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All Journal Jurnal Kesehatan Andalas Majalah Kedokteran Andalas Indonesian Journal of Kidney and Hypertension Bioscientia Medicina : Journal of Biomedicine and Translational Research Indonesian Journal of Multidisciplinary Science The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Deka Viotra
Division Of Nephrology, Department Of Internal Medicine, Faculty Of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, Indonesia
Humanities Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Education Engineering Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Library & Information Science Mathematics Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Diagnostic Value of Proenkephalin A 119 – 159 Serum in Early Detection of Sepsis Associated Acute Kidney Injury Wahyudi, Adefri; Priyono, Drajad; Harun, Harnavi; Viotra, Deka; Najirman, Najirman; Kurniati, Roza; Simajuntak, Rohayat Bilmahdi; Murni, Arina Widya
Indonesian Journal of Kidney and Hypertension Vol 3 No 1 (2026): Vol 3 No 1 (2026): Volume 3 No. 1, April 2026
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v3i1.239

Abstract

Background: Sepsis asscociated acute kidney injury (SA-AKI) is common condition that found in sepsis. Due to the lack of creatinine serum, this condition possibly makes therapy delayed. Proenkephalin A 119-159 (PENK) is a breakdown product of the prohormone proenkephalin A which freely filtered at the glomerulus. In other hand, this prohormone and its receptor predominantly expressed in proximal Tubular Epythelial Cells (pTEC) of kidney. Elevated serum PENK levels are an indicator of AKI. However, previous studies have shown varies results. Objectives: This study aims to determine early detection biomarkers for the presence of AKI in sepsis. Methods: This diagnostic test was conducted at Dr. M. Djamil General Hospital Padang in sepsis patients. The diagnosis of AKI was established based on the 2012 KDIGO criteria. Results: The study involved 98 sepsis patients, 58.16% (n=57) of them experienced AKI. Serum creatinine levels at admission and within 48 hours of hospitalization were 1.0 (IQR 0.8–1.5) mg/dl and 1.6 (IQR 0.9–2.1) mg/dl, respectively. A serum PENK level ≥82.6 pmol/L at admission had sensitivity of 98.6%, specificity of 95.1%, positive predictive value of 96.1%, negative predictive value of 97.5%, and accuracy of 96.9% in early detection of AKI in sepsis. Conclusion: Serum PENK level has excellent diagnostic value in early detection of AKI in sepsis.
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

Abstract

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.
Co-Authors Abdul Alim Rahimi Aini Zhann Alexander Kam Alexander Kam Annesa Fadella Arina Widya Murni Arnelis . Bestari Jaka Budiman Deddy Canceria Suka Rahmatsyah Dela Hangri Jalmas Dolly Irfandy Drajad Priyono Drajad Priyono Drajad Priyono Dwitya Elvira, Dwitya Eva Decroli Evelin Veronike Evelin Veronike Fahrurozi, R. Ifan A. Faurin, Muthia Fauzar Fauzar Fauzar Fauzar Fauzar, Fauzar Harnavi Harun Harun Harnavi Jalmas, Dela Hangri Jersivindo Ranazeri Kam, Alexander Khairat AS Laksono Trisnantoro Martini, Rose D Murni, Arina W Najirman Najirman, Najirman Pratama Yudha, Muhammad Agung Priyono, Drajad Putri Deas Hadilofyani Ramadhan Ananda Putra Raveinal Rezki Sadeli Rivani Sintia Suratman Roza Kurniati Roza Kurniati Roza Mulyana Rudy Afriant Saptino Miro Saptino Miro, Saptino Simajuntak, Rohayat Bilmahdi Sri Puji Rahayuningsih Steven, Rios Vesri Yoga Wahyudi . Wahyudi, Adefri Yanuar Surya Saputra Poedjijo Yayik Supriyani Zaki Mahmudi Dasril Zaki Mahmudi Dasril Zhann, Aini