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The Duration of Hemodialysis and its Implication to Barthel Score and Laboratory Parameters among End Stage Renal Disease Patients Jahidi, Savero Mizan; Mardiana, Nunuk; Wardhani, Indrayuni Lukitra
Clinical and Research Journal in Internal Medicine Vol 2, No 1 (2021): First Issue of 2021
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2021.002.01.3

Background: While it was proven that hemodialysis for treating patients with end stage renal disease (ESRD) provided the reduced mortality rate, the reports on its adequacy in the context of laboratory parameters and psychological function were limited. Aim: To assess the implication of hemodialysis duration on Barthel score and laboratory parameters among ESRD patients. Â Methods: During the period, a cross-sectional study was conducted at Dr. Soetomo General Hospital. Information related to age, gender, history of hypertension, history of diabetes mellitus, and the levels of hemoglobin, albumin, calcium, and phosphor were retrieved from medical records. While, we performed the interview to each participant using Barthel index questionnaire to assess the function independence. We used multiple logistic regression analysis to determine the correlation and estimate of effect. Results: We totally include we included 65 patients with the hemodialysis duration of more than one year and 16 patients with the hemodialysis duration of less than one year. Our results found that the higher levels of albumin and hemoglobin were observed in patients with hemodialysis duration of more than one year. While, the duration of hemodialysis did not affect the Barthel score and serum mineral parameters. Conclusion: Â The duration of hemodialysis of more than one year is associated with the improvement of albumin and hemoglobin levels

Levels of Hemoglobin, Leukocytes, and Platelets of Chronic Kidney Disease Patients Undergoing Hemodialysis in Surabaya Mega Kahdina; Nunuk Mardiana; Dyah Fauziah
Biomolecular and Health Science Journal Vol. 1 No. 1 (2018): Biomolecular and Health Science Journal
Publisher : Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Background: Chronic kidney disease (CKD) is increasing in Indonesia, furthermore, it requires high treatment cost such as conservative therapy and kidney transplantation or dialysis. There are two types of dialysis; hemodialysis (HD) and peritoneal dialysis. The patient who undergoes HD needs periodical laboratories evaluation due to its impact on hemoglobin (Hb), leukocyte and platelets. The purpose of this study was to obtain the levels of Hb, leukocyte and platelets regularly in stage 5 CKD patients undergoing HD.Methods: Data were collected from patients’ medical record from October to December 2014 and it was characterized based on age, sex, HD frequency, HD period, hemoglobin, iron saturation, ESA (erythropoiesis-stimulating agent), leukocyte level and platelets level. 60 samples were included with the same ratio.Results: The average of age was 45 years old and the average of HD period was 40 months. All patients suffered anemia, however, only 51 patients could be evaluated the iron saturation. From it, 37 patients had the iron saturation of ≥20% which 14 (38%) of them received ESA. There were 14 patients who suffered zinc deficiency anemia with the iron saturation of <20% which 4 (29%) of them received ESA.Conclusion: Most of patients’ leukocyte and platelets levels were normal. Patients who received ESA had higher Hb levels. Platelets levels had a reverse correlation with the longer period of hemodialysis.

Risk Factors for Urinary Tract Infection in Hospitalized Patients Hadiati Setyorini; Nunuk Mardiana; Artaria Tjempakasari
Biomolecular and Health Science Journal Vol. 2 No. 1 (2019): Biomolecular and Health Science Journal
Publisher : Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Introduction: Urinary tract infection (UTI) is the most common infection that can be fatal and has higher rate mortality especially in some patient. This study is aim to analyze risk factors for urinary tract infection in hospitalized patients for prevention and more aggressive approach can be taken.Methods: Consecutively, medical records of 285 patients with urinary analysis was recorded for risk factors and urine culture results if suspected UTI. Risk factors for sex, age, urinary catheter, urolithiasis, DM, and immobilization was analyzed with bivariate analysis and multivariate analysis.Results: From 285 patients, 92 patients had UTI with average age was 52.45 years old, 48 (56.49%) were female. Most common pathogen were E. coli (41.3%), Enterobacter sp. (8.8%) and Enterococcus faecalis (7.6 %). From bivariate analysis, geriatric age (>60 years) has RR 1.421 (95% CI 1.015-1.989, p=0.046) and immobilization has RR 1.861 (95% CI 1.266-2.738, p=0.007), whereas sex (RR 1.190 95% CI 0.851 – 1.664, p=0.310), diabetes (RR 1.171 95% CI 0.833 – 1.645, p=0.367), insulin usage (RR 0.900 95% CI 0.519 – 1.561, p= 0.703), glycosuria (RR 1.152 95% CI 0.741 – 1.791, p=0.522), and CKD (RR 1.475 95% CI 0.896 – 2.430, p= 0.126) give insignificant result. From multivariate analysis, urinary catheter has OR 4.506 (95% CI 2.312-8.872, p=0.000), urolithiasis with OR 4.970 (95% CI 1.931-12.787, p=0.001), and hyperglycemia has OR 2.871 (95% CI 1.485-5.551, p=0.002).Conclusion: Geriatric age and immobilization are risk factors for urinary tract infection, and urinary catheter, urolithiasis, and hyperglycemia are independent risk factors for urinary tract infection.

Hearing impairment in hemodyalisis patients with hypertension and diabetes mellitus type-2 Nyilo Purnami; Nunuk Mardiana; Sabrina Izzattisselim; Alfarika Rosmalia; Makhmudyah Indri Cahyani
Oto Rhino Laryngologica Indonesiana Vol 51, No 1 (2021): Volume 51, No. 1 January - June 2021
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v51i1.396

Background: Sensorineural hearing loss could occur in chronic kidney disease (CKD) patients undergoing hemodyalisis. In general, the frequency of hearing impairment in CKD is connected with age and gender, and with associated disorders such as hypertension and diabetes mellitus. Purpose: To find out the incidence of hearing loss (HL) in CKD patients with hypertension and diabetes mellitus who were undergoing hemodialysis, in Dr. Soetomo General Hospital. Method: This was an observational descriptive study. Subjects were all CKD patients who were undergoing hemodialysis from June until December 2019 in Dr. Soetomo General Hospital. Subjects were categorized demographically and the hearing impairment was examined with audiometric examination and otoacoutic emission test. Result: From 52 samples, there were 31 female and 21 male, with the ratio 1.5:1. The highest age group was in 31-40 years old, and the average was 47 years old. Hemodialysis CKD patients with hypertension were 46 subjects, 14 patients with normal hearing and 32 patients had hearing impairment: mild HL 25 patients, moderate HL 5 patients and moderate-severe 2 patients. Hemodialysis CKD patients with DM type-2 were 12 subjects, 3 patients with normal hearing, and 9 patients had hearing impairment: mild HL 4 patients, moderate HL 4 patients, and moderate-severe HL 1 patient. Conclusion: In this study, female hemodyalisis patients were more than male, and the highest age group was between 31-40 years old. Hearing impairment in CKD subjects with hypertension were mostly mild HL, while in CKD subjects with DM type-2 were mostly mild and moderate HL.ABSTRAK Latar belakang: Tindakan hemodialysis yang dilakukan pada penderita penyakit ginjal kronis (PGK) dapat menyebabkan gangguan pendengaran tipe sensorineural. Perlu dikembangkan penatalaksanaan gangguan pendengaran terkait hemodialisis. PGK dan gangguan pendengaran secara umum berhubungan dengan usia dan jenis kelamin, serta penyakit yang sering menyertai PGK seperti hipertensi dan diabetes mellitus. Tujuan: Mendapatkan angka kejadian gangguan pendengaran pada penderita PGK yang menjalani hemodialisis, dengan disertai hipertensi dan diabetes mellitus (DM) di RSUD. Dr. Soetomo. Metode: Disain penelitian ini adalah deskriptif observasional dengan sampel semua penderita PGK yang dilakukan hemodialisis di RSUD Dr Soetomo yang memenuhi kriteria inklusi. Sampel yang diambil berdasarkan data demografi kemudian dilakukan pemeriksaan audiometri dan otoacoustic emission. Hasil: Didapati penderita PGK perempuan sebanyak 31 orang dan laki-laki 21 orang, dengan rasio 1,5:1. Kelompok usia terbanyak adalah 31-40 tahun, dan rerata usia penderita 47 tahun. Pasien PGK yang dihemodialsis dengan disertai hipertensi ada 46 subjek, 14 orang tanpa gangguan pendengaran dan 32 orang mengalami gangguan pendengaran: derajat ringan 25 penderita, derajat sedang 5 penderita, dan derajat sedang-berat 2 penderita. Pasien PGK yang dihemodialisis dengan DM type-2 ada 12 orang: tanpa ganguan pendengaran 3 orang, gangguan pendengaran derajat ringan 4 penderita, derajat sedang 4 penderita,dan derajat sedang-berat 1 penderita. Kesimpulan: Penderita PGK jenis kelamin perempuan lebih banyak daripada laki-laki. Kelompok usia terbanyak adalah 31-40 tahun. Sebagian besar pasien PGK dengan HD mengalami gangguan pendengaran derajat ringan. PGK yang disertai hipertensi terbanyak mengalami gangguan pendengaran derajat ringan, sedangkan yang disertai DM yaitu derajat ringan dan derajat sedang.Kata kunci: gangguan pendengaran, hipertensi, diabetes mellitus tipe 2, penyakit ginjal kronis,hemodialisis

Calculation of Drug Dosage In Chronic Kidney Disease Tenta Hartian Hendyatama; Nunuk Mardiana
Current Internal Medicine Research and Practice Surabaya Journal Vol. 1 No. 1 (2020): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE JOURNAL SURABAYA
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v1i1.16894

Kidneys are the main organ in fluid and electrolyte homeostasis. It also have an important role in eliminating various types of drugs. Drug elimination in the kidney is affected by plasma drug concentrations, plasma protein binding, and kidney function. Glomerular filtration rate (GFR) represents the kidney function. Thus by knowing it, drug dosage can be determined.Chronic kidney disease alter the effect of drug, some decrease drug effect but more often increase drug toxicity. Chronic kidney disease affect the pharmacodynamic and pharmacokinetic of drug. Therefore, providing an optimal treatment for CKD patient, knowledge of the pharmacokinetic and pharmacodynamic changing in CKD is needed.Exploring the patient's history and carrying out complete physical examination is important before giving the drug to patients with impaired kidney function. In addition, identifying drugs that have the potential to cause nephrotoxicity and drug interactions is also important.The body response to drugs in patient with CKD is very varied, complex, and individual. Dosage must be based on several factors, not only glomerular filtration rates but also other comorbid diseases, interactions with other drugs and clinical condition of the patient.

Medical Perioperative Management In Patient with Acute Kidney Disease Caesar Ayudi; Nunuk Mardiana
Current Internal Medicine Research and Practice Surabaya Journal Vol. 1 No. 2 (2020): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE JOURNAL SURABAYA
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v1i2.21459

Bartter syndrome is inherited tubulopathy caused by mutations in several genes causing hypokalemia, hypomagnesemia, hypocalcemia with hypercalciuria, and metabolic alkalosis. Beside from inherited disorder, Bartter syndrome can be caused by the use of aminoglycosides, so it is called Bartter-like syndrome. Hypokalemia has been reported as a side effect of aminoglycosides in many studies, but Bartter-like syndrome due to aminoglycosides has only been reported in a few case reports. We report a 43 years old female patient who developed muscle weakness due to hypokalemia. We found the patient’s laboratory results was consistent with Bartter syndrome. The patient had MDR-TB and received combination therapy with capreomycin for two months. We diagnosed a patient with Bartter-like syndrome due to capreomycin. Following diagnosis, we discontinued capreomycin and started potassium, magnesium and calcium therapy. After electrolyte imbalances improved, capreomycin was given three times per week and the patient was no longer experiencing the same condition.

Bartter-like Syndrome In a Patient Receiving Capreomycin For The Treatment Of Multidrug-Resistant Tuberculosis Rusdi Zakki Aminy; Nunuk Mardiana
Current Internal Medicine Research and Practice Surabaya Journal Vol. 1 No. 2 (2020): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE JOURNAL SURABAYA
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v1i2.21555

Bartter syndrome is inherited tubulopathy caused by mutations in several genes causing hypokalemia, hypomagnesemia, hypocalcemia with hypercalciuria, and metabolic alkalosis. Beside from inherited disorder, Bartter syndrome can be caused by the use of aminoglycosides, so it is called Bartter-like syndrome. Hypokalemia has been reported as a side effect of aminoglycosides in many studies, but Bartter-like syndrome due to aminoglycosides has only been reported in a few case reports. We report a 43 years old female patient who developed muscle weakness due to hypokalemia. We found the patient’s laboratory results was consistent with Bartter syndrome. The patient had MDR-TB and received combination therapy with capreomycin for two months. We diagnosed a patient with Bartter-like syndrome due to capreomycin. Following diagnosis, we discontinued capreomycin and started potassium, magnesium and calcium therapy. After electrolyte imbalances improved, capreomycin was given three times per week and the patient was no longer experiencing the same condition.

Bacterial and Antibiogram Profile of Urinary Tract Infection Patients in a Tertiary Hospital, Surabaya, Indonesia Mahrumi Dewi Tri Utami; Manik Retno Wahyunitisari; Nunuk Mardiana; Rebekah Juniati Setiabudi
Folia Medica Indonesiana Vol. 58 No. 3 (2022): September
Publisher : Universitas Airlangga

Highlights: Most urinary tract infections are caused by Gram-negative bacteria with E. coli being the most common bacteria. Antibiotics with the highest susceptibility for Gram-negative bacteria were ertapenem, meropenem, amikacin, and imipenem. Antibiotics with the highest susceptibility for Gram-positive bacteria mainly were susceptible to chloramphenicol,streptomycin, vancomycin, rifampin, tigecycline, teicoplanin, and ampicillin. Abstract: Urinary tract infection (UTI) is one of the most common bacterial infections. Inappropriate antibiotic use for UTI treatment may lead to antibiotic resistance. This study aimed to provide an updated bacterial and antibiogram profile from urine specimens of patients diagnosed with UTI. This study was a retrospective study using urine culture and antibiotic susceptibility test results obtained from Clinical Microbiology Laboratory in a tertiary general hospital in Surabaya, Indonesia for a two-month period patients. Most aged more than and/or equal to 59 years, in both sexes. Gram-negative bacteria, particularly , was being the most between June to July 2019. There were 215 patients with significant urine culture results of 54.4% from Escherichia coli female bacteria were carbapenem antibiotics and amikacin, while teicoplanin and vancomycin were some antibiotics susceptible to gramcommon bacteria that caused UTI, followed by K. pneumoniae. Some antibiotics with the highest susceptibility to gram-negative positive bacteria. This study result indicated that there was an urge to conduct local antibiogram profile investigation due to the low susceptibilities shown in recent empirical therapy recommendations, such as trimethoprim sulfamethoxazole, fluoroquinolone, nitrofurantoin, and fosfomycin.

Hearing impairment in hemodyalisis patients with hypertension and diabetes mellitus type-2 Nyilo Purnami; Nunuk Mardiana; Sabrina Izzattisselim; Alfarika Rosmalia; Makhmudyah Indri Cahyani
Oto Rhino Laryngologica Indonesiana Vol. 51 No. 1 (2021): Volume 51, No. 1 January - June 2021
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v51i1.396

Background: Sensorineural hearing loss could occur in chronic kidney disease (CKD) patients undergoing hemodyalisis. In general, the frequency of hearing impairment in CKD is connected with age and gender, and with associated disorders such as hypertension and diabetes mellitus. Purpose: To find out the incidence of hearing loss (HL) in CKD patients with hypertension and diabetes mellitus who were undergoing hemodialysis, in Dr. Soetomo General Hospital. Method: This was an observational descriptive study. Subjects were all CKD patients who were undergoing hemodialysis from June until December 2019 in Dr. Soetomo General Hospital. Subjects were categorized demographically and the hearing impairment was examined with audiometric examination and otoacoutic emission test. Result: From 52 samples, there were 31 female and 21 male, with the ratio 1.5:1. The highest age group was in 31-40 years old, and the average was 47 years old. Hemodialysis CKD patients with hypertension were 46 subjects, 14 patients with normal hearing and 32 patients had hearing impairment: mild HL 25 patients, moderate HL 5 patients and moderate-severe 2 patients. Hemodialysis CKD patients with DM type-2 were 12 subjects, 3 patients with normal hearing, and 9 patients had hearing impairment: mild HL 4 patients, moderate HL 4 patients, and moderate-severe HL 1 patient. Conclusion: In this study, female hemodyalisis patients were more than male, and the highest age group was between 31-40 years old. Hearing impairment in CKD subjects with hypertension were mostly mild HL, while in CKD subjects with DM type-2 were mostly mild and moderate HL.ABSTRAK Latar belakang: Tindakan hemodialysis yang dilakukan pada penderita penyakit ginjal kronis (PGK) dapat menyebabkan gangguan pendengaran tipe sensorineural. Perlu dikembangkan penatalaksanaan gangguan pendengaran terkait hemodialisis. PGK dan gangguan pendengaran secara umum berhubungan dengan usia dan jenis kelamin, serta penyakit yang sering menyertai PGK seperti hipertensi dan diabetes mellitus. Tujuan: Mendapatkan angka kejadian gangguan pendengaran pada penderita PGK yang menjalani hemodialisis, dengan disertai hipertensi dan diabetes mellitus (DM) di RSUD. Dr. Soetomo. Metode: Disain penelitian ini adalah deskriptif observasional dengan sampel semua penderita PGK yang dilakukan hemodialisis di RSUD Dr Soetomo yang memenuhi kriteria inklusi. Sampel yang diambil berdasarkan data demografi kemudian dilakukan pemeriksaan audiometri dan otoacoustic emission. Hasil: Didapati penderita PGK perempuan sebanyak 31 orang dan laki-laki 21 orang, dengan rasio 1,5:1. Kelompok usia terbanyak adalah 31-40 tahun, dan rerata usia penderita 47 tahun. Pasien PGK yang dihemodialsis dengan disertai hipertensi ada 46 subjek, 14 orang tanpa gangguan pendengaran dan 32 orang mengalami gangguan pendengaran: derajat ringan 25 penderita, derajat sedang 5 penderita, dan derajat sedang-berat 2 penderita. Pasien PGK yang dihemodialisis dengan DM type-2 ada 12 orang: tanpa ganguan pendengaran 3 orang, gangguan pendengaran derajat ringan 4 penderita, derajat sedang 4 penderita,dan derajat sedang-berat 1 penderita. Kesimpulan: Penderita PGK jenis kelamin perempuan lebih banyak daripada laki-laki. Kelompok usia terbanyak adalah 31-40 tahun. Sebagian besar pasien PGK dengan HD mengalami gangguan pendengaran derajat ringan. PGK yang disertai hipertensi terbanyak mengalami gangguan pendengaran derajat ringan, sedangkan yang disertai DM yaitu derajat ringan dan derajat sedang.Kata kunci: gangguan pendengaran, hipertensi, diabetes mellitus tipe 2, penyakit ginjal kronis,hemodialisis

Providing Intradialytic Parenteral Nutrition Therapy Does Not Improve Anthropometric Status in Hemodialysis Patients with Malnutrition Suryantoro, Satriyo Dwi; Tjempakasari, Artaria; Nurwidda, Arvi Dian Prasetia; Widodo, Widodo; Thaha, Mochammad; Mardiana, Nunuk
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2024): Volume 1 No. 1, April 2024
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v1i1.123

Background: Malnutrition is prevalent in hemodialysis patients and significantly impacts prognosis. It can result from reduced food intake and protein loss during hemodialysis. Nutritional status is determined through anthropometric examinations, which include upper arm circumference (UAC), body mass index (BMI), hand grip strength, bicep, and tricep fold thickness. Laboratory examinations like total cholesterol and Malnutrition Inflammation Score (MIS) or Subjective Global Assessment (SGA) are also used. Intradialytic Parenteral Nutrition (IDPN) is expected to maintain or improve the nutritional status of hemodialysis patients. Objective: This research examines the impact of parenteral nutrition therapy on the anthropometric status of malnourished hemodialysis patients. Methods: This cross-sectional study, a sub-analysis of a larger nutritional therapy study, involved 24 hemodialysis patients experiencing malnutrition based on SGA B and C criteria with 1-10 years of hemodialysis. IDPN therapy was provided, and anthropometric measurements and total cholesterol were taken at baseline and three months after nutritional therapy. Data processing used comparative statistical analysis. Results: The mean age was 45.33 years, with 14 males and 10 females. After 3 months, there were no significant differences in UAC (mean difference = 0.13; p = 0.69), BMI (mean difference = 0.13; p = 0.50), hand grip strength (mean difference = -0.96; p = 0.282), biceps skinfold thickness (mean difference = 0.13; p = 0.69) and triceps (mean difference = 0.59; p = 0.134) or total cholesterol (mean difference = -1.5; p = 0.71). Conclusion: IDPN therapy for 3 months did not improve the anthropometric status of hemodialysis patients with malnutrition.

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