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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.

Kadar Transthyretin Plasma pada Lanjut Usia Sarkopenia dan Non-Sarkopenia Fahrurozi, R. Ifan A.; Martini, Rose D; Mulyana, Roza; Murni, Arina W; Decroli, Eva; Miro, Saptino; Viotra, Deka; Yoga, Vesri
Jurnal Penyakit Dalam Indonesia Vol. 12, No. 4
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Introduction. Sarcopenia is a geriatric syndrome marked by an age-related decline in muscle mass, which is affected by protein intake. Transthyretin is a visceral protein used to evaluate nutritional status and acts as a positive regulator of muscle mass. This study aimed to assess the difference in plasma transthyretin levels between elderly groups with and without sarcopenia. Methods. This was an analytical observational study with a cross-sectional approach. Subjects were elderly patients who visited the Internal Medicine Polyclinic of Dr. M. Djamil Hospital Padang and met the inclusion and exclusion criteria from August to September 2024. Subjects were classified into sarcopenic and non-sarcopenic groups, followed by an examination of plasma transthyretin levels. Sarcopenia was diagnosed using bio-impedance analysis (BIA) measurement, handgrip strength with a Jamar hydraulic hand dynamometer, and physical performance with a walking speed test. Plasma transthyretin levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. Comparative analysis was performed using the unpaired T-test using SPSS 29.0. Results. Among total of 46 subjects who participated in this study, the majority of elderly individuals with sarcopenia were predominantly female. The mean plasma transthyretin level in the sarcopenic elderly group was 10.9 (3.3) mg/dL, while in the non-sarcopenic elderly group was 20.3 (2.5) mg/dL. Comparative analysis demonstrated a significant difference in plasma transthyretin levels between sarcopenic and non-sarcopenic elderly individuals (p < 0.001). Plasma transthyretin levels in the sarcopenic elderly group were lower compared to the non-sarcopenic elderly group. Conclusion. There is a significant difference in plasma transthyretin levels between sarcopenic and non-sarcopenic elderly individuals.

Acute Gouty Arthritis with Knee Effusion in a Patient with Chronic Lymphocytic Leukemia: Diagnostic Confirmation and Pre-Chemotherapy Hyperuricemia Management Panji Hadi Permana; Eka Kurniawan; Raveinal; Deka Viotra; Fadrian Fadrian
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (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.v10i6.1614

Background: Gout and chronic lymphocytic leukemia (CLL) represent distinct hematologic and rheumatologic pathologies; however, their concurrent presentation presents significant diagnostic and therapeutic challenges. Tumor lysis syndrome and chemotherapy-induced hyperuricemia are recognized complications of hematologic malignancies, yet the manifestation of acute gouty arthritis with crystallographic confirmation in CLL patients remains an underreported clinical scenario requiring careful diagnostic stratification. Case presentation: We present a 69-year-old male farmer with newly diagnosed CLL (stage C, Binet classification) admitted for acute left knee arthritis with effusion, left ankle arthritis, and concurrent community-acquired pneumonia (CAP). Clinical examination revealed articular inflammation characterized by pain, swelling, erythema, warmth, and significant joint effusion with documented flexion limitation and positive bulging sign. Musculoskeletal ultrasound demonstrated double contour sign, synovial hypertrophy, and effusion measuring 5.8 cm in the suprapatellar recess with monosodium urate (MSU) crystal deposition confirmed by polarized light microscopy of synovial fluid (5,350 cells/mm³, 40% polymorphonuclear neutrophils, 60% mononuclear cells, positive MSU crystals). Serum uric acid was elevated at 10.6 mg/dL. The patient was successfully managed with colchicine, methylprednisolone, arthrocentesis, and supportive care while maintaining CLL treatment preparedness. Conclusion: This case illustrates the importance of confirmatory synovial fluid analysis and ultrasound imaging in the diagnosis of acute gout in the context of hematologic malignancy. Optimal management requires careful coordination between rheumatology and hematology-oncology services to prevent therapeutic complications and ensure safe chemotherapy initiation in CLL patients with concurrent acute gouty arthritis and hyperuricemia.

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

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.

Acute Gouty Arthritis with Knee Effusion in a Patient with Chronic Lymphocytic Leukemia: Diagnostic Confirmation and Pre-Chemotherapy Hyperuricemia Management Panji Hadi Permana; Eka Kurniawan; Raveinal; Deka Viotra; Fadrian Fadrian
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (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.v10i6.1614

Background: Gout and chronic lymphocytic leukemia (CLL) represent distinct hematologic and rheumatologic pathologies; however, their concurrent presentation presents significant diagnostic and therapeutic challenges. Tumor lysis syndrome and chemotherapy-induced hyperuricemia are recognized complications of hematologic malignancies, yet the manifestation of acute gouty arthritis with crystallographic confirmation in CLL patients remains an underreported clinical scenario requiring careful diagnostic stratification. Case presentation: We present a 69-year-old male farmer with newly diagnosed CLL (stage C, Binet classification) admitted for acute left knee arthritis with effusion, left ankle arthritis, and concurrent community-acquired pneumonia (CAP). Clinical examination revealed articular inflammation characterized by pain, swelling, erythema, warmth, and significant joint effusion with documented flexion limitation and positive bulging sign. Musculoskeletal ultrasound demonstrated double contour sign, synovial hypertrophy, and effusion measuring 5.8 cm in the suprapatellar recess with monosodium urate (MSU) crystal deposition confirmed by polarized light microscopy of synovial fluid (5,350 cells/mm³, 40% polymorphonuclear neutrophils, 60% mononuclear cells, positive MSU crystals). Serum uric acid was elevated at 10.6 mg/dL. The patient was successfully managed with colchicine, methylprednisolone, arthrocentesis, and supportive care while maintaining CLL treatment preparedness. Conclusion: This case illustrates the importance of confirmatory synovial fluid analysis and ultrasound imaging in the diagnosis of acute gout in the context of hematologic malignancy. Optimal management requires careful coordination between rheumatology and hematology-oncology services to prevent therapeutic complications and ensure safe chemotherapy initiation in CLL patients with concurrent acute gouty arthritis and hyperuricemia.

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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