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Journal : Ina Kidney

Association Between Fluid Administration and Hemoglobin Changes During Perioperative Kidney Transplantation Sanyoto, Arundina; Widiana, I Gde Raka; Mahadita, Gede Wira; Kandarini, Yenny; Ayu, Nyoman Paramita; Erawan, I Gusti Ngurah Agung Tresna
Indonesian Journal of Kidney and Hypertension Vol 1 No 3 (2024): Volume 1 No. 3, December 2024
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v1i3.157

Abstract

Background: Chronic Kidney Disease (CKD) is a leading cause of mortality worldwide, particularly in Indonesia, so it requires effective treatment options like kidney transplantation. Optimal fluid therapy during the perioperative period is important for stable hemodynamics and graft function. However, guidelines for fluid administration remain lacking. Objective: This study investigates the association between fluid therapy and changes in hemoglobin levels in patients undergoing renal transplantation. Methods: A retrospective observational cross-sectional study was conducted at RSUP Prof. DR. I.G.N.G. Ngoerah Denpasar from January 2016 to August 2024. Data were collected from medical records of patients who underwent kidney transplantation, excluding those with incomplete data. Key variables included daily fluid intake and hemoglobin levels. The coefficient of variance was calculated and continued with correlation analyses utilizing Pearson correlation and linear regression to assess relationships between fluid administration and hemoglobin changes. Results: Of 28 patients, 10 met inclusion criteria, consisting of 4 males and 6 females. Analysis showed a strong correlation between the variance of fluid intake and the variance of hemoglobin levels (R = 0.86; R² = 0.74; P < 0.001). Conclusion: This study demonstrates a significant relationship between post-operative variance of fluid administration and variance of hemoglobin levels following kidney transplantation. It may have an impact on the management of post-operative reduction in hemoglobin levels.
Ethanol 50% as Antidote in Propylene Glycol Due to Antifreeze Ingestion in General Hospital, Bali, Indonesia: Case Report Barimbing, Morris Lintong; Widiana, I Gde Raka
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2025): Volume 2 No. 1, April 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i1.150

Abstract

Propylene glycol intoxication is a medical emergency requiring immediate intervention. It is metabolized by alcohol dehydrogenase into toxic metabolites, such as lactate and pyruvate, which can lead to metabolic acidosis and organ failure. The primary antidote strategy involves inhibiting alcohol dehydrogenase to prevent the formation of these harmful metabolites. This case report highlights a 53-year-old man who accidentally ingested a propylene glycol radiator coolant. He presented with symptoms of nausea, vomiting, and metabolic acidosis, confirmed through laboratory tests. With no fomepizole available—the preferred antidote—the patient was administered ethanol (gin) at a concentration of 50% over 10 minutes until intoxication occurred. Ethanol competes with propylene glycol for alcohol dehydrogenase, thereby preventing the formation of toxic lactate metabolites. The patient recovered without complications after two days of being given oral ethanol and was discharged. Although ethanol use as an antidote for propylene glycol poisoning is limited, this case underscores its potential effectiveness in reducing morbidity and mortality when fomepizole is unavailable. This approach demonstrates the importance of timely intervention in cases of toxic alcohol exposure.
Effect of Tacrolimus Once Daily XR on Variance of Blood Tacrolimus Concentrations in Comparison with Twice Daily Tacrolimus in Kidney Transplant Recipients Widiana, I Gde Raka; Putra, I Made Rama; Wahyuningrum, Stefany Adi
Indonesian Journal of Kidney and Hypertension Vol 2 No 2 (2025): Volume 2 No. 2, August 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i2.190

Abstract

Background: Variability of tacrolimus concentration in the plasma of recipients is associated with nephrotoxicity, acute rejection, and affects graft survival. Objective: To test the hypothesis that the coefficient variation of plasma tacrolimus in new tacrolimus XR (extended-release) once daily is lower than conventional twice daily. Methods: The study was conducted in two phases. Phase 1, a comparative observational analysis with a single-group crossover, comparing periods of divided-dose treatment with crossover to prolonged-dose treatment. Phase 2, a cross-sectional design, is used to correlate IVP and serum creatinine variation. Results: A total of 19 kidney post-transplant recipients were included. There was a significant difference in blood tacrolimus CoV between XR tacrolimus and divided dose therapy (22.22±7.39% vs 44.32±15.54%, p<0.001). A significant linear correlation was observed between blood tacrolimus CoV and serum creatinine CoV in all patients (r=0.74; r2= 0.54; b=1.15; p<0.001). Subgroup analysis revealed a significant correlation between blood tacrolimus CoV in divided dose tacrolimus therapy subgroup (r=0.58; r2= 0.33; p=0.02) but not in the XR group (r=0.06; r2= 0.004; p=0.84). Multivariate ANCOVA showed serum CoV was associated with CoV of blood tacrolimus (B=0.72; r2= 0.255; p=0.01). Furthermore, XR tacrolimus was associated with lower serum creatinine CoV (B= -20.7; r2=0.20; p=0.02). Conclusion: XR tacrolimus therapy produces significantly lower variance of blood tacrolimus concentrations in kidney transplant recipients. This variance is associated with serum creatinine variance, especially in divided-dose tacrolimus therapy. Serum creatinine variance is linked to variances in blood tacrolimus levels, and XR tacrolimus therapy is associated with lower serum creatinine variance.
Co-Authors A. A. G. Oka, A. A. G. Ade Sinyo Aristantrisna Adnyani, Ni Made Dwi Agrasidi, Putu Anindya Ake, Anselmus Anak Agung Chris Tedy Pramana Anak Agung Gde Oka Anak Agung Wiradewi Lestari and N. Sutarka Anwar Santoso Ari Andayani Arlene Elizabeth Padang Aslesa Wangpathi Pagehgiri Ayu, Nyoman Paramita Bagus Ngurah Putu Arhana Bambang Purwanto Barimbing, Morris Lintong Budi Suprapti Christopher Ryalino Cokorda Bagus Jaya Lesmana Dedi Silakarma Desak Putu Puteri Diah Rahtini Desy Permatasari Dewa Nyoman Putra Adiwinata Dewi Catur Wulandari Dharmi Lestari, Ni Putu Djodi Sidartha E. Elyshanti Elizabeth Haryanti Elysanti Dwi Martadiani Erawan, I Gusti Ngurah Agung Tresna Feliciano Pinto, Feliciano Firman Parulian Sitanggang Firman Sitanggang Gede Andi Aditya Gede Sukma Pranata Darma Gede Wira Mahadita Gede Wirya Kusuma Duarsa Handayani, Putu Novi Hendra Koncoro Hendra S Hendra Salim Hizkia Robinson Junsen Lumban Gaol I Dewa Agung Sutanjaya Giri Nugraha I Dewa Nyoman Wibawa I G. N. Anom-Supradnya I G. N. M. Sugiana I Gede Aditya Krishna Santhi I Gede Hendra Sucipta I Gusti Agung Trisna Windiani I Gusti Ayu Made Juliari I Gusti Kamasan Arijana I Gusti Ngurah Ketut Budiarsa I Gusti Ngurah Made Suwarba I Gusti Rai Putra Wiguna I K. Sudartana I Kadek Agus Setiawan I Ketut Suwiyoga I Ketut Wiargitha I Ketut Widiana I Made Adi Satria Darma I Made Agus Endra Permana I Made Arimbawa I Made Ayusta I Made Gede Widnyana I Made Kardana I Nengah Wiadnyana Steven Christian I Nyoman Adi Putra I Nyoman Semadi I Nyoman Wiryawan I Putu Budhiastra, I Putu I Putu Gede Budiana, I Putu Gede I Putu Gede Eka Ariawan Suyasa, I Putu Gede Eka Ariawan I Wayan Eka Sutyawan I Wayan Gede Jayanegara I Wayan Juli Sumadi I Wayan Putu Sutirta Yasa I Wayan Sudhana I Wayan Wita I Wayan Yudiana IBN Mahendra Ida Bagus Gede Suparyatha Ida Bagus Putra Pramana Ida Safitri IKG Suandi Imam Effendi Indira Prawita Martani Inez Kartika Jetty Kalembang Jod Loekman Jodhi S Loekman Jodi Sidharta Loekman Jodi SL Juliari, IGAM K Suwitra K. Suwitra Kadek Budi Santosa Ketu Suwitra Ketut Mulyadi Ketut Putu Yasa Ketut Rina, Ketut Ketut Suarta Ketut Suega Ketut Suwitra Ketut Tuti Parwati Merati Komang Ayu Witarini Kumbara, Cokorde Istri Yuliandari Krisnawardani Luh Gede Yuliadewi NS Luh Yeni Laksmi Luh Yeni Laksmini Made Agus Dwianthara Sueta Made Agus Kusumadjaja Made Asih MADE RATNA SARASWATI . Made Satria Yudha Dewangga Made Widhi Asih Mahadita, Gede Wira Mahardani, Putu Nandika Tungga Yudanti Mahautama, I Gusti Agung Putra Maria, Dessy Marleen MOCHAMMAD THAHA Moestikaningsih ** Moestikaningsih . Monica Sampurna Ngakan Gede Dwija Hermawan Ni Ketut Putri Ariani Ni Kompyang Rahayu Ni Made Amelia R. Dewi Ni Made Ari Suryathi Ni Made Dharma Laksmi Ni Made Putri Suastari Ni Nyoman Margiani Ni Putu Sriwidyani Ni Wayan Anantika Riani Ni Wayan Winarti NP Veny Kartika Yantie Nyoman Maharmaya Nyoman Paramita Ayu Nyoman Srie Laksminingsih Nyoman Sutarka, Nyoman Oka Udrayana Ommy Agustriadi Pande Made Wisnu Tirtayasa Pande Putu Yuli Anandasari Pantjawati, Ni Luh Diah Patriawan, Putu Paulus Wiyono Pemayun, Cok Istri Dewiyani PITIKA ASPR Poerwono Rahardjo Pradnyana DS, Bagus Ari Prayuda, Prayuda Purnama Purnama Putra, I Made Rama Putu Astri Novianti Putu Ayu Saraswati Putu Junara Putra Putu Yuliawati Raka-Sudewi A. A. Reny Setya Pratiwi Duarsa Rully Roesli Sanyoto, Arundina Satrio Ryandi Semadhi, Putu Gitanjani Mahadewi Setiawan, I Gede Budhi Sianny Herawati Silvester Kristian Taopan Siska Sitanggang, Firman Parulian Soetjiningsih Soetjiningsih Sudaryat S Sudjana, Karismayusa Sukmawati, Nurindah Sutyawan, I Wayan Eka Tianing - Trianto Trianto W Sudhana W. G. Jayanegara Wahyuningrum, Stefany Adi Wayan Aryadana Wayan Aryadana Wayan Sudana Wayan Sudhan Wayan Sudhana Wiradharma, Ketut Gede Y. Saskia-Javi Yenny Kandarini Yoga Putra Yuliawati, Putu Yuriawantini - Zulfariska, Nony