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All Journal Acta Interna : The Journal of Internal Medicine Ina Kidney
Yulia Wardhani, Yulia
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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The Determinants of Detrimental Changes in Pulse Pressure During Maintenance Hemodialysis Treatments Damayanti, Ratna; Kuswadi, Iri; Prasanto, Raden Heru; Puspitasari, Metalia; Wardhani, Yulia; Kuswadi, Danny Pratama
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.v1i3.128

Abstract

Background: Studies indicate that large fluctuations in pulse pressure during hemodialysis are associated with cardiovascular events, cardiovascular mortality, and all-cause mortality. Objective: We investigated the determinants of detrimental changes in pulse pressure (ΔPP) during hemodialysis. Methods: This prospective, observational cohort study was conducted from 1 to 30 April 2023 at Dr. Sardjito Hospital Yogyakarta, involving maintenance hemodialysis patients for ≥ 6 months. Patients were categorized into group 1 (detrimental ΔPP, ΔPP >5 mmHg or <−25 mmHg) and group 2 (stable ΔPP, −25 to 5 mmHg). Mann-Whitney, independent-t, chi-square, Fisher exact tests, and logistic regression were applied to evaluate associations between ΔPP groups and clinical variables. Results: This study involved 136 patients, 75 males (55.1%) with a mean age of 52 (18-87). The most common comorbid was hypertension, present in 85 patients (62.5%). The mean hemodialysis vintage of patients was 47.2 (6.5-330.7) months. We found significant difference between group in post-dialysis systolic blood pressure (SBP) (p=0.003), pre-dialysis diastolic blood pressure (DBP) (p=0.015), post-dialysis DBP (p=0.007), ultrafiltration (p=0.041), pre-dialysis mean-arterial-pressure (MAP) (p=0.013), post-dialysis MAP (p=0.002), and alpha-blocker treatment (p=0.037). Multivariate logistic regression analysis shows a significant association between groups of ΔPP with pre-dialysis DBP (p=0.035; OR=1.153; OR=Exp(10xℬ) =4.137) and post-dialysis SBP (p=0.007; OR=1.052; OR=Exp(10xℬ) =1.6487). Conclusion: Our study demonstrates that group 1, with detrimental changes in pulse pressure during hemodialysis, was found to have higher post-dialysis DBP, pre-dialysis DBP, post-dialysis SBP, pre-dialysis MAP, post-dialysis MAP, alpha-blocker treatment, and ultrafiltration, with significant association with post-dialysis SBP and pre-dialysis DBP.
Effect of Combination Hemodialysis Hemoperfusion on Lowering Leptin Level in Patients with Kidney Failure Receiving Routine Hemodialysis: A Multi-Center Study Naraswari, Ilsya Asti; Puspitasari, Metalia; Wardhani, Yulia
Acta Interna The Journal of Internal Medicine Vol 13, No 1 (2024): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.101288

Abstract

Background: Leptin clearance during conventional haemodialysis (HD) has been found to be minimal or absent. Some authors reported the possibility of decreasing leptin serum levels with high flux membranes, but limited date are available. Leptin has been reported as a marker of inflammation and long-term complications such as cardiovascular events leading to increased quality of life deterioration. Haemodialysis hemoperfusion (HD+HP) has been reported to effectively decrease middle-sized and macromolecular toxin concentrations. In the present study, we compared the effectiveness of high-flux HD and HD + HP can effectively remove serum leptin levels, and is expected to reduce cardiovascular events in patients with kidney failure.Objective: To assess the influence of HD+HP therapy on serum leptin level in routine haemodialysis patients.Metode: Quasi experimental with pre and post exposure measurements in 26 kidney failure patients who received routine HD at three hospital sites were selected according to inclusion criteria and divided into intervention group (HD twice a week + Hemoperfusion once a week) and control group (HD twice a week). Serum leptin levels were compared before and after 8 weeks of therapy, and differences were then compared from each group.Result: Leptin levels reduced significantly (p = 0.017) in the control group (High-Flux HD). Serum leptin levels decreased in HD+HP group but there was no significant differences (p = 0.784). Significant differences were not observed between two modalities (HD and HD+HP) (p = 0.258).Conclusion: Haemodialysis plus hemoperfusion once a week for 8 weeks was not found effectively lowering leptin level compared high-flux HD alone.
Co-Authors Kuswadi, Danny Pratama Kuswadi, Iri Metalia Puspitasari Naraswari, Ilsya Asti Prasanto, Raden Heru Ratna Damayanti