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

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The Impact of Starting Urate-Lowering Therapy (ULT) During A Gout Flare on The Ongoing Episode: A Systematic Review of Randomized Controlled Trials Yogiswara, Komang Satvika; Widhiarta, Putu Raka; Wiwekananda, Ketut Shri Satya; Paramaiswari, Ayu; Achadiono, Dedy Nurwachid; Kambayana, Gede; Kertia, Nyoman
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.101289

Abstract

Background. Gout is a prevalent form of arthritis caused by the accumulation of monosodium urate (MSU) crystals. Urate-lowering therapy (ULT) may be started once an acute flare has subsided to prevent the present episode from lasting longer. Nevertheless, ULT may be commenced during an acute flare-up in order to decrease the frequency of outpatient appointments and enhance patient adherence. The objective of this study was to conduct whether the commencement of urate-lowering therapy (ULT) during an acute gout flare is effective. Method. We performed a systematic review of articles published in MEDLINE, PubMed, Cochrane library, and EMBASE databases from 2018 to 2023. The search was limited to articles published in English, and RCTs in patients older than 18 years.Results and Discussions. Among 242 recorded studies, only four with 323 patients were eligible for this research. The treatment with Allopurinol began with a daily dose    of 100 mg for the initial 14 days, followed by an increase to a daily dose of 200 mg for     the subsequent 14 days. The reported time to resolution was 15.4 days for the group receiving allopurinol and 13.4 days for the group receiving the placebo. According to this review, the start of ULT (uric acid-lowering therapy) should be determined by sufficient anti-inflammatory measures. Commencing ULT during a gout flare has no impact on the intensity, duration, or likelihood of recurrence of the flare within the following 28 to 30 days.Conclusions. This study demonstrated that the commencement of urate-lowering therapy (ULT) during an acute gout flare did not result in a longer duration of the flare. Nevertheless, it is necessary to conduct a clinical  studies with a bigger sample size in order to validate this review.
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 Achadiono, Dedy Nurwachid Ayu Paramaiswari Gede Kambayana Metalia Puspitasari Nyoman Kertia Widhiarta, Putu Raka Wiwekananda, Ketut Shri Satya Yenny Kandarini