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Abstrak :
Aim: to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer. Methods: a cohort study (February-October 2010) was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC) and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG), marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery), and marker of vascular calcification (osteoprotegerin/OPG). Results: median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM), previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications. Conclusion: in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing.

Abstrak :
ABSTRAK
Latar belakang : Penggunaan konsentrasi kalsium dialisat ([Ca-D]) masih kontroversi. Di Indonesia masih digunakan [Ca-D] yang berbeda-beda antara 1,25 mmol/L ? 1,85 mmol/L. Studi DOPPS mendapatkan kegagalan dalam pencapaian kadar kalsium (Ca), fosfat (PO4), produk CaxP dan hormon paratiroid (HPT) sesuai yang ditargetkan K/DOQI dan semua penyebab risiko mortalitas secara signifikan berhubungan dengan tingginya [Ca]-D

Tujuan : Mengetahui perbedaan kadar Ca darah, PO4, HPT dan kalsifikasi vaskular pada penggunaan [Ca]-D tinggi dan rendah.

Metode : Penelitian adalah studi potong lintang analitik dilakukan di Unit Hemodialisis Divisi Ginjal-Hipertensi RS Cipto Mangunkusumo, Jumlah subyek 46 orang. Dua puluh tiga pasien menggunakan [Ca]-D rendah (1,25 mmol/L) dan 23 pasien menggunakan [Ca]-D tinggi (1,85 mmol/L). Penelitian dilakukan Oktober 2013 ? Mei 2014. Analisis statistik dengan uji Mann Whitney dan uji Chi square. Menggunakan SPSS 20.0. Hasil : Sebanyak 46 pasien, terdiri dari 25 laki-laki dan 21 perempuan, dengan rerata usia 50,87 + 12,74 tahun. Lama HD 45,50 (6-168 bulan). Subyek penelitian yang mencapai target kontrol metabolisme sesuai panduan K/DOQI 2002 pada [Ca]-D rendah : Ca terkoreksi, PO4, produk Ca xPO4, dan HPT yang mencapai target sebanyak 8(34,8%), 10(43,5%), 15(65,2%) dan 2(8,7%) pasien. Pada [Ca]-D tinggi didapatkan 10(43,5%), 8(34,8%), 15(65,2%), 8(34,8%) pasien. Penelitian kami mendapatkan dengan [Ca]-D tinggi hasil lebih baik, hal ini tidak sama dengan hasil penelitian DOPPS. Berbeda dengan PO4 yang hasilnya lebih baik dengan [Ca]-D rendah, namun hasil kami juga lebih baik dari penelitian DOPPS. Hasil pada HPT lebih buruk pada [Ca]-D rendah dibandingkan DOPPS, hal ini mungkin disebabkan kami tidak menggunakan vitamin D untuk mengatasi hiperparatiroid sekundernya. Kalsifikasi vaskular dengan metode KAA pada [Ca]-D tinggi sebanyak 13(48,1%) sedangakan pada [Ca]-D rendah sebanyak 14(51,9%). Dengan metode KAAb pada [Ca]-D tinggi didapatkan kalsifikasi sebanyak 16(47,1%) dan pada [Ca]-D rendah didapatkan 18(52,9%) kalsifikasi.

Simpulan : Terdapat perbedaan kadar Ca, PO4, produk Ca x PO4, HPT dan kalsifikasi vaskular, pada penggunaan [Ca]-D tinggi dan rendah, tetapi yang berbeda bermakna hanya Ca dan HPT.

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ABSTRACT
Background : The use of calcium dialysate is still controversial. In Indonesia, the dose for [Ca-D] still varies between 1,25 mmol/L ? 1,85 mmol/L. DOPPS study shows failure in achieving optimal calcium, phosphate as well as parathyroid hormone level in the blood as targetted by K/DOQI and is related to significantly increased mortality and is closely related with increased [Ca]-D.

Aim : Evaluate the difference in Serum Ca, PO4, PTH levels and vascular calcification in concentrations of [Ca]-D high and low.

Methods : This is a cross sectional study done in Hemodialysis unit in Nephrology Division of Cipto Mangunkusumo hospital. Total subject recruited was 46 patients, 23 patient using low concentration [Ca]-D (1.25 mmol/L) and 23 patients using high concentration [Ca]-D (1.85mmol/L). Research was conducted in October 2013 until May 2014. Analysis was performed using Mann Whitney test and Chi Square, statistical analysis was done using SPSS 20.0.

Result : A total of 46 patients consisting of 25 men and 21 women, with mean age of 50,87 + 12,74 years. Mean length of Dialysis was 45,50 months (6-168 months). Subjects using low concentration [Ca]-D who reached target concentration according to K/DOQI consisted of : corrected Ca in 8 (34,8%) patients while in high concentration [Ca]-D consisted of 10(43,5%) patients, better than DOPPS study. In terms of phosphate levels, low concentration [Ca]-D achieved target PO4 level in 10(43,5%) patients while high concentration [Ca]-D achieved target in 8(34,8%) patients. Corrected Ca x PO4 target levels were obtained equally in both groups which was 15(65,2%) patients. Target PTH level was achieved in low concentrated [Ca]-D up to 2(8,7%) patients, very low may be caused we did not use vitamin D and 8(34,8%) patients in high concentrated [Ca]-D. Vascular calcification using KAA method showed incidence of 13(48,1%) in high concentrated [Ca]-D and 14(51,9%) in low concentrated [Ca]-D group. On the other hand, KAAb methods revealed calcification of 16(47,1%) in high concentrated [Ca]-D and 18(52,9%) calcification in low concentrated [Ca]-D.

Conclusion : There is a difference in Ca, PO4, Ca X PO4 product serum level and vascular calcification in high and low [Ca]-D in both group however, statistically significant difference was found only in serum Ca and PTH levels.