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Intradialytic Hypertension in End Stage Renal Disease patient : Prevalence and clinical characteristic Margaret Merlyn; Akhil Deepak Vatvani
Medicinus Vol 7, No 3 (2018): June 2018 - September 2018
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v7i3.2293

Introduction : Intradialytic hypertension (IDH) is common and it increases the incidence of cardiovascular morbidity and mortality, however this is often ignored. The aim of this study is to identify the prevalence of IDH and compare the clinical characteristics of patients with and without IDH.Methods : A cross sectional study was carried out in 3 hemodialysis clinics in Jakarta, Indonesia. We compared several clinical characteristics inpatients with IDH and control group without IDH. Nutritional status was also assessed using Subjective Global Assessment (SGA). IDH was defined as >10 mmHg increase in systolic blood pressure (BP) in at least four of six prior consecutive hemodialysis sessions. Student’s T-test or Mann-Whitney test was used to compare the quantitative variables. Chi-Square or Fischer exact test was used to compare categorical variables.Results : A total of 114 patients was included in this study. There were 86 (62.3%) male patients. IDH was present in 47 (34.1%) patients. The mean age in IDH and control group were 53.4 (±13.2) and 52.8 (±12.4) years respectively (p: 0.800). The mean BMI of IDH and control group were 21.8 (±3.7) and 24.0 (±4.4) kg/m2 respectively (p: 0.031). The mean MAP during dialysis of IDH and control group were 108 (±13.1) and 98.6 (±23.2)mmHg respectively (p: 0.011). The median creatinine levels of IDH and control group were 8.1 (3.02-22.20)mg/dl and 10.8 (2.89-22.0)mg/dl respectively (p: 0.008). Interestingly, moderate to severe malnutrition status had significant association with IDH (OR: 2.31, p: 0.031). Patients who undergo dialysis thrice a week was associated with IDH rather than patients who undergo dialysis twice a week (OR: 2.27, p: 0.035).Conclusion : The prevalence of IDH is higher than previously reported in other countries. The clinical characteristic of patients with IDH is lower BMI, higher MAP and lower creatinine levels than in patient without IDH. Moderate to severe malnutrition and frequency of dialysis per week had significant association with IDH.

Poor Sleep Quality of Hospitalized Geriatric Patients in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia Nata Pratama Hardjo Lugito; Theo Audi Yanto; Andree Kurniawan; Indra Wijaya; Margaret Merlyn Tjiang; Resa Setiadinata; Stevent Sumantri; Euphemia Seto
Medicinus Vol 6, No 1 (2016): October 2016 - January 2017
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v6i1.1136

Background: In Indonesia, geriatric population in the year 2005 was 15.8 million (7.2 % population), and expected to reach 11.34% in the year 2020. There was growing evidence for poor sleep as an independent risk factor for poor physical and mental health. Geriatric population may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulationObjective: To study the epidemiological (gender, age group) and health status (co-morbidities), sleep quality according to Pittsburgh Sleep Quality Index (PSQI) and its associations in geriatric population hospitalized in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia.Materials and Methods: A hospital based cross sectional study was conducted from January to June 2014. A total of 92 subjects aged 60 years and above were selected consecutively from hospitalized geriatric patients for this study. The data was analyzed by means and proportions.Results: The male and female subjects were 51.1% and 48.9%. Mean age was 66.79 + 5.448 years. The age group of 60 – 75 years and above 75 years was 92.4% and 7.6% consecutively. Subjects with diabetes, hypertension, allergy, asthma, cardiac failure and chronic kidney disease were 30.4%, 62.0%, 18.5%, 21.7%, 21.7%, 20.7% consecutively and 63.0% with more than 2 co-morbidities. According to PSQI 72.8% subjects have poor sleep quality. Associations between poor sleep quality to epidemiological and health status were not significant except for diabetes (RR= 3.208 [95% CI: 1.045 – 9.848], p = 0.022) and chronic kidney disease (RR= 6.247 [95% CI: 0.902 – 43.279], p = 0.017)Conclusions: Seventy two percents of subjects have poor sleep quality, and associations between poor sleep quality to epidemiological and health status were not significant except for diabetes.

Incidence And Characteristics Of Double Lumen Induced Central Venous Catheter-Related Thromboembolism In Hemodialytic Patients Tjiang, Margaret Merlyn; Prayoga, Dimas Arsana
Medicinus Vol 10, No 2 (2021): February : 2021
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v8i3.3768

Background: Central venous catheters (CVCs) are frequently used in patients for several indications such as cancer treatment, diagnostic monitoring, parenteral nutrition, hemodialysis, and administration of fluids, blood products or medication. Double lumen catheter induced CVCs thrombosis has not been paid into proper attention in developing countries such as Indonesia.Aims: The aim of this study is to identify the incidence and characteristic of double lumen catheter induced CVCs thrombosis in patients undergoing hemodialysis.Methods: This systematic review has been registered in PROSPERO (CRD42020181584). A systematic search of literature for observational and randomized controlled trial was conducted in PubMed, PubMed central, and Google Scholar through April 16, 2020. Two reviewers independently searched and selected. The risk of bias was evaluated using the Newcastle-Ottawa Quality assessment tool. Results: A total of 408 patients were included in our study. There were 192 (47.1%) male patients. The double lumen catheter was mostly placed in the jugular vein (60%), followed by subclavian vein (25%) and femoral vein (15%). Four (1.1%) patients had deep vein thrombosis after about one month of double lumen catheter placement. All these four patients, the double lumen catheter was inserted in the femoral vein. Any other significant risk factors for thrombosis other than double lumen catheter insertion not found. Out of these four patients, one of them passed away. All patients were treated using heparin.Conclusion: The incidence of double lumen catheter induced thrombosis is low (1.1%) in patients undergoing hemodialysis. However, further larger study is needed to confirm and find the associating factors.

Anemia and Erythropoietin Use Among Hemodialysis Chronic Kidney Disease Patients at Rumah Sakit Umum Siloam Tjiang, Margaret Merlyn; Caroline, Elliscia; Siregar, Jeremia Immanuel
Medicinus Vol 13, No 3 (2024): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v13i3.8885

Background: Chronic kidney disease (CKD) affects an estimated 8-16% of the population and is increasing in prevalence. Anemia, a common and significant complication of CKD, is primarily caused by reduced erythropoietin production, which is essential for red blood cell production. Erythropoietin, a kidney-produced hormone, stimulates bone marrow to produce red blood cells. This study examines trends in the use of erythropoiesis-stimulating agents (ESAs) and the management of anemia in dialysis CKD patients before and after the implementation of ESA reimbursemen.Methods: This cohort study was conducted at Rumah Sakit Umum Siloam, Tangerang, Indonesia, from February to July 2017. Patients who received blood transfusions or iron supplements during the study were excluded. Data collected included age, gender, dry weight, history of diabetes mellitus, hypertension, hemodialysis adequacy, and nutritional status. Statistical analysis with a 95% confidence interval (CI) was used to assess the association between hemoglobin levels (Hb) and erythropoietin use.Results: Sixty patients completed the study. The proportion of anemic patients (Hb <10 g/dL) increased from 22 (36.7%) to 28 (46.7%) after erythropoietin administration. A mean dose of 6000 IU/week (CI: 4679 to 7321 IU/week) was effective in achieving target hemoglobin levels, while a dose of 4131 IU/week (CI: 3479 to 4782 IU/week) was sufficient to maintain them. Additionally, a dosage of 103.31 IU/kg/week increased hemoglobin by 1 g/dL in anemic patients.Conclusions: Erythropoietin use should be optimized given the increasing prevalence of anemia. A dosage of 103.31 IU/kg/week is recommended to achieve target hemoglobin levels, while 4131 IU/week is suggested for maintaining hemoglobin within the target range.

Anemia and Erythropoietin Use Among Hemodialysis Chronic Kidney Disease Patients at Rumah Sakit Umum Siloam Tjiang, Margaret Merlyn; Caroline, Elliscia; Siregar, Jeremia Immanuel
Medicinus Vol. 13 No. 3 (2024): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v13i3.8885

Background: Chronic kidney disease (CKD) affects an estimated 8-16% of the population and is increasing in prevalence. Anemia, a common and significant complication of CKD, is primarily caused by reduced erythropoietin production, which is essential for red blood cell production. Erythropoietin, a kidney-produced hormone, stimulates bone marrow to produce red blood cells. This study examines trends in the use of erythropoiesis-stimulating agents (ESAs) and the management of anemia in dialysis CKD patients before and after the implementation of ESA reimbursemen.Methods: This cohort study was conducted at Rumah Sakit Umum Siloam, Tangerang, Indonesia, from February to July 2017. Patients who received blood transfusions or iron supplements during the study were excluded. Data collected included age, gender, dry weight, history of diabetes mellitus, hypertension, hemodialysis adequacy, and nutritional status. Statistical analysis with a 95% confidence interval (CI) was used to assess the association between hemoglobin levels (Hb) and erythropoietin use.Results: Sixty patients completed the study. The proportion of anemic patients (Hb <10 g/dL) increased from 22 (36.7%) to 28 (46.7%) after erythropoietin administration. A mean dose of 6000 IU/week (CI: 4679 to 7321 IU/week) was effective in achieving target hemoglobin levels, while a dose of 4131 IU/week (CI: 3479 to 4782 IU/week) was sufficient to maintain them. Additionally, a dosage of 103.31 IU/kg/week increased hemoglobin by 1 g/dL in anemic patients.Conclusions: Erythropoietin use should be optimized given the increasing prevalence of anemia. A dosage of 103.31 IU/kg/week is recommended to achieve target hemoglobin levels, while 4131 IU/week is suggested for maintaining hemoglobin within the target range.

Poor Sleep Quality of Hospitalized Geriatric Patients in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia Hardjo Lugito, Nata Pratama; Yanto, Theo Audi; Kurniawan, Andree; Wijaya, Indra; Tjiang, Margaret Merlyn; Setiadinata, Resa; Sumantri, Stevent; Seto, Euphemia
Medicinus Vol. 6 No. 1 (2016): October 2016 - January 2017
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v6i1.1136

Background: In Indonesia, geriatric population in the year 2005 was 15.8 million (7.2 % population), and expected to reach 11.34% in the year 2020. There was growing evidence for poor sleep as an independent risk factor for poor physical and mental health. Geriatric population may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulationObjective: To study the epidemiological (gender, age group) and health status (co-morbidities), sleep quality according to Pittsburgh Sleep Quality Index (PSQI) and its associations in geriatric population hospitalized in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia.Materials and Methods: A hospital based cross sectional study was conducted from January to June 2014. A total of 92 subjects aged 60 years and above were selected consecutively from hospitalized geriatric patients for this study. The data was analyzed by means and proportions.Results: The male and female subjects were 51.1% and 48.9%. Mean age was 66.79 + 5.448 years. The age group of 60 - 75 years and above 75 years was 92.4% and 7.6% consecutively. Subjects with diabetes, hypertension, allergy, asthma, cardiac failure and chronic kidney disease were 30.4%, 62.0%, 18.5%, 21.7%, 21.7%, 20.7% consecutively and 63.0% with more than 2 co-morbidities. According to PSQI 72.8% subjects have poor sleep quality. Associations between poor sleep quality to epidemiological and health status were not significant except for diabetes (RR= 3.208 [95% CI: 1.045 - 9.848], p = 0.022) and chronic kidney disease (RR= 6.247 [95% CI: 0.902 - 43.279], p = 0.017)Conclusions: Seventy two percents of subjects have poor sleep quality, and associations between poor sleep quality to epidemiological and health status were not significant except for diabetes.

Incidence And Characteristics Of Double Lumen Induced Central Venous Catheter-Related Thromboembolism In Hemodialytic Patients Tjiang, Margaret Merlyn; Prayoga, Dimas Arsana
Medicinus Vol. 10 No. 2 (2021): February : 2021
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v8i3.3768

Background: Central venous catheters (CVCs) are frequently used in patients for several indications such as cancer treatment, diagnostic monitoring, parenteral nutrition, hemodialysis, and administration of fluids, blood products or medication. Double lumen catheter induced CVCs thrombosis has not been paid into proper attention in developing countries such as Indonesia.Aims: The aim of this study is to identify the incidence and characteristic of double lumen catheter induced CVCs thrombosis in patients undergoing hemodialysis.Methods: This systematic review has been registered in PROSPERO (CRD42020181584). A systematic search of literature for observational and randomized controlled trial was conducted in PubMed, PubMed central, and Google Scholar through April 16, 2020. Two reviewers independently searched and selected. The risk of bias was evaluated using the Newcastle-Ottawa Quality assessment tool. Results: A total of 408 patients were included in our study. There were 192 (47.1%) male patients. The double lumen catheter was mostly placed in the jugular vein (60%), followed by subclavian vein (25%) and femoral vein (15%). Four (1.1%) patients had deep vein thrombosis after about one month of double lumen catheter placement. All these four patients, the double lumen catheter was inserted in the femoral vein. Any other significant risk factors for thrombosis other than double lumen catheter insertion not found. Out of these four patients, one of them passed away. All patients were treated using heparin.Conclusion: The incidence of double lumen catheter induced thrombosis is low (1.1%) in patients undergoing hemodialysis. However, further larger study is needed to confirm and find the associating factors.

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