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All Journal Medicina journal of internal medicine INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Jurnal Penyakit Dalam Udayana
Ketut Suwitra
Subdepartment of Nephrology & Hypertension Department of Medicine, Udayana University, Bali,
Immunology & microbiology Medicine & Pharmacology Public Health

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Faktor determinan kesintasan hidup lebih dari lima tahun pada pasien hemodialisis reguler Sudjana, Karismayusa; Ayu, Nyoman Paramita; Kandarini, Yenny; Widiana, Raka; Sudhana, Wayan; Loekman, Jodi Sidharta; Suwitra, Ketut
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Abstract

Latar Belakang: Pasien hemodialisis regular memiliki risiko mortalitas yang lebih tinggi dibandingkan populasinormal. Angka kesintasam hidup lima tahun pasien hemodialisis regular adalah 35,8% namun angka ini bervariasi di tiap populasi dan dipengaruhi berbagai faktor.Tujuan: Penelitian ini bertujuan untuk mengetahui faktor determinan dari kesintasan hidup lebih dari lima tahun pada pasien hemodialisis regular.Metode: Penelitian ini menggunakan metode kasus-kontrol. Data diambil dari Indonesian Renal Registry Report di Rumah Sakit Umum Pusat Sanglah, Denpasar, Bali. 37 pasien yang menjalani hemodialisis regular selama lebih dari 5 tahun dicocokkan dengan 37 pasien yang menjalani hemodialisis regular selama kurang dari 5 tahun, berdasarkan umur. Data dianalisis dengan uji chi-square.Hasil: Prevalensi pasien yang menjalani hemodialisis regular selama lebih dari 5 tahun didapatkan 9,52%. Kamimenganalisa etiologi penyakit ginjal kronik (PGK), jenis kelamin, tekanan darah, anemia, dan status kecukupanhemodialisis. Perbedaan signifikan kedua kelompok didapatkan pada etiologi PGK (p = 0,021) dan anemia  p=0,0). Tidak didapatkan perbedaan signifikan pada jenis kelamin, tekanan darah, dan status kecukupan hemodialisis (p = 0,63, p = 0,64, dan p = 0,34).Simpulan: Penelitian kami menunjukkan bahwa faktor determinan yang berperan signifikan pada kesintasan hidup lebih dari 5 tahun adalah etiologi PGK dan status anemia.
Korelasi stadiumacute kidney injurydengankadar fosfat serum Suardana, I Ketut; Kandarini, Yenny; Suwitra, Ketut
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Hiperfosfatemia telah diketahui terjadi pada penyakit ginjal kronis (PGK). Terdapat hubungan linear antaraperburukan laju filtrasi glomerolus (LFG) dan peningkatan kadar fosfat serum pada PGK. Padaacute kidney injury(AKI) hubungan tersebut belum jelas. Beberapa penelitian pendahuluan melaporkan adanya peningkatan kadar fosfatserum pada pasien AKI. Tujuanpenelitian ini adalah mencari korelasi antara stadium AKI dan kadar fosfat serum.Dilakukanpenelitianpotonglintangdi RSUP Sanglah dari bulanJuni sampai Agustus2015 denganbesarsampel 53orang dipilihsecaraconsecutive sampling. Sampel yang memenuhikriteriadimintakankesediannyaberpartisipasidenganmenandatanganiinformed consent.Stadium AKI menggunakan kriteriadariKidneyDiseaseImprovingGlobalOutcome(KDIGO) tahun 2012, yaitu berdasarkan parameter kreatinin serum dan produksi urin.Kadar fosfat serumdiperiksa dengan metodemolibdate UVdi Laboratorium Prodia Denpasar. Hubungan stadiumAKI dan kadarfosfatserum dianalisis denganmenggunakan uji korelasi Spearman.Dari 53 pasienAKIterdiri dari 33(62,3%)orang pria,rerata umur 42(SB10,8)tahun.Berdasarkan kriteria KDIGO 2012 didapatkan 25 (47,2%) pasien AKI stadium 1, 12(22,6%) pasien AKI stadium 2 serta 16 (30,2%) pasien AKI stadium 3. Rerata kadar fosfat serum sebesar 4,7(SB2,10)mg/dl. Rerata kadar fosfat serum pada AKI tadium 1 sebesar 3,7(SB1,00)mg/dl, pada AKI stadium 2 sebesar4,6(SB1,20)mg/dl serta pada AKI stadium3 sebesar 6,5(SB2,70)mg/dl. Terdapat korelasi yang bermakna antarastadium AKIdankadarfosfat serum(r= 0,52,P<0,001).[MEDICINA.2016;50(3):17-22]. Hyperphosphatemia has been recognized in chronic kidney disease (CKD). There is linear correlation betweendecreased glomerular filtration rate (GFR) and increased serum phosphate level in CKD patients. This correlationisnot clear in acute kidney injury (AKI). Previous studies report that there is increasing of serum phosphate level inpatients with AKI.This study wasaimedto assess the correlation betweenseverity of AKIandserum phosphate level.Across-sectional study was performedat Sanglah Hospital from JunetoAugust 2015. Fiftythree patients wereselected with consecutive sampling technique. Eligiblesamples were requested for participation by signed informedconsent. Severity of AKI was defined byKidneyDiseaseImprovingGlobal Outcome(KDIGO) criteria2012, basedon serum creatinin and urine output. Serum phosphate level was measured usingmolibdate UVat Prodia laboratoryDenpasar.Correlationbetween severity of AKI and serumphosphate levelwas performed using spearman correlation.Thirty tree(62.3%) out of53samplesweremale, themean of age was42(SD10.8) years. Twenty five(47.2%)sampleswere categorized AKI stage I, 12samples(22.6%)stage 2  and16samples(30.2%)stage 3. Meanphosphatelevelwas4.7(SD2.10)mg/dl. Meanphophate levelwas3.7(SD1.00)mg/dlin AKI stage 1,4.6(SD1.20)mg/dlinAKI stage 2 and6.5(SD2.70)mg/dlin AKI stage 3. There wassignificantcorrelation between severity of AKI andserum phosphate levelhad been showed by this study (r = 0.52,P<0.001).[MEDICINA.2016;50(3):17-22].
kognitif, MMSE, hemoglobin, hemodialisis reguler Wiradharma, Ketut Gede; Suwitra, Ketut; Widiana, I Gede Raka
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Gangguan fungsi kognitif merupakan masalah umum pada penyandang hemodialisis (HD) reguler. Belum jelas adanya kaitan antara penurunan kadar hemoglobin (Hb) dengan terjadinya penurunan fungsi kognitif pada penyandang HD reguler. Penelitian ini bertujuan mengetahui korelasi antara kadar Hb dan fungsi kognitif pada penyandang HD reguler di Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar. Penelitian berupa studi potong lintang analitik. Kriteria inklusi ialah penyandang HD reguler di RSUP Sanglah hingga Juli 2013, berusia 18-80 tahun, pendidikan minimal sekolah dasar atau sederajat, mengerti bahasa indonesia, bisa membaca dan menulis, kooperatif, dan bersedia ikut dalam penelitian. Kriteria eksklusi ialah dalam kondisi penurunan kesadaran akut, gangguan penglihatan atau pendengaran, riwayat stroke, trauma kepala, epilepsi, dan penggunaan obat penenang. Dari 56 sampel, karakteristik data didapatkan pria sebanyak 37 orang (66,1%) dan wanita 19 orang (33,9%), rerata umur (simpang baku/SB) 47,8 (14,3) tahun, lama HD (lama minimum-maksimum) 19,5 (4-131) bulan, kadar Hb (SB) 9,5 (2,02) g/dl, nilai mini mental state examination (MMSE) (nilai minimum-maksimum) 27,5 (19-30). Analisis dengan korelasi Spearman, antara kadar Hb dan MMSE didapatkan nilai r=0,13 dan P=0,18. Disimpulkan bahwa terdapat korelasi lemah tidak bermakna antara kadar Hb dan fungsi kognitif pada penyandang HD reguler di RSUP Sanglah.
COMPARISON OF GLOMERULAR FILTRATION RATE AND CHRONIC KIDNEY DISEASE PREVALENCE USING COCKCROFT-GAULT(C-G) AND MODIFICATION OF DIET IN RENAL DISEASE (MDRD FOR CHINESE FORMULA AMONG BALINESE POPULATION Widiana, I Gde Raka; Suwitra, Ketut
Medicina Vol 45 No 3 (2014): September 2014
Publisher : Medicina

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Abstract

Some community based study to determine the prevalence of chronic kidney disease has been conducted.It is reported that a reasonable rate of prevalence of CKD if calculated with different formula (either C-Gor MDRD). This  study  is aiming  to  compare estimated GFR and CKD prevalence determined byeitherC-G or MDRD  and the new Chinese modified MDRD formulaThis  study  analyzed  4528  subjects  from  7  areas  in Bali  Islands  including  219(4.8%)    subjects  inSembiran, 302 (6.7%), Denpasar 302 (6.7%), Nusa Ceningan 305 (6.7%), Legian282 (6.2%)  Blahbatuh3038(67.1%), Tenganan,  81(1.8%),  and  in Ubud  301(6.6%),  consisted  2217  (49%) males  and  2311(51%) females. It is found that there were a substantial differences and stepwise increase (79, 83, 86,and105 mL/min/  1.73 m2),  consecutively  of mean  of  estimated-GFR  if  calculated  by C-G, MDRD,MDRD for Chinese (if  non-Chinese), and MDRD for Chinese (if Chinese) formula. It was also foundthat differences of prevalence rate CKD using different formulas.  More than twenty percent (20.6%) ofCKD defined by estimated-GFR of 59 to 30 ml/min per 1.73m2 when were calculated by C-G,  and 6.9and 6.8 percent if were calculated by MDRD and  MDRD for Chinese (if  non-Chinese), consecutively,however, it is much lower (2.2%) using MDRD formula for Chinese (if Chinese).In conclusion, this study shows difference inmeanvalues of e GFR and  prevalence of CKD if calculatedusing  different  formulas. A  valid  formula  is  needed  for  specific  Indonesian  people.  [MEDICINA2014;45:151-155].
GAMMA-GLUTAMYL TRANSFERASE SERUM BERASOSIASI POSITIF DENGAN PENYAKIT GINJAL KRONIK. STUDI BERBASIS MASYARAKAT DI KECAMATAN BLAHBATUH GIANYAR BALI Sutarka, Nyoman; IG, Raka-Widiana; Suwitra, Ketut
Medicina Vol 45 No 2 (2014): Mei 2014
Publisher : Medicina

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Abstract

Penyakit ginjal kronik (PGK) merupakan masalah global kesehatan masyarakat. Gamma-glutamyl transferase (ãGT) serum banyak diusulkan sebagai marker yang sensitif terhadap stres oksidatif yang diperkirakan berhubungan dengan terjadinya PGK. Penelitian ini bertujuan untuk mengetahui asosiasi antara ãGT serum dan PGK. Dilakukan penelitian potong lintang di Kecamatan Blahbatuh Kabupaten Gianyar Bali dengan jumlah sampel 122 orang yang dipilih secara simple proportional random sampling. Sampel yang memenuhi kriteria dimintakan kesediaannya berpartisipasi dengan menandatangani informed consent. Diagnosis PGK ditegakkan sesuai kriteria NKF-KDOQI dengan perkiraan laju filtrasi glomerulus dihitung memakai rumus MDRD. Pemeriksaan ãGT serum dengan metode enzymatic colorimetrix. Data yang terkumpul dianalisis dengan SPSS 16 for windows meliputi uji Chi-Square dan analisis regresi logistik multipel. Dari 122 subyek yang memenuhi syarat, tiga subyek menolak berpartisipasi. Sebanyak 95 subyek adalah laki-laki dan 24 perempuan dengan rerata umur 62,68 (SB 1,27) tahun. Nilai median ãGT didapatkan sebesar 21 U/L. Prevalensi PGK didapatkan sebesar 16,8%. Dari 61 subyek dengan kadar ãGT serum sama dengan nilai median atau lebih 16 diantaranya didapatkan dengan PGK sedangkan dari 58 subyek dengan kadar ãGT serum di bawah nilai median hanya empat yang didapatkan dengan PGK. Didapatkan adanya asosiasi bermakna antara ãGT serum dan PGK (P=0,005 ; OR=4,8; IK95%=1,5 sampai 15,4). Setelah dikontrol dengan variabel umur, jenis kelamin, hipertensi, dan obesitas didapatkan asosiasi ãGT serum dan PGK ini masih tetap bermakna (P=0,029; adjusted OR =4,1; IK95% =1,2 sampai 14,9).Disimpulkan ada asosiasi positif antara ãGT serum dan PGK. Asosiasi ini independen terhadap  variabel umur, jenis kelamin, hipertensi, dan obesitas. ãGT serum mungkin dapat dipakai sebagai biomarker PGK. [MEDICINA. 2014;45:73-8].  
SEORANG PENDERITA SINDROM NEFRITIK AKUT PASCA INFEKSI STREPTOKOKUS Renny A Rena, Ni Made; Suwitra, Ketut
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

Acute nephritic syndrome is classically de! ned by symptoms of oliguria, oedem, hypertension and also urinalysisabnormality such as proteinuria less than 2 grams/day, hematuria, or ! nding of erytrocite silinder in the urine. The etiology ofacute nephritic syndrome are disorders of primary glomerulopathy (idiopathic), glomerulopathy after infection, DisseminatedLupus Erythomatosus (DLE), vasculitis and hereditary nephritis (Alport syndrome). Acute nephritic syndrome is one of clinicalmanifestation of acute glomerulonephritis after streptococcal infection, which is in" lamation occur on tubulus and glomerularof the kidney, after streptococcal infection of skin or upper respratory tract. The most frequent cause by particular strain ofhemolyticus streptococcus ß group A type 12. Herewith, we reported a case of acute glomerulonephritis after streptococcalinfection with clinical manifestation acute neph! tic syndrome. A fourteen years old Balinese male patient found with anasarcaoedem, oliguria and hematuria. Previous medical history with infection of throat 2 weeks before admitted to hospital. On physicalexamination, we found with Stage II hypertension, laboratory data shown urinalysis: hematuria and proteinuria, protein esbach3.25 gram/liter/day, ASTO 200 IU/ml, ANA test negative and throat swab isolated Streptococcus viridans, alpha hemoliticus.Imaging data showed right pleural effusion and bilateral nephritis of the kidney. Patient gives a good respon to corticosteroid(metilprednisolone), diuretic and also ACE inhibitor
PENGARUH VITAMIN C TERHADAP C-REACTIVE PROTEIN SEBAGAI PETANDA INFLAMASI PADA GAGAL GINJAL KRONIK DENGAN HEMODIALISIS REGULER Wulandari, Diah Catur; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

One of possible treatment to diminish the inflammation in regularly hemodialysis chronic kidney disease (RHCKD) isantioxidant. Ascorbic acid can inhibit nuclear factor B (NF-B) activation, decrease C-reactive protein (CRP) levels. The objectiveis to determine whether ascorbic acid 1000 mg intravenously can decrease CRP levels in RHCKD. In this randomized singleblind controlled clinical trial, thirty two patients were recruited. CRP was examined at baseline and 4 weeks. Permutted blockrandomization was done to receive vitamin C 1000 mg or NaCL 0.9%. CRP levels were compared between the two groups asprimary outcome. During study 16 patients were received i.v. ascorbic acid 1000 mg and 16 patients were received NaCl 0.9%.One of patient in vitamin C 1000 mg group was dropped out due to infection. During follow-up, both groups showed increased ofCRP among ascorbic acid 1000 mg groups (from 1.77 ± 1.41 mg/L before to 1.83 ± 1.78 mg/L after study; increase by 0.06 ± 1.38mg/L; 95% CI -0.20 ? 0.28 P = 0.72) and among NaCl 0.9% group (from 2.83 ± 2.86 mg/L before to 2.98 ± 3.29 mg/L afterstudy increase by 0.15 ± 1.38 mg/L 95% CI -0.14 ? 0.11 P = 0.82 ). Although CRP levels were increased, no statistically differentof CRP increament in both groups. The conclusion of this study is ascorbic acid 1000 mg during 4 weeks can not decrease CRPlevels in RHCKD.
HUBUNGAN ANTARA PRODUK KALSIUM X FOSFAT SERUM DENGAN PENYAKIT ARTERI PERIFER PADA PASIEN HEMODIALISIS REGULER DI RSUP SANGLAH DENPASAR Wulandari, Dewi Catur; Raka Widiana, I G; SL, Jodi; Sudhana, I W; Suwitra, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Peripheral Arterial Occlusive Disease (PAOD) is common among patients undergoing hemodialysis (HD). In the generalpopulation, DM, male, cigarette smoking, advanced age, hypertension and dyslipidemia are the most important risk factorsfor PAOD. Recently, some studies in patients with regular HD found evidences that PAOD associated with increase of calciumand phosphate serum level and increase of Ca.P product due to secondary hyperparatiroidism. A cross-sectional study was doneon 46 regular HD patients to evaluate prevalence of PAOD among patients who are undergoing regular HD and their associationbetween Ca.P product. Morning fasting plasma were taken for lipid profile, blood sugar, blood urea nitrogen, serum creatinin,albumin level, Ca, inorganic P. Ankle-brachial index (ABI) of blood pressure as measured after dialysis session using Va-SeraVS-100. Fourty six (26 males, 20 females) regular HD patients, age 50.95 ± 9.90 years, duration of HD 27.7 ± 22 months wereincluded in this study. Using ABI < 0.9 as cut off value for the presence of PAOD, 15.2% had PAOD. Means of Ca serum levelwas 9.04 ± 0.76 mg/dl, phosphate serum level was 56.48 ± 23.90 mg/dl. Using 55 or more as cut off value for abnormal concentrationof Ca.P product, 47.7% patients had abnormal Ca.P product. Three of 21 patients with Ca.P 55 had PAOD and 4 of 23patients with Ca.P < 55 had PAOD ( OR 0.79 with 95% CI : 0.15 ? 4.04 for patients with Ca.P < 55 ). Using logistic regression tocontrol Ca and P levels, Ca.P 55 tend to associate with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)More than fifteen percent of patients with regular HD had PAOD. More than fourty seven percent of patients had abnormal Ca.P.Patients with Ca.P 55 tend to associated with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)
PERAN HIPOKSIA PADA PATOGENESIS PENYAKIT GINJAL Sastrawan, I Gede Pande; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Chronic kidney disease is a current major worldwide health problem with an increasing prevalency.Kidney is a sensitive organ with hypoxic condition relate to its high tubular epithelial cells and vascular oxygenconsumption. Chronic peritubular ischemia may occur through several interrelating mechanisms. The activationof local renin-angiotensin system, angiotensin II, could induce hypoxia by means of hemodinamic and nonhemodinamicmechanisms.Anemia in renal disease could accelerate the decline of renal function through the induction oftubulointerstitial hypoxia. Non Steroidal Anti Inflamatory Drugs (NSAID) could evoke renal medullar hypoxiaby its regional hypoperfusion mechanism and the escalation of tubular transport. The Outer region of renalmedulla and tubulus are main target of hypoxic renal damage. The mechanism of hypoxia induced AcuteKidney Disease involves renal vascular and tubulus through the reduction of blood flow and the increasing oftubular oxygen demands. The Patofisiology of hypoxia induced chronic kidney disease occurs bytubulointerstitial damage which induce fibrogenesis, causing interference of peritubular blood flow and oxygenconsumption.
HUBUNGAN ANTARA KADAR LEPTIN DAN ADIPONEKTIN PLASMA PADA PASIEN DENGAN DIALISIS RUTIN Raka Widiana, I Gde; Kandarini, Yenny; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Abstract

Leptin and adiponectin (ADPN) are adipokines with respective pro-atherogenic and anti atherogenic properties. In nonrenalpatients, both hyperleptinemia and hypoadiponectinemia are associated with cardiovascular complication. Relationshipsbetween serum leptin and ADPN in patients with dialysis is not consistently reported.Objective of this study is evaluate relationships between serum ADPN and leptin in patients with dialysis. A cross sectionalstudy was performed in and 54 HD and 22 CAPD patients.Seventy six patients were enrolled this study, M/F 41/76, aged 48.4±11.4 year, BMI 21.4±2.7 kg/m2, haemoglobin (Hb)7.9±1.5 mg/dL, blood sugar 94.8±33.5 mg/dL, albumin 4.1±0.4 g/dL, total-cholesterol 177.9±46.3 mg/dL, triglyserida 164.4±104.8mg/dL, SC 14.3±3.8 mg/dL, TNF 14.40±7.43 pg/mL, ADPN 17.6±7.6 µg/mL, leptin 13068±23589 µg/mL (log leptin 3.7±0.59µg/ml). Using Spearmans rho analysis there were negative correlation between log-leptin and ADPN (r= -0.39, p= 0.00), andpositive correlation between log leptin and Hb (r= 0.25, p= 0.04), insulin(r= 0.44, p = 0.00), total-cholesterol (r= 0.34, p = 0.003),triglyserida (r= 0.41, p= 0.00), and BMI (r= 0.41, p= 0.00), but there was no correlation between log-leptin and albumin, bloodsugar, SC and TNF alfa. Using multiple regression to analyze relationship between ADPN and leptin, insulin, Hb, and dialysismodality, we found log leptin independently correlated with ADPN (B= -0.402, p= 0.01, 95%CI B: -1.24 to -0.32). Using multipleregression to analized relationship between ADPN with log-leptin, BMI, total cholesterol, and triglyserida, we found log leptin(beta= -0.3, p= 0.01, 95%CI B: -0.98 to -0.13) and triglyserida independently correlated with ADPN (beta= -0.5, p= 0.00, 95%CIB: -0.008 to -0.003).Serum leptin and triglyseride relate with ADPN. Some metabolic parameters such as insulin resistance, anemia, dialysismodality, nutritional status (BMI and total cholesterol) have indirect relationship with ADPN may be through leptin secretion.
Co-Authors Ali Djamhuri Cilik Wiryani Dewi Catur Wulandari Diah Catur Wulandari Elizabeth Haryanti Elysanti Dwi Martadiani I Gde Raka Widiana I Gede Pande Sastrawan I KETUT SUARDANA, I KETUT I Made Gede Darmaja I Wayan Sudhana Jod Loekman Jodi S Loekman Jodi Sidharta Loekman Jodi SL Made Ariwijaya Ni Made Renny A Rena Nyoma Sutarka Nyoman Margian Nyoman Paramita Ayu Nyoman Sutarka, Nyoman Ommy Agustriadi Rully Roesli Sudjana, Karismayusa SUMARNO Wayan Sudhana Wiradharma, Ketut Gede Yenny Kandarini