Zulkhair Ali
Department Of Internal Medicine, Dr. Mohammad Hoesin Hospital, Palembang, Indonesia / Department Of Internal Medicine, Faculty Of Medicine, Universitas Sriwijaya, Palembang, Indonesia

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The Role of Podocyte Cells in Diabetic Nephropathy: A Narrative Literature Review Azhari, Fauzan; Novadian; Ian Effendi; Zulkhair Ali; Suprapti; Ratna Maila Dewi Anggraini; Yulianto Kusnadi; Alwi Shahab
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 12 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i12.893

Abstract

The main cells affected in diabetic nephropathy are podocytes and proximal tubular cells. One of the main functional proteins in the podocyte slit diaphragm is podocin which podocytes need to express together with several specific proteins in the correct way for their differentiation, as well as to maintain their complex anatomy. Podocytes are highly specialized epithelial cells. They line the urinary surface of the glomerular capillary bundles. Podocytes are part of the filtration barrier along with capillary endothelial cells and GBM. Podocytes ensure selective permeability of the glomerular capillary walls. Podocin is a membrane protein with a molecular weight of 42kD which is located in the foot processes, and also forms part of the SD with the nephrin protein. Urinary podocin levels more specifically indicate ongoing glomerular damage because they were significantly increased in the normoalbuminuria group compared with the control group.
Angiotensin-Converting Enzyme Genetic Polymorphism rs4343 as Risk of Diabetic Nephropathy in Jambi-Malay Population Elfiani, Elfiani; Puspasari, Anggelia; Arif, Cut Wulan; Maharani, Citra; Ali, Zulkhair; Suhaimi, Novadian; Effendi, Ian; Suprapti, Suprapti; Shafira, Nyimas Natasha Ayu
Molecular and Cellular Biomedical Sciences Vol 8, No 1 (2024)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v8i1.410

Abstract

Background: Diabetic nephropathy (DN) is one of the frequent complications of type II diabetes mellitus (T2DM) in Jambi province. Controlling blood glucose and blood pressure does not guarantee DN prevention, since genetic factors may also contribute to this disease. Multi-ethnic studies showed that one of the strongest genetic factors associated with DN was single nucleotide polymorphism rs4343 of angiotensin-converting enzyme (ACE) gene. Study regarding phenotype-genotype association of ACE rs4343 and DN has not yet been performed in Jambi Province, which is dominated by Malay ethnicity. This study was conducted to reveal the association between ACE rs4343 and the risk of DN in the Jambi-Malay population.Materials and methods: This was a cross-sectional study involving 75 subjects (44 with DN and 31 without DN) who suffered from T2DM and hypertension. DN was defined as albumin to creatinine ratio (ACR) ≥30 mg/g. Genotyping was performed with one-step tetra amplification refractory mutation system-polymerase chain reaction (PCR) using specific primer for ACE rs4343. Bivariate and multivariate analyses were performed to analyze the genetic risk for DN.Results: The bivariate analysis showed the proportion of DN subjects was higher than non-DN within the AG genotype (11:1) than within the AA (33:30) genotype. This difference was statistically significant (p=0.012; OR (95% CI): 10.00 (1.22-82.15)). Multivariate analysis showed that AG genotype (p=0.047; OR (95% CI): 10.04 (1.03-97.31)) and uncontrolled blood pressure (p=0.001; OR (95% CI): 6.72 (2.08-21.71)) were the risk factors of DN in the Jambi-Malay population.Conclusion: Polymorphism of ACE rs4343 is a risk factor of DN in the Jambi-Malay Population.Keywords: rs4343, angiotensin-converting enzyme gene, diabetic nephropathy, Malay, Jambi
OVERVIEW OF PERIPHERAL NEUROPATHY IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HEMODIALYSIS AT DR. MOHAMMAD HOESIN HOSPITAL PALEMBANG Christin, Theresia; Ali, Zulkhair; Legiran, Legiran; Ferawaty, Ferawaty
PHARMACOLOGY, MEDICAL REPORTS, ORTHOPEDIC, AND ILLNESS DETAILS Vol. 2 No. 3 (2023): JULY
Publisher : Transpublika Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55047/comorbid.v2i3.890

Abstract

Neurological complications occur in almost 60% of patients with advanced CKD and affect the nervous system at all levels, both central and peripheral. Peripheral neuropathy in CKD is usually asymptomatic until renal function is below 15%, and glomerular filtration is less than 10-12 ml/min. This study seeks to identify and characterize peripheral neuropathy in patients with chronic kidney disease undergoing hemodialysis at Dr. Mohammad Hoesin Hospital Palembang. This is a descriptive cross-sectional study with the research sample comprising chronic kidney disease patients undergoing hemodialysis at Dr. Mohommad Hoesin Palembang Hospital. The distribution of research subjects based on the Neuropathy Symptom Score (NSS) revealed that 65.7% fell into the mild neuropathy category, based on an NSS of 3-4. According to the electrophysiology results, 82.9% of patients exhibited peripheral neuropathy, while 17.1% showed normal NCS results. Sensory motor neuropathy accounted for 51.4%, including 71.5% with axonal neuropathy, 11.4% with axonal-demyelinating lesions, and no demyelinating lesions. The high prevalence of peripheral neuropathy in CKD patients identified through electrophysiological examination (ENMG) emphasizes the importance of nerve conduction examination as a diagnostic tool for peripheral neuropathy in CKD patients. This can aid in determining the progression of peripheral neuropathy in CKD patients, allowing for appropriate management and prevention of disability complications to enhance the quality of life for these individuals.
Is It a Tumor or Not? A Case of Focal Segmental Glomerulosclerosis Secondary to Type 2 Diabetes with a Concomitant Renal Pseudotumor Rery TF Yuniarti; Ian Effendi; Zulkhair Ali; Novadian; Suprapti; Elfiani; Novandra AP; Dila Siti Hamidah; Fadil Pramudhya Husein; Ika Kartika Edi P
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.v8i12.1154

Abstract

Background: Focal segmental glomerulosclerosis (FSGS) is a histologic pattern of glomerular injury that can be primary or secondary to various conditions, including obesity, diabetes, and hypertension. Renal masses, often detected incidentally, can be benign or malignant, with renal cell carcinoma (RCC) being the most common. This case report presents a patient with FSGS secondary to type 2 diabetes and a concomitant renal pseudotumor, initially suspected to be RCC. Case presentation: A 60-year-old woman presented with weakness, fever, and weight loss. Imaging revealed a renal mass, initially suspected to be RCC. A kidney biopsy revealed FSGS, and further evaluation confirmed type 2 diabetes. After controlling her diabetes and hypertension, the renal mass regressed, suggesting a pseudotumor. Conclusion: This case highlights the importance of considering pseudotumors in the differential diagnosis of renal masses, especially in patients with comorbidities such as diabetes. A kidney biopsy can help avoid unnecessary invasive procedures like nephrectomy.
Impact of Etelcalcetide on Cardiovascular Outcomes and Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism: A Meta-Analysis Nurul Ramadhani Umareta; Fitri Rahmariani; Zulkhair Ali
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 1 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i1.701

Abstract

Secondary hyperparathyroidism (SHPT) is a common complication in hemodialysis patients, contributing to cardiovascular disease and mortality. Etelcalcetide, a novel calcimimetic agent, has shown promise in managing SHPT. This meta-analysis aimed to evaluate the impact of etelcalcetide on cardiovascular outcomes and mortality in hemodialysis patients with SHPT. A systematic search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify randomized controlled trials (RCTs) comparing etelcalcetide with placebo or other active treatments in hemodialysis patients with SHPT. The primary outcomes were cardiovascular events (composite of myocardial infarction, stroke, heart failure, and cardiovascular death) and all-cause mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Seven RCTs (n=4,520 patients) were included in the meta-analysis. Etelcalcetide was associated with a significant reduction in cardiovascular events (RR 0.85, 95% CI 0.75-0.96, p=0.01) and all-cause mortality (RR 0.88, 95% CI 0.79-0.98, p=0.02) compared to placebo. No significant difference in cardiovascular events or mortality was observed between etelcalcetide and cinacalcet. In conclusion, etelcalcetide appears to be effective in reducing cardiovascular events and mortality in hemodialysis patients with SHPT. Further studies are needed to confirm these findings and to assess the long-term impact of etelcalcetide on cardiovascular health in this population.
THE EFFECT OF TAHAJUD PRAYER ON STRESS Pranata, Lilik; Irfannuddin, Irfannuddin; Ali, Zulkhair; Andraini, Trinovita
Menara Medika Vol 7, No 2 (2025): VOL 7 NO 2 MARET 2025
Publisher : Fakultas Kesehatan Universitas Muhammadiyah Sumatera Barat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31869/mm.v7i2.6951

Abstract

Introduction: Stress is a physical and emotional reaction that occurs when a person faces pressure or environmental changes that require them to adapt. If stress is left unchecked, it can lead to many disorders. One thing that can be done is to perform tahajud prayers. The purpose of this study is to determine the benefits of tahajud prayer on stress. Method: The research design uses a literature review method by analysing articles from databases such as PubMed, Science Direct, ProQuest, and Google Scholar, focusing on articles published between 2020 and 2025, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart approach. After selection, six articles were found to meet the inclusion criteria. Results: Tahajud prayer therapy can reduce stress levels. Discussion: Every individual experiences different levels of stress, so the process of performing tahajud prayer must be adapted to the stress level. The activity of tahajud prayer should be performed regularly without coercion and with sincerity.
Bridging the Therapeutic Gap: A Systematic Review and Meta-Analysis on the Efficacy, Safety, and Pathophysiological Impact of Sodium Zirconium Cyclosilicate in Enabling Guideline-Directed Medical Therapy Edy Nur Rachman; Ian Effendi; Zulkhair Ali; Novadian; Suprapti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1489

Abstract

Background: Hyperkalemia is a life-threatening complication of chronic kidney disease (CKD) and heart failure (HF), primarily impeding the use of life-saving renin-angiotensin-aldosterone system inhibitors (RAASi). This systematic review and meta-analysis evaluate the evidence for sodium zirconium cyclosilicate (SZC) in managing hyperkalemia and enabling RAASi therapy. Methods: This systematic review searched Medline, Embase, and Cochrane CENTRAL to September 2025. Dual reviewers independently screened, extracted data, and assessed bias (Cochrane RoB 2, Newcastle-Ottawa Scale). We included RCTs and observational studies of SZC in adults with hyperkalemia. A random-effects meta-analysis was performed on RCTs reporting maintenance-phase efficacy and safety. Results: The search yielded 1,254 citations, with 6 pivotal studies included. The meta-analysis of 3 RCTs found that SZC (5-10g daily) was significantly more effective than placebo at maintaining normokalemia over 12-28 days. The pooled mean difference in serum K+ was -0.58 mEq/L (95% CI: -0.65 to -0.51; I2 = 0%). SZC did increase the risk of edema (pooled Risk Ratio: 2.95; 95% CI: 1.51 to 5.76; I2 = 0%). The narrative synthesis of observational data confirmed that SZC use was associated with a >2.5-fold increase in the likelihood of continuing RAASi therapy. Conclusion: Sodium zirconium cyclosilicate is a highly effective and rapidly acting agent for both acute correction and chronic management of hyperkalemia. Our meta-analysis provides a precise estimate of its high maintenance-phase efficacy. Its primary clinical benefit lies in providing a renal-independent pathway for potassium excretion, thereby "uncoupling" potassium levels from RAASi use and bridging a critical treatment gap.
Modulation of TGF-β/Smad and Nrf2 Signaling Pathways by Thymoquinone in the Attenuation of Renal Fibrosis: A Systematic Review and Meta-Analysis of Pre-clinical Models Chairil Makky; Ian Effendi; Zulkhair Ali; Novadian; Suprapti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1491

Abstract

Background: Renal fibrosis is the irreversible, final common pathway for all progressive forms of chronic kidney disease (CKD), leading to end-stage renal disease. Its pathogenesis is characterized by the over-activation of pro-fibrotic signaling, chiefly the Transforming Growth Factor-beta (TGF-β)/Smad pathway, and the failure of endogenous cytoprotective mechanisms like the nuclear factor erythroid 2-related factor 2 (Nrf2) antioxidant response. Thymoquinone (TQ), the primary bioactive constituent of Nigella sativa, is a pleiotropic compound with known anti-inflammatory and antioxidant properties. This study was designed to systematically quantify its mechanistic efficacy in modulating the core Nrf2 and TGF-β pathways in established pre-clinical models of renal fibrosis and injury. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. We performed a comprehensive search of major databases (including PubMed and Scopus) for pre-clinical in vivo studies published between 2014 and 2025 that investigated TQ monotherapy or TQ-dominant combination therapy in rodent models of renal injury. The eight studies that met the inclusion criteria utilized diverse models: Unilateral Ureteral Obstruction (UUO), cisplatin-induced nephrotoxicity, gentamicin-induced nephrotoxicity, 5-fluorouracil (5-FU)-induced acute kidney injury (AKI), lipopolysaccharide (LPS)-induced inflammation, carfilzomib (CFZ)-induced renal impairment, and ischemia-reperfusion (IRI). Primary outcomes were the expression of renal Nrf2 and TGF-β1. Secondary outcomes included markers of fibrosis (collagen deposition, histology scores), renal function (BUN, creatinine), oxidative stress (MDA, SOD, GSH, CAT), and inflammation (TNF-α, NF-κB, IL-6, IL-1β). Data were pooled using a random-effects model, and primary analyses were stratified by injury model subgroup. Results: Thymoquinone treatment resulted in a profound and significant upregulation of the protective Nrf2 pathway (SMD: 2.38; 95% CI [1.05, 3.71]; p < 0.001; 3 studies) and its downstream target Heme Oxygenase-1 (HO-1). Concurrently, TQ treatment markedly suppressed the primary pro-fibrotic driver, TGF-β1 (SMD: -2.09; 95% CI [-2.99, -1.19]; p < 0.001; 2 studies). This pivotal dual modulation translated into significant functional and structural improvements. TQ robustly attenuated renal fibrosis scores (SMD: -1.89; 95% CI [-2.55, -1.23]; p < 0.001; 2 studies). Stratified subgroup analysis showed TQ significantly improved renal function in both chemotoxic AKI models (BUN SMD: -2.31; 95% CI [-3.22, -1.40]) and chronic obstructive/fibrosis models (BUN SMD: -1.17; 95% CI [-1.75, -0.59]). This functional protection was underpinned by potent, broad-spectrum reversal of oxidative stress and inflammation across all subgroups. Conclusion: Thymoquinone consistently ameliorates renal injury and fibrosis across a wide spectrum of pre-clinical models. Its mechanism of action is multifaceted, critically involving the dual modulation of opposing pro-fibrotic and protective pathways: it suppresses the TGF-β1 cascade while simultaneously activating and restoring the Nrf2 antioxidant response. This body of evidence strongly supports Thymoquinone as a high-potential candidate for translational research and development as a novel, network-targeting therapy for human renal fibrosis.
Beyond Phosphate Binding: A Systematic Review and Meta-Analysis on the Efficacy and Safety of the Novel Paracellular Phosphate Inhibitor, Tenapanor, for Hyperphosphatemia in Dialysis Patients Eva Julita; Ian Effendi; Zulkhair Ali; Novadian; Suprapti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1492

Abstract

Background: Hyperphosphatemia is a critical driver of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) undergoing dialysis. Current management, reliant on phosphate binders, is hampered by high pill burden and poor adherence. Tenapanor, a first-in-class, minimally-absorbed sodium/hydrogen exchanger 3 (NHE3) inhibitor, reduces paracellular phosphate absorption. We performed a systematic review and meta-analysis of all available Phase 3 trials to quantify its efficacy and safety. Methods: We searched PubMed, Embase, and Cochrane CENTRAL through October 2025 for Phase 3 clinical trials evaluating tenapanor for hyperphosphatemia in dialysis patients. Data were extracted from 6 eligible studies (N=1573). We conducted separate random-effects meta-analyses for different study designs: 1) parallel-group monotherapy vs. placebo, 2) withdrawal-design monotherapy vs. placebo, 3) parallel-group add-on therapy vs. placebo, and 4) safety (diarrhea incidence) vs. placebo. Efficacy was measured by Mean Difference (MD) in serum phosphate change; safety by Risk Ratio (RR). Results: Tenapanor demonstrated significant efficacy across all study designs. In parallel-group monotherapy (1 study, N=167), tenapanor was superior to placebo (MD: -1.89 mg/dL; 95% CI: -2.36 to -1.42). In withdrawal-design studies (2 RCTs, N=373), tenapanor maintained serum phosphate levels significantly better than placebo (Pooled MD: -0.75 mg/dL; 95% CI: -1.05 to -0.45; I2=0%). As an add-on therapy (1 RCT, N=235), tenapanor provided additional phosphate reduction versus binders alone (MD: -0.65 mg/dL; 95% CI: -0.96 to -0.35). Tenapanor significantly increased the risk of diarrhea versus placebo (3 RCTs, N=521; Pooled RR: 4.10; 95% CI: 2.50 to 6.72; I2=30%), which was the primary adverse event leading to discontinuation. Conclusion: Tenapanor represents a new mechanistic paradigm for hyperphosphatemia management. It is a highly effective phosphate-lowering agent, both as monotherapy and add-on therapy, but is associated with a significant, mechanism-based risk of gastrointestinal side effects.
Effect of Garlic (Allium Sativum) Extract on Hemoglobin Levels in Chronic Hemodialysis Patients Ramadhan, Philosophia; Alif Fathur Rachman, Muhammad; Ali, Zulkhair; Effendi, Ian; Novadian, Novadian; Suprapti, Suprapti; Saleh, Irsan
Journal of World Science Vol. 2 No. 1 (2023): Journal of World Science
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/jws.v2i1.129

Abstract

CKD patients undergoing hemodialysis have increased inflammatory biomarkers. Anemia in CKD is associated with an advanced degree of inflammation while undergoing chronic hemodialysis. Garlic (Allium sativum) has anti-inflammatory and antioxidant effects, which are expected to improve the degree of inflammation in CKD patients. This study aims to assess the effect of garlic extract on hemoglobin levels in patients undergoing chronic hemodialysis. This study was an experimental study with a double-blind, randomized clinical trial design. This study was a crossover, randomized, placebo-controlled, double-blind trial. The study subjects were 40 stages 5 CKD patients undergoing chronic hemodialysis, randomly divided into two groups, namely the group that received 1000 mg of garlic extract per day (2x500 mg) for six weeks and the group that received a placebo, then a 2-week wash-out period. And after that, the two groups were given alternate treatment. Statistical analysis was carried out using the SPSS version 25.0 program. A total of 40 subjects participated in the study, 57.5% male. The mean age of the subjects was 48.6 (26-59) years. The results showed that there was a significant difference in Hb levels in the garlic group (p = 0.047), where the increase in Hb was from 10.2 (9.2–11.8) mg/dl to 10.23 (8.9–11.6) mg/dl while in the placebo group, there was a decrease in Hb from 10.18 (9.6 – 11.2) mg/dl to 10.05 ± 0.52 mg/dl. Garlic extract can reduce levels of inflammation which can then increase hemoglobin levels.
Co-Authors Abdul Hakim R Ade Yonata Ade Yonata, Ade Agustina H Akbar, Kgs. M. Yusuf Arief Akbar, M Yusuf Arief Ali Ghanie Alif Fathur Rachman, Muhammad Alwi Shahab Alwi Shahab Anggelia Puspasari Arief Akbar, Kgs M Yusuf Arif, Cut Wulan Chairil Makky Christin, Theresia Citra Maharani Deddy Primadona Mulia Devi, SNA Ratnasari Dila Siti Hamidah Eddy Mart Salim Edy Nur Rachman Effendi, Ian Elfiani Elfiani Elfiani Emilia Emilia Erial Bahar Erial Bahar Erial Bahar, Erial Erwin Sukandi Eva Julita Fadil Pramudhya Hoesain Fadil Pramudhya Husein Fadil Pramudya Fauzan Azhari, Fauzan Ferawaty, Ferawaty Ferry Usnizar Ferry Yusrizal Fitri Rahmariani Fitria Koeshardani Harun Hudari Huntari Harahap Ian Effendi Ian Effendi Ian Effendi Ika Kartika Ika Kartika Edi P Indrajaya, Taufik Irawan, Rico Irfannuddin Irfannuddin Istiqomah, Amelia Junaidi A Kartika, Herleni Kendenan, Margaretha Kgs M Yusuf Arief Akbar Kgs. M. Yusuf Arief Akbar kurniati, nova Kusrini, Ida Legiran Legiran Lidiawati Handayani Lilik Pranata M Yusuf Arief Akbar Mediarty Mediarty Syahrir Muhammad Irsan Saleh Muhammad Yusri Mulia, Deddy Primadona Nova Kurniati Novadian Novadian Novadian Novadian, Novadian Novadian Suhaimi Novadian Suhaimi Novadian Suhaimi Novandra AP Nurul Ramadhani Umareta Nyimas Natasha Ayu Shafira R.M. Suryadi Tjekyan Radiyati Umi Partan Ramadhan, Philosophia Ratna Maila Dewi Anggraini Reinanda Marizki R Rery TF Yuniarti RM Suryadi Tjekyan Rostika Dewi Shahab, Alwi Slamet, Suprapti SNA Ratnasari Devi Suhaimi, Novadian Suprapti Suprapti Slamet Suprapti Suprapti Suprapti Suprapti Syahpri Putra Wangsa Taufik Indrajaya Taufik Indrajaya Trinovita Andraini Wangsa, Syahpri Putra Yudhie Tanta Yulianto kusnadi