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Hyperhomocysteinemia in Chronic Kidney Disease: A Meta-Analysis Faurin, Muthia; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i12.1133

Background: Hyperhomocysteinemia, an elevated level of homocysteine in the blood, has been implicated in the progression of chronic kidney disease (CKD). This meta-analysis aims to comprehensively evaluate the association between hyperhomocysteinemia and CKD and its potential impact on clinical outcomes. Methods: This study systematically searched electronic databases (PubMed, Embase, Cochrane Library) for studies published between 2018 and 2024 investigating the relationship between hyperhomocysteinemia and CKD. Studies reporting data on the association between hyperhomocysteinemia and CKD progression, cardiovascular events, or mortality were included. We extracted relevant data and performed a meta-analysis using random-effects models. Results: The meta-analysis included 25 studies comprising 5,672 patients with CKD. Hyperhomocysteinemia was significantly associated with an increased risk of CKD progression (pooled odds ratio [OR] 1.85, 95% confidence interval [CI] 1.52-2.24), cardiovascular events (pooled OR 1.63, 95% CI 1.31-2.02), and all-cause mortality (pooled OR 1.48, 95% CI 1.17-1.87) in CKD patients. Subgroup analyses revealed a consistent association across different CKD stages and etiologies. Conclusion: Hyperhomocysteinemia is an independent risk factor for CKD progression, cardiovascular events, and mortality. Monitoring and managing hyperhomocysteinemia may represent a potential therapeutic target to improve outcomes in CKD patients.

β2-Microglobulin: A Powerful Biomarker for Chronic Kidney Disease Progression Yanuar Surya Saputra Poedjijo; Drajad Priyono; Deka Viotra; Harun, Harnavi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1219

Background: Chronic kidney disease (CKD) is a global health concern with increasing prevalence. Early detection and accurate prognosis are crucial for effective management. β2-microglobulin (β2M) has emerged as a promising biomarker in CKD, but its prognostic value requires further evaluation. This meta-analysis aimed to comprehensively assess the association between β2M and CKD progression. Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2013 and 2024 investigating the relationship between β2M and CKD progression. Studies were included if they reported hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between β2M levels and renal endpoints (e.g., end-stage renal disease [ESRD], doubling of serum creatinine, or a decline in estimated glomerular filtration rate [eGFR]). A random-effects model was used to pool the HRs. Results: Six eligible studies involving 5,420 participants were included. The pooled analysis demonstrated a significant association between elevated β2M levels and increased risk of CKD progression (HR = 2.15; 95% CI: 1.78-2.59; p < 0.001). Subgroup analyses revealed that this association remained consistent across different CKD stages and underlying etiologies. Conclusion: Elevated β2M is a strong and independent predictor of CKD progression. Its incorporation into clinical practice may improve risk stratification and guide therapeutic interventions in CKD patients.

Efficacy, Safety, and Metabolic Effects of Low-Molecular-Weight Heparin versus Unfractionated Heparin in Chronic Hemodialysis: A Systematic Review and Meta-Analysis of Clinical Studies Evelin Veronike; Harnavi Harun; Drajad Priyono; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1494

Background: The optimal anticoagulation for chronic hemodialysis (HD) remains debated. Unfractionated heparin (UFH) is the historical standard but carries risks of metabolic complications and requires intensive monitoring. Low-Molecular-Weight Heparin (LMWH) offers pharmacological advantages, but concerns over bleeding risk in end-stage renal disease (ESRD) have limited its use. This study aimed to provide a holistic comparison by synthesizing recent evidence on the efficacy, safety, and, uniquely, the key metabolic consequences of LMWH versus UFH. Methods: This systematic review followed PRISMA 2020 guidelines. We searched PubMed, EMBASE, and CENTRAL from January 2014 to March 2025 for clinical studies comparing LMWH and UFH in chronic HD patients. We included 6 studies (3 prospective trials, 3 retrospective cohorts) totaling 7,890 patients. The primary efficacy outcome was circuit thrombosis; the primary safety outcome was major bleeding. Secondary outcomes focused on key metabolic markers (pre-dialysis potassium, lipid profile). Data from prospective trials and observational studies were analyzed separately using subgroup analysis and tested for interaction. Metabolic data were pooled using a random-effects model. Results: The analysis of key metabolic outcomes, derived from homogenous prospective trials (I2=0%), was the most robust finding. LMWH use was associated with a clinically significant reduction in pre-dialysis serum potassium (Mean Difference [MD]: -0.30 mEq/L; 95% CI: -0.50 to -0.10) and a superior atherogenic profile, including lower triglycerides (MD: -20.10 mg/dL) and higher HDL (MD: +4.50 mg/dL). For safety, no difference in major bleeding was found, a finding that was consistent across prospective trials (OR: 0.78; 95% CI: 0.33-1.85) and large retrospective cohorts (OR: 0.87; 95% CI: 0.69-1.09), with no subgroup interaction (p=0.75). Efficacy for preventing circuit thrombosis was also similar. Conclusion: This meta-analysis provides strong, high-quality evidence that LMWH confers significant and clinically relevant metabolic advantages over UFH, particularly in mitigating hyperkalemia and atherogenic dyslipidemia. Furthermore, our stratified analysis provides high confidence from real-world data that LMWH, when dosed appropriately, is as safe and effective as UFH.

Circulating Syndecan-1 as a Biomarker of Endothelial Injury and Survival in Hemodialysis: A Systematic Review and Meta-Analysis of Hemodynamic and Prognostic Associations Redo Augusta M Sabebegen; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1549

Background: Cardiovascular disease remains the primary cause of mortality in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). Conventional risk factors fail to fully explain the high prevalence of resistant hypertension and intradialytic hemodynamic instability in this population. Emerging evidence points to the degradation of the endothelial glycocalyx (eGC), a protective luminal layer regulating vascular tone and permeability. Syndecan-1 (SDC-1), a core component of the eGC, sheds into the circulation during vascular stress. This study aimed to synthesize evidence regarding the magnitude of dialysis-induced SDC-1 shedding and its validity as a prognostic biomarker for survival and vascular stiffness. M ethods: We conducted a systematic review and associative meta-analysis of observational studies and clinical trials. We searched Scopus, PubMed, and Web of Science for studies quantifying serum SDC-1 in HD patients and relevant physiologic comparators. Data were stratified to analyze three domains: the second hit phenomenon (acute pre- vs. post-dialysis shedding), diagnostic correlations with pulse wave velocity (PWV) and fluid status, and prognostic hazard ratios (HR) for all-cause mortality. A random-effects model was employed to account for population heterogeneity, specifically stratifying hemodialysis cohorts from heart failure comparators. Results: Ten pivotal studies involving over 1,500 patients were included. The analysis confirmed a substantial acute surge in serum SDC-1 post-hemodialysis (Standardized Mean Difference = 1.24, p < 0.001), indicating that the dialysis procedure actively injures the endothelium. Elevated baseline SDC-1 correlated significantly with arterial stiffness (PWV) and sodium overload, supporting a mechanism of salt-induced vascular stiffening. In prognostic analysis, high SDC-1 was a robust independent predictor of mortality (Pooled HR = 1.65, 95% CI: 1.12–2.43). Conclusion: Hemodialysis acts as a vascular stressor, triggering acute shedding of the endothelial glycocalyx. This shedding is mechanistically linked to sodium dysregulation and vascular stiffness, independent of traditional uremic toxins. SDC-1 serves as a valuable prognostic marker for endothelial health and survival, suggesting a need for endothelium-protective dialysis strategies.

Circulating Syndecan-1 as a Biomarker of Endothelial Injury and Survival in Hemodialysis: A Systematic Review and Meta-Analysis of Hemodynamic and Prognostic Associations Redo Augusta M Sabebegen; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1549

Background: Cardiovascular disease remains the primary cause of mortality in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). Conventional risk factors fail to fully explain the high prevalence of resistant hypertension and intradialytic hemodynamic instability in this population. Emerging evidence points to the degradation of the endothelial glycocalyx (eGC), a protective luminal layer regulating vascular tone and permeability. Syndecan-1 (SDC-1), a core component of the eGC, sheds into the circulation during vascular stress. This study aimed to synthesize evidence regarding the magnitude of dialysis-induced SDC-1 shedding and its validity as a prognostic biomarker for survival and vascular stiffness. M ethods: We conducted a systematic review and associative meta-analysis of observational studies and clinical trials. We searched Scopus, PubMed, and Web of Science for studies quantifying serum SDC-1 in HD patients and relevant physiologic comparators. Data were stratified to analyze three domains: the second hit phenomenon (acute pre- vs. post-dialysis shedding), diagnostic correlations with pulse wave velocity (PWV) and fluid status, and prognostic hazard ratios (HR) for all-cause mortality. A random-effects model was employed to account for population heterogeneity, specifically stratifying hemodialysis cohorts from heart failure comparators. Results: Ten pivotal studies involving over 1,500 patients were included. The analysis confirmed a substantial acute surge in serum SDC-1 post-hemodialysis (Standardized Mean Difference = 1.24, p < 0.001), indicating that the dialysis procedure actively injures the endothelium. Elevated baseline SDC-1 correlated significantly with arterial stiffness (PWV) and sodium overload, supporting a mechanism of salt-induced vascular stiffening. In prognostic analysis, high SDC-1 was a robust independent predictor of mortality (Pooled HR = 1.65, 95% CI: 1.12–2.43). Conclusion: Hemodialysis acts as a vascular stressor, triggering acute shedding of the endothelial glycocalyx. This shedding is mechanistically linked to sodium dysregulation and vascular stiffness, independent of traditional uremic toxins. SDC-1 serves as a valuable prognostic marker for endothelial health and survival, suggesting a need for endothelium-protective dialysis strategies.

Comparative Prognostic Value of Podocyturia Versus Microalbuminuria in Predicting Diabetic Nephropathy Progression: A Meta-Analysis Bayu Arief Hartanto; Deka Viotra; Harnavi Harun; Drajad Priyono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1578

Background: Diabetic nephropathy represents the primary etiology of end-stage renal disease globally. Historically, clinical practice relied upon microalbuminuria as the definitive non-invasive biomarker for early detection. However, advanced histopathological evidence establishes that severe structural degradation of the glomerular filtration barrier, specifically the visceral epithelial cells known as podocytes, occurs significantly earlier than the clinical manifestation of microalbuminuria. Podocyturia, defined as the urinary excretion of intact podocytes and podocyte-specific proteins or messenger RNA, emerged as a direct indicator of active glomerular injury. This meta-analysis investigated the comparative prognostic value of podocyturia versus microalbuminuria in predicting the longitudinal progression of diabetic nephropathy. Methods: A systematic literature search was executed to identify comparative clinical studies evaluating both podocyturia and microalbuminuria in diabetic cohorts. Seven essential manuscripts met rigorous inclusion criteria. Following peer-review recommendations, statistical pooling was strictly stratified by study design. Data extraction focused on prognostic effect sizes in longitudinal cohorts and diagnostic effect sizes in cross-sectional cohorts. Statistical synthesis utilized DerSimonian-Laird random-effects models to calculate pooled Standardized Mean Differences and 95% confidence intervals. Results: Synthesized data demonstrated podocyturia possessed a significantly superior prognostic value compared to microalbuminuria. In longitudinal cohorts, the pooled Standardized Mean Difference for podocyturia predicting progression was 1.95 (95% CI: 1.50 to 2.40, p < 0.001), whereas microalbuminuria was 0.58 (95% CI: 0.25 to 0.91, p = 0.04). Cross-sectional data similarly demonstrated massive podocyte biomarker elevation in strictly normoalbuminuric patients. Conclusion: Podocyturia represents a substantially more accurate, sensitive, and temporally earlier prognostic biomarker for diabetic nephropathy progression than microalbuminuria. Incorporating podocyte-specific urinary quantification into routine clinical practice could fundamentally alter early therapeutic intervention strategies, shifting the focus toward arresting primary podocyte detachment.

Comparative Prognostic Value of Podocyturia Versus Microalbuminuria in Predicting Diabetic Nephropathy Progression: A Meta-Analysis Bayu Arief Hartanto; Deka Viotra; Harnavi Harun; Drajad Priyono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1578

Background: Diabetic nephropathy represents the primary etiology of end-stage renal disease globally. Historically, clinical practice relied upon microalbuminuria as the definitive non-invasive biomarker for early detection. However, advanced histopathological evidence establishes that severe structural degradation of the glomerular filtration barrier, specifically the visceral epithelial cells known as podocytes, occurs significantly earlier than the clinical manifestation of microalbuminuria. Podocyturia, defined as the urinary excretion of intact podocytes and podocyte-specific proteins or messenger RNA, emerged as a direct indicator of active glomerular injury. This meta-analysis investigated the comparative prognostic value of podocyturia versus microalbuminuria in predicting the longitudinal progression of diabetic nephropathy. Methods: A systematic literature search was executed to identify comparative clinical studies evaluating both podocyturia and microalbuminuria in diabetic cohorts. Seven essential manuscripts met rigorous inclusion criteria. Following peer-review recommendations, statistical pooling was strictly stratified by study design. Data extraction focused on prognostic effect sizes in longitudinal cohorts and diagnostic effect sizes in cross-sectional cohorts. Statistical synthesis utilized DerSimonian-Laird random-effects models to calculate pooled Standardized Mean Differences and 95% confidence intervals. Results: Synthesized data demonstrated podocyturia possessed a significantly superior prognostic value compared to microalbuminuria. In longitudinal cohorts, the pooled Standardized Mean Difference for podocyturia predicting progression was 1.95 (95% CI: 1.50 to 2.40, p < 0.001), whereas microalbuminuria was 0.58 (95% CI: 0.25 to 0.91, p = 0.04). Cross-sectional data similarly demonstrated massive podocyte biomarker elevation in strictly normoalbuminuric patients. Conclusion: Podocyturia represents a substantially more accurate, sensitive, and temporally earlier prognostic biomarker for diabetic nephropathy progression than microalbuminuria. Incorporating podocyte-specific urinary quantification into routine clinical practice could fundamentally alter early therapeutic intervention strategies, shifting the focus toward arresting primary podocyte detachment.

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