus pada PGK dapat dijadikan saran pemberikan suplementasi probiotik Bifidobacteria, sehingga diharapkan dapat meningkatkan konsentrasi mikrobiota filum Bacteroides.......Chronic kidney disease (CKD) has become a global health problem with increasing in prevalence and incidence of kidney failure. One of the causes of severe morbidity in CKD is the occurrence of intestinal microflora dysbiosis, an increase in pathogenic flora compared to normal flora in CKD patients with hemodialysis (CKD-HD). This study aims to obtain patterns of gut microbiota in CKD patients on hemodialysis by quantitative PCR method with Ct approach analysis The design was a cross-sectional study with 71 CKD patients aged >18 years with routine hemodialysis in the hospital. General National Center Dr. Cipto Mangukusumo. Samples are feces that are stored at -20oC for less than one year. Extraction and purification of DNA with silica binding techniques using Exgene Stool DNA buffer kit method, Bioneer. Measurement of DNA concentration with the NanoVue spectrophotometer, followed by standardization of DNA concentration by diluting the sample based on the smallest DNA concentration. Real-time q-PCR examination of the Boneer ExicyclerTM 96 machine using 13 kinds of primers, namely E.coli, Parasuterella excrementihominis, Prevotella, Bacteroides, Bifidobacterium, L.casei, L.acidophillus, Enterococcus faecalis, Enterococcus faecium, Clostridium difficile, Clostridium cocoides, Akkermansia muciniphila and Beta-actin as a housekeeping gene (HKG). There was the dominance of the gut microbiota of E. coli and the F/B ratio of CKD-HD patients 2.76. There is a significant relationship between hypertension and the F/B ratio of 9.35 ± 4.0. This study is the first study on gut microbial dysbiosis in CKD patients on hemodialysis in Indonesia using stool samples using quantitative PCR method with Ct approach analysis. Knowing the gut microbiota profile in CKD, can be used as a suggestion for Bifidobacteria probiotic supplementation, as is expected to increase the concentration of the Bacteroides phylum microbiota."