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"Studi eksperimental hewan memperlihatkan bahwa kadar vasopresin serum yang tinggi berhubungan dengan hiperfiltrasi, albuminuria dan hipertrofi glomerulus, dan dikhawatirkan berlanjut menjadi penurunan laju filtrasi glomerulus (LFG) dalam jangka panjang. Namun, belum terdapat laporan yang membuktikan hubungan sebab-akibat antara peningkatan vasopresin serum dengan gangguan ginjal. Studi ini bertujuan untuk mengetahui hubungan peningkatan vasopresin serum dengan gangguan ginjal, beserta lokasi gangguan ginjal tersebut. Studi ini juga ditujukan untuk melihat kemampuan berat jenis (BJ) urin untuk mendeteksi gangguan ginjal.Penelitian ini adalah studi potong lintang dengan consecutive sampling di sebuah pabrik sepatu pada bulan Januari–Maret 2020. Subjek adalah pekerja terpajan panas yang dinyatakan sehat berdasarkan medical checkup tahun 2019. Sampel darah dan urin diambil lima jam setelah subjek bekerja. Subjek diperiksakan kreatinin plasma, estimasi LFG berdasarkan CKD-EPI, BJ urin, albuminuria carik-celup, albumincreatinine ratio (ACR) urin, vasopresin serum, kidney injury molecule-1 (KIM-1) urin, dan nefrin urin. Data masa kerja, dan jenis kelamin diperoleh melalui wawancara.Pada studi ini, diperoleh 119 subjek wanita dengan median usia 38 (31–51) tahun dan median masa kerja 10 (3–14) tahun. Hiperfiltrasi didapatkan pada 18 subjek, LFG tidak menurun pada 104 subjek (87,4%), dan peningkatan nefrin urin pada 104 pekerja (87,4%). Tidak terdapat hubungan antara vasopresin meningkat dengan hiperfiltrasi, penurunan LFG, albuminuria, nefrin urin, dan KIM-1 urin. Terdapat hubungan bermakna antara peningkatan nefrin urin dengan masa kerja ≥ 10 tahun (p = 0,03). Terdapat hubungan peningkatan KIM-1 urin dengan albuminuria (p = 0,008). Terdapat area under the curve (AUC) antara BJ urin dan nefrin urin sebesar 81,7% (95% CI 68,8–94,6%), dengan titik potong BJ urin ≥ 1,018 yang memiliki sensitivitas 71,2% dan spesifisitas 80% untuk kenaikan nefrin.Sebagai simpulan, peningkatan vasopresin serum tidak berhubungan dengan hiperfiltrasi, penurunan LFG, albuminuria, dan peningkatan KIM-urin. Masa kerja > 10 tahun dihubungkan dengan peningkatan nefrin urin. BJ urin ≥ 1,018 dapat dijadikan acuan untuk mendeteksi kenaikan nefrin urin pada pekerja terpajan panas.

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Animal experimental studies have shown that high serum vasopressin levels are associated with hyperfiltration, albuminuria, and glomerular hypertrophy, which may lead to decreased glomerular filtration rate (GFR) in long-term. However, there was no earlier report that has established the causal relationship between elevated serum vasopressin and renal impairment. This study aims to determine the association between increased serum vasopressin and kidney impairments, along with the location of these impairments. This study is also aimed to look at the ability of urine specific gravity to detect elevated serum vasopressin and kidney impairments.This study was a cross-sectional study with consecutive sampling in a shoe factory from January–March 2020. Subjects were heat-exposed workers who were declared healthy based on the medical checkup in 2019. Blood and urine samples were taken five hours after the subject worked. Subjects were examined for plasma creatinine, estimated GFR (eGFR) based on CKD-EPI, urine specific gravity, dipstick albuminuria, urine albumin-creatinine ratio (ACR), serum vasopressin, urine kidney injury molecule-1 (KIM-1), and urinary nephrin. Data on age, length of service, and gender were obtained through interviews.There were 119 female subjects with a median age of 38 (31–51) years and a median length of service 10 (3–14) years. eGFR was not decreased in 104 subjects (87.4%) and urinary nephrin increased in 104 workers (87.4%). There were no increase in urinary albumin excretion and urinary KIM-1. There were significant association between increased urinary nephrin with length of service ≥ 10 years (p = 0.03), normal-increased eGFR with age 30–39 years (p = 0.001), and increased urinary KIM-1 with albuminuria (p = 0.008). There was an area under the curve (AUC) of 81.7% (95% CI 68.8–94.6%) between urine specific gravity and urinary nephrin, with a cut-off point of urine specific gravity > 1.018 having a sensitivity of 71.2% and a specificity of 80% for the increase in urinary nephrin.In conclusion, increased serum vasopressin does not cause a decrease in GFR, albuminuria, and increase in urinary KIM, but does cause an increase in urinary nephrin. urine specific gravity ≥ 1.018 can be used as a cut-off for detecting increased urinary nephrin in heat-exposed workers."

"Untuk hemodialisis pasien Penyakit Ginjal Tahap Akhir (PGTA) akses vaskular terpilih adalah pembuatan fistula arteriovenosa (FAV) native, namun FAV memiliki angka kegagalan maturitas yang relatif tinggi. Primary balloon angioplasty (PBA) merupakan salah satu teknik dilatasi untuk membantu maturitas FAV. Teknik konstruksi FAV yang traumatik dan peregangan diameter lumen vena dengan balon dapat menyebabkan cedera fokal pada endotelium vena dan memberikan respons hiperplasia intima serta memengaruhi kadar NO, VEGF dan EMP yang dapat berdampak negatif pada maturitas FAV. Penelitian ini bertujuan untuk mengetahui efek PBA terhadap hiperplasia intima, kadar NO, VEGF, EMP serta maturitas FAV pada pasien dengan PGTA.Desain penelitian adalah uji klinis tersamar acak tunggal di RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, RSUD Kabupaten Tangerang, dan RS Hermina Depok pada bulan Desember 2019 sampai Februari 2022; dengan subjek penelitian 112 pasien. Setelah randomisasi sampel terstratifikasi, 48 pasien menjalani konstruksi FAV dengan PBA (intervensi) dan 64 pasien menjalani konstruksi FAV tanpa PBA (kontrol). Pengukuran meliputi intimal medial thickness (IMT) jukstaanastomosis, VF dan PSV draining vein 1, 2 dan 6 minggu pascaoperasi; kadar NO, kadar VEGF, kadar EMP pascaoperasi dan 2 minggu pascaoperasi serta maturitas FAV yang dievaluasi 6 minggu pascaoperasi. Terkait pandemi COVID-19, 32 pasien lost to follow-up dan 5 pasien kontrol dieksklusi karena trombus pada FAV sehingga subjek yang dianalisis 36 pasien intervensi dan 39 pasien kontrol.Terdapat perbedaan bermakna antara grup kontrol dan intervensi pada maturitas, VF dan PSV draining vein 6 minggu pascaoperasi; kadar EMP 2 minggu pascaoperasi pada pasien PGTA yang menjalani operasi konstruksi FAV (Uji Mann Whitney U, p < 0,05). Tidak didapatkan perbedaan bermakna IMT jukstaanastomosis serta kadar NO dan VEGF antara kelompok kontrol dan intervensi (Uji Mann Whitney U, p > 0,05).Simpulan: PBA meningkatkan maturitas FAV pada pasien PGTA yang menjalani operasi konstruksi FAV yang ditandai dengan peningkatan VF dan PSV draining vein hingga 6 minggu pascaoperasi tanpa memengaruhi ketebalan intima pada daerah jukstaanastomosis, kadar NO dan kadar VEGF. Terdapat peningkatan kadar EMP 2 minggu pascaoperasi pada FAV dengan PBA.

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The preferred vascular access for hemodialysis for patients with end-stage renal disease (ESRD) is through the creation of a native arteriovenous fistula (AVF). The weakness of AVF is the relatively high maturation failure rate. Primary balloon angioplasty (PBA) is a dilation technique to assist AVF maturation. Traumatic AVF construction technique and diameter stretching of the vein lumen with balloons can cause focal injury to the venous endothelium which will eventually affect intimal hyperplasia and NO, VEGF and EMP levels which can negatively impact AVF maturation. This study aimed to determine the effect of PBA on intimal hyperplasia, levels of NO, VEGF, EMP and AVF maturation in patients with ESRD who underwent AVF construction surgery.

This study used a single-blind randomized clinical trial design at RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, RSUD Kabupaten Tangerang, dan RS Hermina Depok in December 2019 until February 2022 with 112 subjects. With stratified sample randomization method, 48 patients underwent AVF construction with PBA (intervention), 64 patients underwent AVF construction without PBA (control). Measurements included jukstaanastomosis intimal medial thickness (IMT), VF and peak systolic value (PSV) draining veins 1, 2 and 6 weeks postoperatively; NO, VEGF, EMP levels postoperative and 2 weeks postoperative; and AVF maturation evaluated 6 weeks postoperatively. Regarding the COVID-19 pandemic, 32 patients lost to follow-up and 5 control patients were excluded because of thrombus in the AVF so that analysis was carried out on 75 subjects (36 intervention patients and 39 control patients).

There were significant differences between control and intervention groups in maturity, VF and PSV draining vein 6 weeks postoperatively; EMP levels 2 weeks postoperatively in ESRD patients undergoing AVF construction (Mann Whitney U, p < 0,05). There were no significant differences in jukstaanastomosis IMT; NO and VEGF levels between control and intervention groups (Mann Whitney U, p > 0.05).

Conclusion: PBA increases the maturity of the arteriovenous fistula in ESRD patients undergoing AVF construction surgery which is characterized by an increase in VF and PSV draining veins up to 6 weeks postoperatively without affecting the IMT in jukstaanastomosis area, NO and VEGF levels. There was an increase in EMP levels 2 weeks postoperatively in AVF with PBA."

"Kelebihan beban cairan pascaresusitasi dihubungkan dengan luaran buruk sehingga diperlukan deresusitasi. Tekanan vena sentral (TVS) rendah penting untuk menjamin aliran balik darah, meningkatkan curah jantung dan memperbaiki perfusi jaringan. Penelitian ini bertujuan menilai efektivitas deresusitasi dengan target TVS 0–4 mmHg pada pasien pascaresusitasi renjatan sepsis di ICU. Penelitian menggunakan desain randomized controlled trial dan dilakukan di RSUPN dr. Cipto Mangunkusumo pada bulan September 2019–Oktober 2020. Subjek berusia 18–60 tahun dengan renjatan sepsis pascaresusitasi. Kriteria eksklusi adalah gangguan jantung primer, gagal jantung kanan, penyakit jantung bawaan, penyakit paru obstruksi menahun berat, efusi pleura berat, batu atau tumor ginjal dan gagal ginjal kronik. Subjek penelitian dibagi menjadi dua kelompok dengan target TVS 0–4 mmHg dan 8–10 mmHg dan dilakukan dideresusitasi. Target TVS dicapai dengan furosemid drip dan loading kristaloid. Parameter luaran adalah perbedaan hasil PVD, stadium AKI, indeks curah jantung, lama penggunaan ventilator, dan lama hari perawatan di ICU. Data dianalisis program SPSS versi 20.0 meliputi analisis deskriptif dan inferensial memakai uji yang sesuai. Dari 44 subjek, 1 subjek dikeluarkan karena menjalani hemodialisis karena gagal ginjal kronik pada kelompok dengan target TVS 8–10 mmHg. Karakteristik dasar pasien berupa stadium AKI, ureum, kreatinin dan nilai TVS inisial berbeda bermakna pada kedua kelompok. Deresusitasi dengan target TVS 0–4 mmHg tidak berbeda bermakna pada nilai PVD, perbaikan AKI, CI, lama penggunaan ventilator, dan perawatan ICU (p>0,05). Tiga subjek meninggal sebelum selesai follow up pada kelompok dengan target TVS 0–4 mmHg dan 6 subjek meninggal sebelum selesai follow up, pada kelompok dengan target TVS 8–10 mmHg. Simpulan: Tidak didapatkan perbedaan efektivitas antara target deresusitasi TVS 0‒4 mmHg dengan target TVS 8‒10 mmHg terhadap nilai PVD sublingual, perubahan stadium AKI KDIGO, indeks curah jantung, lama penggunaan ventilator, lama perawatan ICU

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Post-resuscitation fluid overload is associated with a poor outcome in critically patient and thus requires deresuscitation (aggressive fluid removal). Low central venous pressure (CVP) is important to ensure the venous return, increase cardiac output and improve tissue perfusion. This study aims to assess the effectiveness of deresuscitation with a CVP target of 0–4 mmHg in post-septic shock resuscitation patients in the emergency department and ICU. This study used a randomized controlled trial design at RSUPN Dr. Cipto Mangunkusumo in September 2019–October 2020. The study sample was patients 18–60 years old with septic shock in the post-resuscitation ICU. Exclusion criteria were patients with primary heart failure, right heart failure, congenital heart disease, severe chronic obstructive pulmonary disease, severe pleural effusion, kidney stones or tumors, and chronic renal failure. The study subjects were deresuscited and divided into two CVP target groups (0–4 mmHg and 8–10 mmHg). Furosemide drip and cristaloid were given to reach target of CVP. Outcome parameters were differences in PVD, AKI stage, cardiac index (CI), ventilator duration, and length of stay in ICU. Statistical analysis includes descriptive and inferential analysis testing the appropriate test. Data analysis was performed using the SPSS version 20.0 statistical program. Results: There were 44 subjects, 1 subject were excluded due to hemodialysis in CVP target of 8–10 mmHg. Baseline characteristics have significant difference in ureum, creatinine, AKI stage and initial CVP value between two groups. Deresuscitation with a CVP target of 0–4 mmHg did not have a significant difference in the value of PVD, improvement in AKI, CI, ventilator duration, and length of ICU stay (p > 0.05). Three subjects died before 7 days of follow up in CVP target of 0–4 mmHg and 3 subjects died before 7 days of follow up in CVP target of 8–10 mmHg."

"Riskesdas 2007 dan 2013 menyebutkan penduduk Indonesia berusia di atas 10 tahun mengonsumsi garam harian cukup tinggi. Riskesdas 2013 dan 2018. menunjukkan prevalensi hipertensi meningkat dari 25,8% menjadi 34,1%. Indonesia merupakan salah satu penghasil rumput laut merah, Euchema cottonii terbesar di dunia, tapi belum ada penelitian potensi rumput laut ini sebagai pengganti garam. Penelitian ini bertujuan untuk mengevaluasi efek mengganti garam biasa dengan garam rumput laut Euchema cottonii dengan kandungan Na lebih rendah dari garam biasa dalam usaha menurunkan tekanan darah pada subyek hipertensi esensial derajat 1. Tahap pertama penelitian ini adalah pembuatan garam rumput laut (GRL) yang aman dan memiliki rasa asin garam biasa (GB), dilakukan di unit produksi makanan di rumah sakit, dari Desember 2016 sampai Maret 2017. Hasil uji sensori oleh 9 panelis digunakan untuk menentukan konsentrasi garam rumput laut yang dipakai pada penelitian tahap dua. Penelitian tahap kedua adalah uji klinis dengan pembanding secara acak tersamar ganda. Subyek diwawancara dengan food frequency questionnaire, dilakukan uji cita rasa GRL dengan konsentrasi yang telah ditetapkan tahap pertama dibandingkan dengan GB. Subyek diukur antropometri, tekanan darah, angiotensin II plasma, CRP serum, gula darah puasa, serum kreatinin, urin lengkap, serta kadar Na, K dan kreatinin dalam urin 24 jam. Subyek dievaluasi keluhan, dan diukur tekanan darahnya setiap minggu selama empat minggu. Rumput laut dari Saumlaki, Maluku dipilih berdasarkan analisis keamanan dari cemaran logam, kapang dan bakteri. Uji cita rasa asin oleh panelis mendapatkan garam rumput laut (GRL), yaitu komposisi bubuk garam rumput laut dan bubuk garam biasa dengan rasio 1:1, mempunyai rasa asin yang tidak berbeda bermakna dengan garam biasa (GB) (p=0.332). Analisis mineral menunjukkan GRL mengandung kadar Na lebih rendah dan kadar K lebih besar daripada GB. Uji klinis pada 62 subyek dilakukan di rumah sakit dan tiga puskesmas di Jakarta dari Desember 2017 hingga Desember 2019. Setelah empat minggu perlakuan, ditemukan perbedaan penurunan secara bermakna tekanan darah sistolik (p=0.004) dari subyek kelompok GRL (Δ-15,3±9,7) dibandingkan kelompok GB (Δ-8,0±9,2). Demikian pula perbedaan penurunan tekanan darah diastolik terjadi secara bermakna (p=0.005) pada kelompok GRL (median Δ-8,0; 20-(-24)) dibandingkan kelompok GB (Δ-2,2±6,8). Tidak ada perbedaan bermakna perubahan kadar angiotensin II plasma, Na dan K urin 24 jam pada kedua kelompok GRL dan GB. Kesimpulan: GRL yang rendah Na dan tinggi K aman digunakan dan bermanfaat sebagai pengganti garam biasa bagi penderita hipertensi esensial derajat 1 usia 25-59 tahun tanpa memengaruhi kadar angiotensin II plasma, Natrium dan Kalium urin.

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Basic Health Research 2007 and 2013, Indonesian population aged over 10 years consume high daily salt. Basic Health Research 2013 and 2018 showed hypertension' prevalence in Indonesian adults increased from 25.8% to 34.1%. Indonesia is one of the biggest producers of red seaweed, Euchema cottonii in the world, but there is no research about the potential of this seaweed as a substitute for salt. Aim of this study to evaluate the effect of replacing ordinary salt with seaweed salt of Euchema cottonii with lower Na content than ordinary salt in an effort to lower blood pressure in subjects with grade 1 essential hypertension. The first phase of the study was to produce seaweed salt (GRL) which is safe and has a salty taste of ordinary salt (GB), it was carried out in the food production unit at the hospital, from December 2016 to March 2017.

The sensory test results by 9 panelists were used to determine concentration of GRL used in phase two. The second stage of the study was a double blind randomized comparison clinical trial. Subjects were interviewed with a food frequency questionnaire, and a salty sensory test of GRL compared to GB was conducted. Anthropometry, blood pressure, plasma angiotensin II, serum CRP, fasting blood sugar, serum creatinine, complete urine examination and levels of Na, K and creatinine in 24 hours urine were measured. Subjects were evaluated for complaints, and their blood pressure were measured every week for four weeks. Seaweed from Saumlaki, Maluku was selected based on a safety analysis: metal, mold and bacterial contamination. The salty taste test by the panelists obtained GRL, composition of seaweed powder and ordinary salt powder with a ratio of 1:1, and has a salty taste that was not significantly different from GB (p=0.332).

Mineral analysis found that GRL contains lower Na levels with higher K levels than GB. Clinical trials on 62 subjects were conducted at one hospital and three health centers in Jakarta from December 2017 to December 2019. After four weeks of treatment, it was found that there was a significant difference in the decrease of systolic blood pressure (p=0.004) from GRL group's subjects ((Δ-15,3±9,7) compared to GB group's subjects (Δ-8,0±9,2). There was also a significant difference in the decrease of diastolic blood pressure (p=0.005) from GRL group's subjects (median Δ-8,0; 20-(-24)) compared to GB group's subjects (Δ-2,2±6,8). There was significant difference in changes in plasma angiotensin II levels, Na and K from 24 hours urine in both GRL and GB groups. Conclusion: GRL which is low in Na and high in K is safe to use and is useful as a substitute for GB for patients with grade 1 essential hypertension aged 25-59 years without affecting plasma angiotensin II, urinary Na and K."