Protein energy wasting (PEW) merupakan sindrom gangguan nutrisi yang sering terjadipada pasien penyakit ginjal kronik (PGK) dengan hemodialisis rutin sekitar 28-80%.Proses hemodialisis dapat meyebabkan hilangnya nutrien seperti asama amino,meningkatkan proses inflamasi yang kemudian dapat meningkatkan katabolisme protein,dan dapat menghambat utilisasi asam amino dalam sintesis protein. Jika tidak ditangani,PEW dapat meningkatkan morbiditas dan mortalitas pasien PGK. Tujuan utamapenelitian adalah untuk mengetahui profil asam amino pasien PGK dengan hemodialisisrutin. Desain penelitian adalah potong lintang dengan 60 subjek pasien PGK usia >18tahun dengan hemodialisis rutin di RS. Umum Pusat Nasional Dr. Cipto Mangukusumo.Sampel berupa dried blood spot (DBS) dan pemeriksaan asam amino menggunakanmetode Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS). Asam aminoyang diperiksa adalah asam amino nonesensial (alanin, arginin, asam aspartat, asamglutamat, asparagin, glisin, glutamin, prolin, serin, tirosin), esensial (histidin, fenilalanin,isoleusin, leusin, lisin, metionin, treonin, triptofan, valin), dan khusus (ornitin, sitrulin).Hasil penelitian didapatkan hampir semua kadar asam amino pada subjek lebih rendahterutama alanin, tirosin, histidin, dan valin; sebaliknya asam aspartat dan serin ditemukanlebih tinggi kadarnya dibandingkan nilai rujukan Mayo dan data internal dewasa sehat.Didapatkan adanya hubungan bermakna antara jenis kelamin dengan fenilalanin,isoleusin, leusin; hipoalbuminemia (albumin <4 g/dL) dengan glisin; hipoalbuminemia(<3,5 g/dL) dengan arginin, asam aspartat, asparagin, histidin, lisin, metionin, danornitin. Didapatkan korelasi yang bermakna antara usia dengan BCAA (isoleusin, leusin,valin), dan metionin; dan hemoglobin dengan isoleusin. Penelitian ini merupakanpenilitian pertama tentang profil asam amino pada pasien PGK dengan hemodialisis diIndonesia dan penelitian pertama kali yang menggunakan sampel DBS pada orangdewasa. Dengan diketahuinya profil asam amino pada PGK dapat dimanfaatkan sebagaidasar pemberian jenis suplementasi asam amino yang sesuai dengan populasi pasien PGKdengan hemodialisis di Indonesia.
Protein energy wasting (PEW) is a nutritional disorder syndrome that often occurs inpatients with chronic kidney disease (CKD) on routine hemodialysis around 28-80%. Theprocess of hemodialysis can cause the loss of nutrients such as amino acids, increase theinflammatory process which can increase protein catabolism, and be able to inhibit theutilization of amino acids in protein synthesis. If untreated, PEW can increase themorbidity and mortality of CKD patients. The main objective of the study was todetermine the amino acid profile of CKD patients on routine hemodialysis. The studydesign was cross sectional with 60 subjects of CKD patients aged >18 years on routinehemodialysis at Dr. Cipto Mangunkusumo National Public Hospital. Samples in the formof dried blood spot (DBS) and amino acid examination using the Liquid ChromatographyTandem Mass Spectrometry (LC-MS/MS) method. Amino acids examined werenonessential amino acids (alanine, arginine, aspartic acid, glutamic acid, asparagine,glycine, glutamine, proline, serine, tyrosine), essential (histidine, phenylalanine,isoleucine, leucine, lysine, methionine, glycine, glutamine, proline, serine, tyrosine),special (ornithine, citrulline). The results showed that almost all amino acid levels in thesubjects were lower especially alanine, tyrosine, histidine, and valine; in contrast, asparticacid and serine were found to be higher than Mayo reference value and internal data ofhealthy adults. A significant relationship was found between gender and phenylalanine,isoleucine, leucine; hypoalbuminemia (albumin <4g/dL) with glycine; hypoalbuminemia(<3.5 g/dL) with arginine, aspartate acid, asparagine, histidine, lysine, methionine, andornithine. Significant correlation was obtained between age with BCAA (isoleucine,leucine, valine), and methionine; and hemoglobin with isoleucine. This study is the firststudy of the amino acid profile in CKD patients with hemodialysis in Indonesia and thefirst study using DBS samples in adults. Knowing the amino acid profile in CKD can beused as a basis for the of amino acid supplementation that is suitable for the populationof CKD patients with hemodialysis in Indonesia. |
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