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All Journal Acta Interna : The Journal of Internal Medicine Ina Kidney Ahmad Dahlan Medical Journal
Metalia Puspitasari
Division Of Nephrology, Department Of Internal Medicine, Faculty Of Medicine, Public Health And Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Albumin Description of Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients in Sardjito Hospital Yogyakarta Barkah Purwanto; Dewi Yuniasih; Metalia Puspitasari
Ahmad Dahlan Medical Journal Vol. 2 No. 1 (2021): May 2021
Publisher : Universitas Ahmad Dahlan

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1108.024 KB) | DOI: 10.12928/admj.v2i1.4086

Abstract

Albumin profile is an important sign of nutritional status as a quality-of life parameter, whereas hypoalbuminemia has been shown to be associated with a high mortality rate for patients with End Stage Renal Disease (ESRD) undergoing dialysis including CAPD. The study was conducted to determine serum albumin levels in patients with ESRD undergoing CAPD therapy. The study was conducted in a cross-sectional manner on ESRD patients who were still actively undergoing CAPD in the outpatient Installation of Dr. Sardjito Hospital Yogyakarta until November 2018. Subjects were examined for serum albumin levels. There were 57 research subjects with the category of albumin levels <3.5 g / dL as many as 19 (33.3%), between 3.5-4.0 g / dL as many as 27 (47.3%) and albumin levels> 4.0 g / dL of 11 (19.3%). There were no significant differences in all age groups, BMI and duration of CAPD. Albumin profile can be an independent parameter of quality of life and even a predictor of mortality in CAPD patients because it does not depend on age group, BMI and length of CAPD
Change in Serum Cystatin C Level as Predictor for Length of Hospital Stay in Patients Undergoing Primary Percutaneous Coronary Intervention Putra, Andika; Prasanto, Raden Heru; Puspitasari, Metalia
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): 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.98162

Abstract

Background. Percutaneous Coronary Intervention (PCI) is one of the most frequently performed medical procedures. Length of stay for patients after undergoing PCI should be standardized to achieve the best quality of health services. The existence of complications is one of the main factors considering the length of stay after PCI. Cystatin C has the ability as a predictor of complications in patients with acute coronary syndrome, especially those undergoing PCI, as well as the increase in length of stay associated with complications after the PCI procedure.Objectives. To determine the average changes in serum cystatin C levels, the correlation between serum cystatin C levels and length of treatment, and changes in serum cystatin C levels as predictors of length of stay in patients undergoing primary PCI at Dr. Sardjito Hospital.Methods. Analytical observational study with a prospective cohort method conducted on patients with a STEMI diagnosis who underwent primary PCI procedures in Emergency Room, Cardiovascular Care Unit (CVCU) of Dr. Sardjito Hospital, treated from November 2020 to April 2021. The data was then analyzed for normality, multicollinearity, bivariate, and multivariate tests to see the effect of changes in cystatin C and other variables on the length of stay for patients after primary PCI (p <0.05 is significant).Results. Of the 111 patients, 92 patients were subjected to further analysis. Patients included in the study had an average age of 59.55 (+10.80) years, majority of men, reduced LVEF, using trans-radial PCI access, Killip I, average eGFR of 64 ml / 1.73m2, length of stay in hospital is 5 days, delta cystatin C and creatinine 0.10 and 0.04 U / L, respectively. The increase in cystatin C had a moderate positive correlation (0.502) with the length of hospital stay (p<0.001), in multivariate analysis serum cystatin C does not correlate with length of hospital stay (p=0.590). Other variables including LVEF, eGFR, infection, and contrast-induced acute kidney injury had a significant correlation with length of stay (p<0.001). The multivariate test showed that LVEF, eGFR, and infection had the most significant correlation (p = 0.034; 0.001; 0.005 respectively) to the length of hospital stay with a regression coefficient of 0.72; -0.04; and 1.93.Conclusion. An increase of cystatin C serum does not correlate significantly with the length of hospitalization in STEMI patients undergoing PCI procedure in Dr. Sardjito Hospital.
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.
Automated Peritoneal Dialysis Versus Continuous Ambulatory Peritoneal Dialysis For People With Kidney Failure: A Review Yogiswara, Komang Satvika; Widhiarta, Putu Raka; Kandarini, Yenny; Puspitasari, Metalia; Kertia, Nyoman
Indonesian Journal of Kidney and Hypertension Vol 2 No 2 (2025): Volume 2 No. 2, August 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i2.186

Abstract

Background: Peritoneal dialysis is a well-established renal replacement therapy for patients with end-stage kidney disease, offering two primary modalities: Automated Peritoneal Dialysis (APD) and Continuous Ambulatory Peritoneal Dialysis (CAPD). Both methods provide effective solute and fluid removal, cost-effectiveness, accessibility, and impact on patient lifestyle that vary significantly, particularly in resource-limited settings such as Indonesia. Objective: This review compares APD and CAPD in terms of efficacy, convenience, cost-effectiveness, and accessibility, with a focus on their implications for patient care in Indonesia. Methods: A systematic review of relevant literature was conducted to evaluate the benefits and limitations of both dialysis modalities. Factors such as treatment outcomes, cost, infection risk, insurance coverage, and availability were analyzed to determine the most suitable option for different patient populations. Results: APD offers greater convenience, improved quality of life, and a lower risk of peritonitis due to fewer disconnections. However, its higher cost, dependency on electricity, and limited insurance coverage reduce its accessibility. Conversely, CAPD is more cost-effective, widely available, and covered by BPJS Kesehatan, making it the preferred option for many patients. Despite its affordability, CAPD requires greater patient commitment, increases peritonitis risk, and may interfere with daily activities. Conclusions: Both APD and CAPD are effective dialysis options, but CAPD remains the more accessible and cost-effective choice in Indonesia. APD may benefit select populations if economic and infrastructural challenges are addressed. Expanding insurance coverage, reducing equipment costs, and improving infrastructure are crucial to increasing APD accessibility and optimizing dialysis care in Indonesia.
Co-Authors Andika Putra Barkah Purwanto Dewi Yuniasih Heru Prasanto Iri Kuswadi Kuswadi, Danny Pratama Kuswadi, Iri Naraswari, Ilsya Asti Nyoman Kertia Prasanto, Raden Heru Ratna Damayanti Widhiarta, Putu Raka Yenny Kandarini Yogiswara, Komang Satvika Yulia Wardhani, Yulia