Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar Belakang: Kadar asam urat darah berhubungan dengan peningkatan risiko penyakit kardiovaskular (PKV) serta meningkatkan angka kematian terutama pada populasi hemodialisis (HD) dan dialisis peritoneal (CAPD). Symmetric Dimethylarginine (SDMA) sudah sering dipakai dan diperiksa sebagai penanda PKV pada studi epidemiologi terutama pada populasi HD maupun CAPD. Pada populasi umum dewasa sehat dan HD, telah didapatkan adanya hubungan peningkatan kadar asam urat darah dengan peningkatan kadar SDMA. Namun pada populasi CAPD, peningkatan kadar asam urat darah terhadap peningkatan risiko yang terjadi masih menjadi kontroversi. Tujuan: Studi ini bertujuan untuk melihat hubungan antara kadar asam urat darah dengan kadar SDMA pada pasien penyakit ginjal kronik yang menjalani CAPD.Metode: Penelitian dengan desain potong lintang yang dikerjakan pada bulan Juni 2021 sampai bulan Agustus 2021 pada pasien CAPD kronik > 3 bulan. Subjek dengan obat penurun asam urat, wanita hamil dan menyusui, dan pasien dengan riwayat keganasan tidak diikutsertakan pada penelitian ini. Kadar asam urat dan SDMA diambil saat pasien kontrol ke poli CAPD. Analisis bivariat dilakukan dengan analisis Mann – Whitney dan analisis multivariat dengan regresi logistik.Hasil: Total 55 subjek diikutsertakan pada penelitian ini. Didapatkan rerata kadar asam urat7.30 +1.59 mg/dl dan sebanyak 33 subjek (60%) dengan kadar asam urat > 7 mg/dl. Rerata kadar SDMA didapatkan sebesar 633.73 +231.54 ng/mL. Subjek dengan kadar asam urat > 7 mg/dl memiliki peningkatan kadar SDMA secara signifikan bila dibandingkan pada kelompok asam urat <7 mg/dl (721.58 + 220.57 vs 501.95 +182; P < 0.001). Didapatkan cut – off SDMA 536 ng/ml berdasarkan kurva ROC dengan Sensitivitas 81.8%, Spesifisitas 63.6%, PPV 77.78% dan NPV 73.68%. Setelah dilakukan adjustifikasi terhadap faktor perancu didapatkan bahwa DM (OR: 7.844; CI95%: 1.899 – 32.395: P value: 0.004) dan dyslipidemia (OR: 6.440; CI95%: 1.483 – 27.970; P value: 0.013) sebagai faktor risiko.Simpulan: Terdapat hubungan kadar asam urat darah > 7 mg/dl dengan peningkatan kadar SDMA pada pasien yang menjalani CAPD. Diabetes melitus dan dyslipidemia merupakan faktor risiko yang berhubungan dengan peningkatan kadar asam urat dengan peningkatan kadar SDMA.

---

Background and Objectives: Uric Acid (UA) levels are associated with increased risk of cardiovascular events and mortality in hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. Symmetric dimethylarginine (SDMA) is a known marker of cardiovascular disease in a number of epidemiological studies, including in the HD and CAPD patient population. In a study with a population of healthy young adults and HD there was a correlation between high blood uric acid levels and blood SDMA level. However, in CAPD population, there are still conflicting data on the mechanism of increased risks related to uric acid levels. This study aimed to assess the association between uric acid levels and SDMA in the subjects undergoing CAPD.

Materials and Methods: This was a cross – sectional study conducted in all the adults who underwent CAPD for at least three months in tertiary hospital in Jakarta, Indonesia. Subjects already on uric lowering therapy, pregnant or lactating women, and those with a history of malignancy were excluded. Uric acid and SDMA level were measured at the same time patients controlled to outpatient clinic. Bivariate analysis was performed using the Mann – Whitney test and multivariate analysis performed using logistic regression test.

Results: A total of 55 subjects were included. The median level of UA was 7.30 +1.59 mg/dl and 33 subjects (60%) had UA levels of 7 mg/dl or higher. The median SDMA level was 633.73 +231.54 ng/mL. Subjects with UA levels > 7 mg/dl had significantly higher SDMA levels compared to subjects with UA levels <7 mg/dl (721.58 +220.57 vs 501.95 +182; P < 0.001). The cut – off value of SDMA 536 ng/mL was obtained from the receiver operating characteristic (ROC) curve with sensitivity 81.8%, specificity 63.6%, PPV 77.78% and NPV 73.68%. After fully adjusted with the confounders, the determinant factors in this study were diabetes mellitus (OR: 7.844; CI95%: 1.899 – 32.395: P value: 0.004) and dyslipidemia (OR: 6.440; CI95%: 1.483 – 27.970; P value: 0.013) as risk factors.

Conclusion: In CAPD patients, UA levels above 7 mg/dl were associated with increased SDMA levels. This study demonstrates the determinant factors regarding association between UA level and SDMA in CAPD patients were diabetes mellitus and dyslipidemia. The cut – off value of SDMA above 536 ng/mL were significant to increased risk of cardiovascular events."

"Latar Belakang: Penurunan kapasitas latihan dan kekuatan otot merupakan gambaran yang umum dijumpai pada pasien hemodialisis (HD) kronik. Perbaikan kadar hemoglobin (Hb) tidak memperbaiki secara optimal kapasitas latihan. Prevalensi kalsifikasi arteri tinggi pada pasien HD. Hal ini menyebabkan berkurangnya elastisitas pembuluh darah sehingga meningkatkan kekakuan arteri. Terdapat bukti klinis bahwa kekakuan arteri sentral memengaruhi kapasitas latihan pada pasien penyakit ginjal kronik (PGK). Kapasitas latihan dapat diprediksi dengan menilai kekuatan otot perifer. Tujuan: Mengetahui korelasi kekakuan arteri sentral dengan kekuatan genggam tangan pada pasien yang menjalani HD kronik. Metode: Penelitian ini merupakan penelitian potong lintang dengan subyek pasien HD kronik yang diambil dengan teknik consecutive sampling dengan rentang usia 18 – 59 tahun.  Analisis bivariat dilakukan untuk menilai korelasi kekakuan arteri sentral (dengan menilai central pulse wave velocity/cPWV) dengan kekuatan genggam tangan (KGT), kemudian dilakukan korelasi parsial terhadap variabel perancu (usia, dialysis vintage, Hb, dan aktivitas fisik). Hasil: Terdapat 45 pria dan 40 wanita dengan median usia masing-masing 47 (19-59) dan 47 (18-59) tahun. Kedua kelompok mempunyai tingkat aktivitas fisik sedang. Tidak terdapat korelasi antara cPWV dengan KGT baik pada  pria (r = -0,046, p = 0,763) maupun wanita (r = -0,285, p = 0,113). Analisis stratifikasi pada wanita yang memiliki tinggi badan (TB) >150 cm menunjukkan korelasi negatif derajat sedang antara cPWV dengan KGT (r = -0,466; r² = 0,217; p = 0,016). Nilai cPWV berperan sebesar 21,7% terhadap KGT, dan 78,3% diduga dipengaruhi oleh faktor perancu. Kelompok KGT rendah memiliki nilai cPWV yang meningkat pada semua kategori usia. Simpulan: Kekakuan arteri sentral tidak berhubungan dengan kekuatan genggam tangan pada pasien yang menjalani HD kronik. Terdapat kecenderungan peningkatan nilai cPWV pada subjek yang memiliki KGT rendah.

---

Background: Exercise intolerance and muscle weakness are the common features in hemodialysis patients. However, correction of renal anemia by eritropoetin does not optimize the exercise capacity. The prevalence of arterial calcification among the hemodialysis patient is high. It thereby decreased the elasticity of the vessels and increased the arterial stiffness. Clinical evidence showed that central arterial stiffness affects the exercise capacity in chronic kidney disease (CKD). Exercise capacity can be predicted by assessing peripheral muscle strength.

Objective: To investigate the correlation between central arterial stiffness and handgrip strength in chronic hemodialysis patients.

Methods: This study use cross-sectional design which perform in chronic HD patients aged between 18 and 59 years old by consecutive sampling. Bivariate analysis was done to determine the correlation between central arterial stiffness (assessed using central pulse wave velocity /cPWV) and handgrip strength (HGS). Afterwards, partial correlation of confounding variables (age, dialysis vintage, Hb and physical activity) were also be analyzed.

Results: There were 45 men and 40 women with the median age of 47 (19-59) and 47 (18-59) years old, respectively. Both groups have moderate level of physical activity. There was no correlation between cPWV and HGS in men (r = -0.046, p = 0.763) and women (r = -0.285, p = 0.113). Stratified analysis in women with height over 150 cm showed a moderate negative correlation between cPWV and HGS (r = -0,466; r² = 0,217; p = 0,016). cPWV accounted for 21.7% of HGS, while 78.3% were suggested to be influenced by the confounding factors. The group with low HGS had an increased cPWV in all age categories.

Conclusion: Central artery stiffness was not associated with HGS in chronic HD patient. There was a tendency of increased central arterial stiffness in the group of subjects who had low HGS."