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"Transplantasi ginjal dapat memperbaiki fungsi jantung Penelitianeksperimental pada binatang membuktikan bahwa peningkatan kadar hormoneritropoetin memperbaiki fungsi jantung namun secara klinis masih menjadi bahanperdebatan Tujuan: Untuk menilai hubungan peningkatan kadar eritropoetin dengan perbaikanfungsi jantung pada pasien gagal ginjal yang menjalani transplantasi Metoda: Penelitian Kohor prospektif pada pasien gagal ginjal yang menjalanitransplantasi di RSCM Jumlah subyek 21 orang yang dikumpulkan dalam kurunwaktu Maret September 2013 Pengambilan data ekokardiografi dan kadareritropoetin dilakukan sebelum dan 3 bulan sesudah transplantasi ginjal Analisisstatistik dengan uji korelasi Pearson atau Spearman Hasil: Penelitian ini menunjukkan peningkatan bermakna kadar eritropoetin 7 58 2 56 mlU ml menjadi 18 1 6 4 mlU ml Terdapat hubungan peningkatan kadareritropoetin dengan LVEDD r 0 56 p0 05 Kesimpulan: Terdapat hubungan peningkatan kadar eritropoetin dengan perbaikanLVH LVEDD pada pasien gagal ginjal yang menjalani transplantasi Tidak ada hubungan peningkatan kadar eritropoetin dengan perbaikan LVEF

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Kidney transplantation improved cardiac function Based on animaltrials elevated levels of erythropoietin hormone can improved cardiac function butin clinically still debate Aim: To determine association between elevated levels of erythropoietin andimprovement cardiac function on renal failure who underwent transplantation Methods: Prospective cohort study on renal failure who underwent kidneytransplantation at Cipto Mangunkusumo Hospital The study include 21 subjects whocollected it from Marct to September 2013 Data of echocardiography anderythropoietin level were collected at time prior to kidney transplantation and repeat 3months there after The association between elevated levels of erythropoietin andcardiac function was analyzed using Pearson correlation and Spearman test Results: The study showed a significantly elevated levels of erythropoietin from7 58 2 56 to 18 1 6 4 mlU ml There was statistically significant association between elevated levels of erythropoietin and LVEDD r 0 56 p Conclusions: There was association elevated levels of erythropoietin and improvement of LVH, LVEDD on renal failure who underwent transplantation, however, there was no association of elevated levels of erythropoietin level and improvement of LVEF."

"Latar belakang: Transplantasi ginjal dapat memperbaiki fungsi endotel. Berbagai penelitian membuktikan bahwa peningkatan kadar eritropoietin (Epo) dapat mengaktifasi dan memobilisasi Endothelial Progenitor Cell (EPC) sehingga mampu memperbaiki fungsi endotel melalui proses angiogenesis dan neovaskularisasi. Membaiknya fungsi endotel akan menurunkan angka kesakitan dan kematian akibat penyakit kardiovaskular pada penderita PGK. Tujuan: Untuk mengetahui hubungan peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel pada penderita gagal ginjal 3 bulan setelah transplantasi ginjal. Metode Penelitian: Potong lintang sebelum dengan 3 bulan setelah transplantasi ginjal pada penderita gagal ginjal yang menjalani transplantasi ginjal di RSCM. Jumlah subyek 21 orang yang dikumpulkan dalam kurun waktu Juli 2013 - Februari 2014. Pengambilan sampel darah untuk memeriksa kadar Epo, jumlah EPC CD34+ dan CD133+ dan kadar asimetrik dimetilarginin (ADMA) dilakukan sebelum dan 3 bulan setelah transplantasi ginjal. Analisis statistik dengan uji korelasi Pearson atau Spearman. Hasil: Penelitian ini menunjukkan adanya peningkatan kadar Epo tetapi tidak bermakna secara statistik (p>0.05), sedangkan jumlah EPC CD34+ dan CD133+ meningkat (p<0.05), serta kadar ADMA menurun yang bermakna secara statistik (p<0.05). Tiga bulan setelah transplantasi ada korelasi bermakna antara peningkatan kadar Epo dengan jumlah EPC CD34+ (r = 0.466 ; p < 0.05). Tidak ada hubungan peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel 3 bulan setelah transplantasi ginjal. Kesimpulan: Tiga bulan setelah transplantasi ginjal didapatkan adanya peningkatan kadar Epo, jumlah EPC CD34+ dan CD133+ serta penurunan kadar ADMA. Tetapi tidak ada korelasi peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel dalam rentang 3 bulan setelah transplantasi ginjal.

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Background: Kidney transplantation improved endothelial function. Various studies have shown that elevated level of erythropoietin (Epo) could activate and mobilize Endothelial Progenitor Cell (EPC), thus would improve endothelial function through the process of angiogenesis and neovascularization. The improvement of endothelial function will decrease morbidity and mortality from cardiovascular disease in patients with CKD.

Aim: To determine association between elevated level of Epo and the numbers of EPC CD34+ - CD133+ with the improvement of endothelial function in patients three months after kidney transplantation.

Methods: cross sectional study prior and 3 months after kidney transplantation in patients with renal failure who underwent kidney transplantation in RSCM. The study included 21 subjects who enrolled from July 2013 to February 2014. Blood samples prior and 3 months after kidney transplantation were collected to evaluate the level of Epo, numbers of EPC CD34+ and CD133+ and level of assymetric dimethylarginine (ADMA). Statistical analysis was performed using Pearson or Spearman correlation test.

Resulys: The results of the study showed that prior to kidney transplantation, level of Epo was increased but not statistically significant (p>0.05). The EPC numbers of CD34+ and CD133+ were significantly increased (p<0.05), whereas the ADMA level was significantly decreased (p<0.05). Three months after transplantation showed a significant association between elevated level of Epo and the numbers of EPC CD34+ (r = 0.466, p > 0.05). There was no association between the elevated level of Epo and the numbers of EPC CD34+ and CD133+ with the improvement of endothelial function three months after kidney transplantation.

Conclusion: Three months after kidney transplantation showed an elevated level of Epo, the numbers of EPC CD34+ and CD133+ and the decreased level of ADMA. However, there was no association between the elevated level of Epo and the numbers of EPC CD34+ and CD133+ with the improvement of endothelial function in patients 3 months after kidney transplantation."

"[ABSTRAKLatar Belakang. Malnutrisi merupakan salah satu masalah kesehatan utama yang banyak dijumpai terutama di negara berkembang. Malnutrisi pada pasien gagal jantung diketahui berhubungan dengan luaran klinis yang lebih buruk, meliputi peningkatan lama perawatan, readmisi dan mortalitas. Pada pasien gagal jantung dekompensasi akut (GJDA), perburukan fungsi ginjal (PFG) selama perawatan diduga merupakan komorbid yang memberikan dampak luaran klinis yang lebih buruk tersebut. Namun sampai saat ini belum diketahui bagaimana hubungan antara status malnutrisi dengan terjadinya PFG pada pasien GJDA. Oleh karena itu, penelitian ini bertujuan untuk mengetahui hubungan antara status malnutrisi dengan terjadinya PFG pada pasien GJDA, sekaligus untuk menilai besarnya pengaruh malnutrisi terhadap luaran klinis tersebut.Metode. Studi kohort prospektif dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK). Kejadian PFG didefinisikan sebagai peningkatan nilai kreatinin > 0,3 mg/dL atau > 25% dibandingkan kreatinin saat masuk rawat. Karakteristik dasar, pemeriksaan klinis awal, status antropometri dan data laboratorium diambil pada saat admisi. Pasien dibagi berdasarkan nilai NRI menjadi kelompok malnutrisi (NRI < 97,5) dan tidak malnutrisi (NRI > 97,5). Kemudian pemeriksaan serial kreatinin dilakukan dengan interval setiap 3 hari selama pasien menjalani perawatan di RS. Data kemudian diolah dengan analisis bivariat dan multivariat untuk mengetahui hubungan antara malnutrisi dengan PFG, lama perawatan, dan mortalitas.Hasil Penelitian. Sebanyak 265 pasien GJDA diikutsertakan dalam penelitian ini, dengan proporsi kelompok malnutrisi sebesar 50,2%. Pada kelompok malnutrisi PFG terjadi pada 31,6% pasien, sedangkan pada kelompok tidak malnutrisi sebesar 26,5% pasien. Tidak didapatkan hubungan yang bermakna antara malnutrisi dengan kejadian PFG, namun terdapat kecenderungan peningkatan risiko PFG pada pasien GJDA yang disertai malnutrisi (OR 1,279; 95%IK 0,751-2,178; p=0,364). Malnutrisi ditemukan memiliki pengaruh yang signifikan terhadap tingginya lama rawat (HR 6,254; 95%IK 4,614-8,477; p<0,001) serta kematian pada pasien GJDA.Kesimpulan. Penelitian prospektif ini tidak menemukan hubungan yang bermakna antara malnutrisi dengan PFG, namun didapatkan kecenderungan bahwa malnutrisi akan semakin meningkatkan risiko terjadinya PFG pada pasien GJDA. Pada pasien GJDA di RSJPDHK ditemukan proporsi malnutrisi yang sangat besar, dan malnutrisi pada kelompok ini memberikan kontribusi yang signifikan terhadap tingginya lama perawatan serta kematian.

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ABSTRACTBackground. Malnutrition is the leading cause of disease burden especially in developing countries. Malnutrition in heart failure patients is associated with longer length of stay (LOS), higher readmission and mortality rates. Worsening renal function (WRF) has also been shown to contribute to the worsened outcomes in patients with acute decompensated heart failure (ADHF) patients. It is not known, however, whether malnutrition contributed to the worse outcomes in ADHF patient through the WRF. Accordingly, this study sought to investigate the association between malnutrition and WRF in ADHF patients.Methods. A prospective cohort study was conducted in National Cardiovascular Center Harapan Kita (NCCHK) to all patients admitted with ADHF. WRF was defined as the occurrence, at any time during the hospitalization, of > 0,3 mg/dL or > 25% increase in serum creatinine from admission. Baseline and clinical characteristics, anthropometry status, and laboratory data were collected during hospital admission. Subjects were divided based on NRI into malnutrition (NRI < 97,5) and no malnutrition group (NRI > 97,5). Serial serum creatinine was evaluated within 3 days interval during hospitalization. Statistical analysis was done using bivariate and multivariate analysis to determine the association between malnutrition with WRF, LOS and mortality rates.Results. Two hundred and sixty-five ADHF patients were included in this cohort study. Of those subjects, 50,2% were on malnutrition group. WRF occured in 31,6% patients of malnutrition group and 26,5% patients of no malnutrition group. Although there was an increased probability of WRF occurence in ADHF patients with malnutrition (OR 1,279; 95%CI 0,751-2,178; p=0,364), but this increased probability was not statistically significant. Malnutrition was found significantly prolonged the LOS (HR 6,254; 95%CI 4,614-8,477; p<0,001) and increased mortality rates in ADHF patients.Conclusion. This prospective study demonstrated there was no significant association between malnutrition and WRF, but there was an increased probability of WRF occurrences in ADHF patients with malnutrition. Nevertheless, we found high burden of malnutrition in ADHF patients in NCCHK, and this burden contributed significantly to longer LOS and higher mortality rates in this population., Background. Malnutrition is the leading cause of disease burden especially in developing countries. Malnutrition in heart failure patients is associated with longer length of stay (LOS), higher readmission and mortality rates. Worsening renal function (WRF) has also been shown to contribute to the worsened outcomes in patients with acute decompensated heart failure (ADHF) patients. It is not known, however, whether malnutrition contributed to the worse outcomes in ADHF patient through the WRF. Accordingly, this study sought to investigate the association between malnutrition and WRF in ADHF patients.Methods. A prospective cohort study was conducted in National Cardiovascular Center Harapan Kita (NCCHK) to all patients admitted with ADHF. WRF was defined as the occurrence, at any time during the hospitalization, of > 0,3 mg/dL or > 25% increase in serum creatinine from admission. Baseline and clinical characteristics, anthropometry status, and laboratory data were collected during hospital admission. Subjects were divided based on NRI into malnutrition (NRI < 97,5) and no malnutrition group (NRI > 97,5). Serial serum creatinine was evaluated within 3 days interval during hospitalization. Statistical analysis was done using bivariate and multivariate analysis to determine the association between malnutrition with WRF, LOS and mortality rates.Results. Two hundred and sixty-five ADHF patients were included in this cohort study. Of those subjects, 50,2% were on malnutrition group. WRF occured in 31,6% patients of malnutrition group and 26,5% patients of no malnutrition group. Although there was an increased probability of WRF occurence in ADHF patients with malnutrition (OR 1,279; 95%CI 0,751-2,178; p=0,364), but this increased probability was not statistically significant. Malnutrition was found significantly prolonged the LOS (HR 6,254; 95%CI 4,614-8,477; p<0,001) and increased mortality rates in ADHF patients.Conclusion. This prospective study demonstrated there was no significant association between malnutrition and WRF, but there was an increased probability of WRF occurrences in ADHF patients with malnutrition. Nevertheless, we found high burden of malnutrition in ADHF patients in NCCHK, and this burden contributed significantly to longer LOS and higher mortality rates in this population.]"

"Latar Belakang: Pruritus menjadi salah satu gejala yang dialami oleh pasien dengan penyakit ginjal kronik (PGK). Pruritus yang berasosiasi dengan PGK mayoritas terjadi pada pasien yang menjalani hemodialisis (HD) dan dapat terjadi pada resipien transplantasi ginjal (RTG). Gejala pruritus yang tidak ditangani dengan baik dapat memberikan dampak terhadap kualitas hidup. Belum terdapat penelitian yang membandingkan proporsi derajat keparahan pruritus, kualitas hidup, dan korelasi berbagai faktor biokimia antara pasien HD dengan RTG di Indonesia. Tujuan: Membandingkan derajat keparahan pruritus, kualitas hidup, serta korelasi kadar hs-CRP, kalsium, fosfat, dan e-GFR antara pasien PGK yang menjalani HD dengan RTG. Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang. Setiap SP dilakukan anamnesis, pemeriksaan fisis, dan pemeriksaan laboratorium. Skala gatal 5 dimensi (5-D) digunakan untuk evaluasi derajat keparahan pruritus dan Indeks Kualitas Hidup Dermatologi (IKHD) digunakan dalam menilai kualitas hidup. Analisis statistik yang sesuai dilakukan untuk membuktikan hipotesis penelitian dengan nilai kemaknaan yang digunakan adalah p <0,05. Hasil: Dari 30 SP di masing-masing kelompok, proporsi pruritus derajat sedang-berat sebesar 76,7% pada kelompok HD sedangkan pada kelompok RTG sebanyak 83,3% mengalami pruritus derajat ringan (RR = 4,6; IK 95% = 2,02–10,5; p <0,001). Median skor IKHD pada kelompok HD adalah sebesar 5 (3–6) sedangkan pada kelompok RTG sebesar 3 (2–4) (p <0,001). Terdapat korelasi positif yang bermakna antara hs-CRP dengan skor skala gatal 5-D pada kelompok HD (r = 0,443; p <0,05). Terdapat korelasi negatif yang bermakna antara e-GFR dengan skor skala gatal 5-D pada RTG (r = -0,424; p <0,05). Tidak terdapat korelasi yang bermakna secara statistik antara kadar kalsium dan fosfat dengan skor skala gatal 5-D pada kedua kelompok. Kesimpulan: Pasien HD lebih banyak mengalami pruritus derajat sedang-berat dibandingkan pada RTG. Pruritus pada kelompok HD berdampak ringan hingga sedang terhadap kualitas hidup sedangkan pada kelompok RTG pruritus berpengaruh ringan terhadap kualitas hidup. Pada pasien HD, semakin tinggi kadar hs-CRP maka semakin meningkat skor skala gatal 5-D. Pada pasien RTG, semakin menurun nilai e-GFR maka semakin meningkat skor skala gatal 5-D.

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Background: Pruritus is one of the symptoms experienced by patients with chronic kidney disease (CKD). Most patients with chronic kidney disease-associated pruritus (CKD-aP) occur in dialysis patients and could also happen in kidney transplant (KT) recipients. Inappropriate management of pruritus could impact the quality of life (QoL). No studies have compared the severity of pruritus, QoL, and the correlation of various biochemical factors between hemodialysis (HD) and KT recipients in Indonesia. Objective: To compare the severity of pruritus, QoL, and the correlation of hs-CRP, calcium, phosphate, and e-GFR levels between HD and KT recipients. Methods: This is a cross-sectional analytic observational study. Medical history, physical examination, and laboratory examination were conducted on each subject. The 5-dimensional (5-D) itch scale was used to evaluate the severity of pruritus. Dermatology Life Quality Index (DLQI) was used to assess the QoL. Appropriate statistical analysis was conducted to prove the research hypothesis with a significance value of p <0.05. Results: Out of 30 subjects in each group, the proportion of moderate to severe pruritus was 76.7% in the HD group. In the KT group, 83.3% experienced mild pruritus (RR = 4.6; CI 95% = 2.02– 10.5; p <0.001). The median DLQI score in the HD group was 5 (3–6), while in the KT group was 3 (2–4) (p <0.001). There was a significant positive correlation between hs-CRP and the 5-D itch scale in the HD group (r = 0.443; p <0.05). The KT group had a significant negative correlation between e-GFR and the 5-D itch scale (r = -0.424; p <0.05). Both groups had no statistically significant correlation between calcium and phosphate levels and the 5-D itch scale. Conclusion: Moderate-to-severe pruritus was more common in HD patients than in KT recipients. Pruritus in HD patients had a mild to moderate effect on QoL, whereas pruritus in KT recipients had a mild impact on QoL. A higher level of hs-CRP in HD patients results in a higher 5-D itch scale. In KT recipients, the lower the e-GFR value, the higher the 5-D itch scale."

"Latar belakang: Hiperfosfatemia pada penyakit ginjal kronik (PGK) terjadi akibat kegagalan ginjal dalam mengekskresi fosfat, tingginya asupan fosfat atau peningkatan pelepasan fosfat dari ruang intraselular. Hipertrofi ventrikel kiri (left ventricle hypertrophy/LVH) adalah perubahan jantung yang umum terjadi dan menjadi tanda awal penyakit kardiovaskular pada anak dengan PGK. Penelitian ini bertujuan untuk menilai hubungan antara kadar fosfat darah dengan fungsi sistolik serta penebalan ventrikel kiri jantung pada pada pasien anak penyakit ginjal kronik tahap akhir. Metode: Penelitian ini merupakan studi potong lintang di RSUPN dr. Cipto Mangunkusumo Jakarta terhadap anak PGTA tanpa ada kelainan jantung bawaan dari april-mei 2024 dengan dilakukan pemeriksaan fosfat darah dan ekokardiografi. Hasil: Terdapat 56 subyek dengan titik potong kadar fosfat darah 7,35 mg/dL. Didapatkan penurunan fungsi fraksi ejeksi dengan rasio prevalens pada pasien dengan hiperfosfatemia adalah 3,895 dengan IK 95% antara 2,552-9,773 (p = 0,002) serta kecenderungan hubungan kadar fosfat dengan penebalan LVMI (p = 0,680) dan disfungsi diastolik jantung kiri (p = 0,145). Kesimpulan: Terdapat hubungan antara kadar hiperfosfemia darah dengan fungsi sistolik pada pasien anak penyakit ginjal kronik tahap akhir. Tetapi tidak terdapat hubungan dengan peningkatan massa ventrikel kiri jantung dan diastolik jantung.

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Background: Hyperphosphatemia in chronic kidney disease (CKD) occurs due to renal failure to excrete phosphate, high phosphate intake or increased phosphate release from the intracellular space. Left ventricle hypertrophy (LVH) is a common heart change and an early sign of cardiovascular disease in children with CKD. This study aimed to assess the relationship between blood phosphate levels to decreased systolic and diastolic function and thickening of the left ventricle in pediatric patients with end-stage chronic kidney disease. Method: This was a cross-sectional observational study at RSUPN dr. Cipto Mangunkusumo Jakarta with PGTA children without congenital heart defects. Paremeters for function and LVM were assessed by Doppler echocardiography and blood phosphate examination. Results: There were 56 subjects with a cut point for blood phosphate levels of 7.35 mg/dL. It was found that a decrease in ejection fraction function with a prevalence ratio in patients with hyperphosphatemia was 3.895 with a 95% CI between 2.552-9.773 (p = 0.002) as well as a trend in the relationship between phosphate levels and LVMI thickening (p = 0.680) and left heart diastolic dysfunction (p = 0.145) Conclusion: There is association between blood levels of phosphemia and systolic function in pediatric patients with end-stage chronic kidney disease. However, there is no association with increased left ventricular mass index and dyastolic function."

"[ABSTRAKLatar Belakang. Perburukan fungsi ginjal berkaitan dengan luaran klinis yang lebih buruk pada pasien gagal jantung dekompensasi akut. Karakteristik klinis pada saat pasien masuk ke unit gawat darurat (UGD) dapat menolong untuk identifikasi pasien yang berisiko terhadap kejadian perburukan fungsi ginjal. Tujuan penelitian ini adalah membuat sistem skor untuk mempermudah identifikasi pasien yang berisiko terhadap perburukan fungsi ginjal pada gagal jantung dekompensasi akut.Metode. Studi kohort retrospektif dilakukan terhadap 614 pasien yang menjalani perawatan karenan gagal jantung dekompensasi akut. Perburukan fungsi ginjal didefinisikan sebagai peningkatan nilai kreatinin serum ≥ 0.3 mg/dL kapanpun selama perawatan atau ≥ 25% dari awal masuk perawatan.Hasil. Perburukan fungsi ginjal terjadi pada hampir 26% pasien. Prediktor independen terhadap kejadian perburukan fungsi ginjal yang didapat melalui analisis dengan logistik regresi backward selection adalah usia > 75 tahun (p < 0.0001); perempuan (p = 0.034); riwayat hipertensi (p = 0.001); anemia (p = 0.005); dan serum Creatinin saat masuk di UGD > 2.5 mg/dL (p = 0.013). Sistem skor dibuat dari model akhir tersebut. Dilakukan validasi internal dengan metode bootstrap didapatkan hasil optimisme yang baik (0.01088808).Kesimpulan. Sistem skor baru dapat memprediksi kejadian perburukan fungsi ginjal pada pasien gagal jantung dekompensasi akut yang menjalani rawat inap.

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ABSTRACTBackground. Worsening renal function (WRF) is associated with worse outcomes among patients who are hospitalized with acute decompensated heart failure (ADHF). Clinical characteristics at admission may help identify patients at increased risk of WRF. The aim of this study was to create in admission scoring system to simplify identification patients at risk of WRF in ADHF setting.Methods. A retrospective data of 614 patients admitted with ADHF was analyzed. By the definition WRF occurred when serum Creatinin increased at anytime during hospitalization by ≥ 0.3 mg/dL or by ≥ 25% from admission.Results. Worsening renal function developed in near 26% patients. The independent predictors of WRF analyzed with backward selection logistic regression were: age > 75 years old (p < 0.0001), female (p = 0.034); history of hypertension (p = 0.001); anemia (p = 0.005); and in admission serum Creatinin (p = 0.013). A scoring system was generated from this final model. An internal validation with bootstrap method showed good optimism (0.01088808).Conclusion. A new scoring system could predict in-hospital worsening renal function among patients hospitalized with acute decompensated heart failure., Background. Worsening renal function (WRF) is associated with worse outcomesamong patients who are hospitalized with acute decompensated heart failure(ADHF). Clinical characteristics at admission may help identify patients at incresedrisk of WRF. The aim of this study was to create in admission scoring system tosimplify identification patients at risk of WRF in ADHF setting.Methods. A retrospective data of 614 patients admitted with ADHF was analyzed.By the definition WRF occurred when serum Creatinin increased at anytime duringhospitalization by ≥ 0.3 mg/dL or by ≥ 25% from admission.Results. Worsening renal function developed in near 26% patients. Theindependent predictors of WRF analyzed with backward selection logisticregression were: age > 75 years old (p < 0.0001), female (p = 0.034); history ofhypertension (p = 0.001); anemia (p = 0.005); and in admission serum Creatinin (p= 0.013). A scoring system was generated from this final model. An internalvalidation with bootstrap method showed good optimism (0.01088808).Conclusion. A new scoring system could predict in-hospital worsening renal function among patients hospitalized with acute decompensated heart failure.]"

"ABSTRAK Latar Belakang. Optimalisasi hemodinamik perioperatif berkorelasi dengan peningkatan hasil terapi pascaoperasi. Alat pantau pulse contour analysis telah digunakan rutin pada operasi transplantasi ginjal di RSCM. Teknologi ini mahal dan harus dilakukan pemasangan akses kateter arteri. Terdapat alat ukur lain dengan kelebihan tidak invasif.Tujuan. Mengetahui kesesuaian hasil pengukuran hemodinamik antara teknik bio-impedance analysis dan pulse contour analysis pada pasien resipien transplantasi ginjal.Metode. Penelitian observasional statistik potong lintang terhadap 35 pasien resipien transplantasi ginjal di RSCM dan RSCM Kencana Jakarta periode Oktober 2017-Febuari 2018. Parameter hemodinamik pasien diukur menggunakan kedua alat uji yaitu ICONTM dan EV1000TM, pencatatan dilakukan pascainduksi, pascainsisi dan pascapelepasan klem arteri renalis. Analisis data menggunakan uji kesesuaian Bland-Altman dan korelasi.Hasil. Rerata perbedaan nilai indeks curah jantung dan indeks isi sekuncup antara kedua alat adalah 1,3 l/mnt/m2 dan 22,1 ml/denyut/m2 lebih tinggi pada EV1000TM. Rerata perbedaan hasil indeks tahanan vaskular sistemik dan stroke volume variation antara kedua alat adalah 973,3 dynes-detik-m2/cm5 dan 4,8 lebih rendah pada EV1000TM.Simpulan. Tidak terdapat kesesuaian hasil pengukuran curah jantung, tahanan vaskular sistemik dan stroke volume variation antara teknik bio-impedance analysis dengan teknik pulse contour analysis pada pasien resipien transplantasi ginjal.

Background. Hemodynamic optimization perioperative has strong correlation with improvement of post-operative outcome. Pulse contour analysis uses regularly for monitoring in renal transplantation surgery at RSCM hospital. This technology is expensive and need access to artery vascular. There is other monitoring device with excess non-invasive use. Purpose. Comparing hemodynamic measurement results between bio-impedance analysis and pulse contour analysis in renal transplant recipients.Method. Cross sectional observasional study to 35 renal transplantation recipient patients at RSCM and RSCM Kirana hospitals Jakarta during October 2017-February 2018. Each patient was measured with both devices ICONTM and EV1000TM. Data collected after induction, after incision and after renal artery release. All the data analyzed with Bland-Altmant agreement and corellation.Result. Mean difference of cardiac output index and stroke volume index are 1,3 l/mnt/m2 and 22,1 ml/denyut/m2 higher in EV1000TM. Mean difference of systemic vascular resistance index and stroke volume variation are 973,3 dynes-detik-m2/cm5 and 4,8 lower in EV1000TM. Conclusion. There is no agreement in measurement of cardiac output, systemic vascular resistance and stroke volume variation between bio-impedance analysis and pulse contour analysis in renal transplantation recipient patients. "

"Latar Belakang: Disfungsi ginjal prabedah meningkatkan risiko gagal ginjal dan kematian pada pasien bedah jantung. Studi yang meneliti efek proteksifurosemid pada bedah jantung sebagian besar dilakukan pada pasien dengan fungsi ginjal normal. Penelitian ini bertujuan mengevaluasi efek furosemid dosis rendah profilaksis pada pasien bedah jantung dengan disfungsi ginjal ringan-sedang.Metode: Delapan puluh tujuh pasien bedah jantung elektif dengan disfungsi ginjal ringan -sedang (LFGe30-89 mL/min/1,73 m2), terdaftar dalam kelompok furosemid (n = 43) atau kontrol (n = 44). Furosemid (2 mg/jam) atau NaCl 0,9% 2 cc/jam diberikan setelah induksi dan dilanjutkan selama total 12 jam. Kami memeriksa sampel darah pada 12, 24, 48, dan 120 jam setelah infus mulai mengukur perubahan LFGe. Penurunan LFGe>20% dianggap sebagai perburukan fungsi ginjal, sedangkan peningkatan LFGe>20% dianggap sebagai pemulihan fungsi ginjal. Kami membandingkan kebutuhan infus furosemid terapeutik dan terapi penggantian ginjal pada kedua kelompok.Hasil: Dari 90 subjek yang direkrut, 3 subjek drop out(1 subjek data tidak lengkap dan 2 subjek dipasangintra-aortic balloon pump/IABPsaat pembedahan), hanya 87 subjek yang diikutsertakan dalam analisis. Insiden penurunan LFGepada jam ke-12, ke-24 dan ke-48 lebih banyak terjadi pada kelompok kontrol, berbedasignifikan pada sampel jam ke-48 (p value0,047). Proporsi peningkatan LFGe>20% pada sampel 120 jam hampir sama pada kedua kelompok. Subyek dalam kelompok furosemid membutuhkan lebih sedikit pemberian infus furosemid dosis terapeutik (p<0,05). Namun, penggunaan terapi pengganti ginjal lebih banyak ditunjukkan pada kelompok furosemid daripada kelompok kontrol meskipun tidak signifikan. Lama rawat di ICU dan rumah sakit lebih lama pada kelompok furosemid dibandingkan dengan kontrol, sedangkan angka kematian ditunjukkan sama antara kedua kelompok.Simpulan: Furosemid dosis rendah dapat mengurangi kejadian perburukan fungsi ginjal, dan kebutuhan infus terapeutik furosemid, tetapi tidak mencegah kebutuhanuntuk terapi pengganti ginjal. Penggunaan infus furosemid dosis rendah perioperatif dapat dipertimbangkan karena menunjukkan efek yang menguntungkan.

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Background: Preoperative renal dysfunction increases the risk of postoperative renal failure and mortality in cardiac surgery patients. Studies investigated the protective effect of furosemide in cardiac surgery mostly conducted in patients with normal renal function. This study aim to evaluate the effect of prophylactic low-dose furosemide in cardiac surgery patients with mild to moderate renal dysfunction.

Methods: Eighty-seven patients of elective cardiac surgery with mild to moderate renal dysfunction (eGFR 30-89 mL/min/1.73 m2), were enrolled in either furosemide (n = 43) or control (n = 44) groups. Furosemide (2 mg/h) or 0.9% NaCl is administered after induction and continued for a total of 12 hours. We examined blood samples on 12, 24, 48, and 120 hours after infusion started to measure the change in eGFR. A >20% decrease in eGFR was considered as worsening of renal function, while >20% increase in eGFR as recovering of renal function. We compared the requirement for therapeutic furosemide infusion and renal replacement therapy in both groups. 

Results: 90 subjects recruited, 3 were dropped out (1 subject's data incomplete and 2 subjects underwent intraoperativeintraaortic balloon pump/IABP installation), only 87 subjects were included in the analysis. The incidence of decreasing of GFR at the 12th, 24th and 48th hour was shown more likely in control group, more significantin 48 hours (p value 0.047). The proportion of >20% GFR increase in the 120-hour sample was almost the same in both groups. Subjects in furosemide group required less administration of therapeutic dose furosemide infusion (p<0.05). However, use of renal replacement therapy was shown more in the furosemide group than the control group although is not significant. The length of stay in ICU and hospital were longer in the furosemide group compared to  control, while the mortality rate were shown to be equal between two groups.

Conclusions: Low-dose furosemide can reduce the incidence of  worsening renal function, and the need for a therapeutic furosemide infusion, but does not prevent the usage for renal replacement therapy. Continuous low-dose furosemide perioperative can be considereddue to beneficial effects proven."

"Latar belakang: Gagal ginjal akut (GGA) menjadi salah satu komplikasi serius yang dapat terjadi setelah prosedur bedah pintas arteri koroner (BPAK). GGA paskaoperasi jantung secara independen berhubungan dengan peningkatan 3-8 kali lipat angka morbiditas dan mortalitas serta memperpanjang durasi perawatan (hospitalisasi) sehingga dapat meningkatkan biaya kesehatan. Untuk menurunkan insidensi GGA ini, dibutuhkan modalitas pemeriksaan sebelum operasi yang berhubungan dengan kejadian GGA paska BPAK sehingga dapat digunakan sebagai prediktor nantinya untuk tindakan pencegahan. Indeks resistif renal (IRR) diketahui dapat menggambarkan kondisi resistensi dan komplians pembuluh darah yang berhubungan dengan patofisiologi GGA paska BPAK. Namun hingga saat ini belum ada penelitian yang menilai hubungan langsung antara nilai IRR dan kejadian GGA paska BPAK. Tujuan: Mengetahui hubungan nilai IRR terhadap kejadian GGA paska BPAK Metode: Pasien yang akan dilakukan prosedur BPAK akan menjalani pemeriksaan dupleks renalis untuk mendapatkan nilai IRR. Luaran gagal ginjal akut dinilai dengan pemeriksaan kadar kreatinin darah selama 48 jam paska BPAK Hasil: Terdapat 96 pasien yang menjadi subjek penelitian. Median nilai IRR pada subjek penelitian ini ialah 0.71 (0.57-0.87). Terdapat perbedaan median nilai IRR antara kelompok GGA dan non GGA (0.73, rentang 0.57-0.87 dan 0.65, rentang 0.58-0.72). Nilai IRR memiliki korelasi yang cukup baik terhadap kejadian GGA paska BPAK (nilai koefisien korelasi r = 0.66, p < 0,001) dengan titik potong padanilai IRR 0.685 (sensitivitas 82.40%, spesifisitas 73.30%). Faktor-faktor lain seperti usia, diabetes melitus, hipertensi, nilai kreatinin serum pre operatif, klirens kreatinin pre operatif, fraksi ejeksi, durasi mesin pintas kardiopulmonal dan durasi klem silang aorta secara statistika berbeda bermakna berhubungan terhadap kejadian GGA paska BPAK. Namun dari analisis multivariat, hanya faktor fraksi ejeksi, durasi mesin pintas kardiopulmonal, nilai IRR, dan diabetes mellitus terbukti bermakna Kesimpulan: Terdapat hubungan antara IRR dengan kejadian gagal ginjal akut paska BPAK. Nilai IRR 0.685 merupakan titik potong optimal (sensitivitas 82,40% dan spesifisitas 73.30%)

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Background: Acute kidney injury (AKI) still become one of the serious complications that can occur after a coronary artery bypass graft (CABG) procedure. Post-operative AKI is independently associated with a 3-8 fold increase in morbidity and mortality and extending the duration of treatment (hospitalization) thereby increasing health costs. To reduce the incidence of AKI, a modality of examination prior surgery which is related to the incidence of post-operative AKI is needed so that it can be used as a predictor later for preventive action. The renal resistive index (RRI) is known to be able to describe the condition of resistance and vascular compliance which are related to the pathophysiology of post-operative AKI. However, there has been no research that assesses the direct relationship between RRI values and the incidence of post-operative AKI Objectives: To investigate the relationship between RRI value and incidence of post-operative AKI in patients underwent CABG procedure. Methods: CABG candidates patients will undergo duplex renalis examination to obtain an RRI score. Outcome of renal impairment was assessed by blood creatinine examination within 48 hours after CABG procedure. Results: There were 96 patients who became the subject of the study. The median of RRI value in this study subjects was 0.71 (0.57-0.87). There were differences in median of RRI values between groups with post-operative AKI and those not (0.73, range 0.57-0.87 dan 0.65, range 0.58-0.72). There was quite good correlation between RRI and post-operative AKI (p < 0.001 with correlation coefficient r = 0.66) with cut off point of IRR value was 0.685 (sensitivity 82.40%, specificity 73.30%). Other factors such as age, diabetes mellitus, hypertension, ejection fraction, CPB duration, and aortic cross clamp duration are associated with incidence of post-operative AKI. However, multivariat analysis showed only ejection fraction, cardiopulmonary bypass duration, RRI, and diabetes mellitus significantly related to post-operative AKI Conclusion: RRI values has relationship with post-operative AKI. The optimal cut off value of RRI retrieved by this study is 0.685 (sensitivity 82.40%, specificity 73.30%)"

"Pendahuluan dan Tujuan: Transplantasi ginjal telah menjadi terapi pengganti ginjal pilihan untuk penyakit ginjal kronis stadium akhir. Di Indonesia, belum ada penelitian yang pernah membahas mengenai kualitas hidup resipien transplantasi ginjal pasca operasi. Penelitian ini bertujuan untuk mengetahui apakah ada perbedaan yang signifikan dalam kualitas hidup resipien sebelum dan sesudah operasi transplantasi ginjal. Metode: Ini adalah studi prospektif yang menggunakan kuesioner KDQoL-SF sebelum dan sesudah operasi (pada bulan ke-1, 3, dan 6). Sampel diambil secara berurutan sejak bulan Januari hingga Mei 2016 dan dilanjutkan sampai Desember 2016. KDQoL-SF telah divalidasi dalam bahasa Indonesia dan sudah banyak digunakan untuk menilai kualitas hidup resipien (cronbach alfa> 0,6). Data dianalisis dengan menggunakan software statistik SPSS versi 21.0. Dalam penelitian ini, repeated Anova dengan perbandingan post hoc Bonferroni digunakan. Hasil: Terdapat 33 pasien yang disertakan dalam penelitian ini yaitu dari Januari - Desember 2016. Usia rata-rata pasien adalah 44,6 ± 12,88 tahun. Mayoritas pasien adalah laki-laki (n = 24; 72,7%). Rata-rata IMT pasien adalah 23,8 ± 3,74 kg/m2. Komorbid yang paling sering terjadi adalah hipertensi (n = 32; 97%) kemudian diikuti oleh diabetes melitus (n = 11; 33,3%), dan dislipidemia (n = 5; 15,2%). Biaya operasi transplantasi ginjal dan pengobatannya sebagian besar menggunakan biaya pribadi (n = 14; 42,4%) (n = 14; 42,4%) kemudian diikuti oleh asuransi swasta (n = 8; 24,2 %) (n = 10; 30,3%), dan asuransi pemerintah (n = 6; 18,2%) (n = 5; 15,2%). Hampir semua resipien tidak mengeluh dengan biaya biaya tersebut ketika dan setelah operasi (n = 29; 87,9%). Dibandingkan dengan kondisi awal, kualitas hidup pada penerima meningkat pada bulan pertama, ketiga, dan keenan setelah operasi. Perubahan utama pada kualitas hidup terlihat diantara tahap pra operasi (median: 50%, IQR: ±20) dan 1 bulan setelah operasi (median: 90%, IQR: 0), sedangkan pada tahap berikut tidak ada peningkatan yang signifikan pada skor median pada bulan ketiga (median: 90%, IQR: ± 7,5) dan bulan keenam (median: 90%, IQR: ± 10) setelah operasi. Terdapat perbaikan signifikan secara statistik pada gejala, efek penyakit ginjal, beban penyakit ginjal, status kerja, fungsi kognitif, kualitas interaksi sosial, kualitas tidur, kepuasan pasien, fungsi fisik, peran fisik, kesehatan umum, kesejahteraan emosional, peran emosional, dan perbaikan pada kondisi kelelahan, skor sebelum dan sesudah transplantasi ginjal (p <0,01). Penelitian ini juga menunjukkan bahwa tidak ada perbedaan signifikan dalam dukungan sosial (p = 0,656), nyeri (p = 0,274), fungsi seksual (p = 1), dan skor fungsi sosial (p = 0,01) sebelum dan sesudah operasi. Angka keberhasilan transplantasi ginjal di RSCM sama dengan pusat transplantasi ginjal lainnya di dunia, yaitu sekitar 95%. Kesimpulan: Studi ini menunjukkan bahwa ada perbaikan yang signifikan pada hampir semua aspek kualitas hidup resipien setelah transplantasi ginjal. Kualitas hidup pasien setelah transplantasi ginjal di Rumah Sakit Cipto Mangunkusumo Indonesia sama baiknya dengan di negara lain. Ini bisa menjadi database untuk studi lebih lanjut di pusat transplantasi ginjal. ……Introduction and Objectives: Kidney transplantation has become the chosen kidney replacement therapy for end stage chronic kidney disease. In Indonesia, no study about quality of life in kidney transplantation recipient after surgery has been done. This study aims to determine whether there is a significant difference in the recipient’s quality of life before and after kidney transplantation surgery. Methods:This was a prospective study KDQoL-SF questionnaire before and after surgery (1^st, 3^rd, and 6^th month). Samples were consecutively taken from January until May 2016 and followed up to December 2016. KDQoL-SF has been validated in Indonesian language and widely used to assess recipient’s quality of life (Cronbach alfa >0,6). The data were analyzed using SPSS statistical software 21.0 version. In this study, repeated Anova with post hoc comparison Bonferroni was used. Results: There were 33 patients included in this study from January–December 2016. The average age of patients was 44,6 ± 12,88 years old. The majority of patients were males (n=24; 72,7%). Mean BMI of the patients was 23,8 ± 3,74 kg/m². The most frequent comorbid of the patients was hypertension (n=32;97%) then followed by diabetes mellitus (n=11;33,3%), and dyslipidemia (n=5;15,2%). The cost fee of kidney transplantation surgery and its following medication mostly covered by personal financial support (n=14;42,4%), (n=14;42,4%) then followed by private insurance (n=8;24,2%), (n=10;30,3%), and governmental insurance (n=6;18,2%), (n=5;15,2%). Almost all the recipients did not complain with those cost fee during and after surgery (n=29; 87,9%). Compared to baseline, the quality of life in recipients increased at 1^st, 3^rd, and 6^th month after operation. Major changes in the perceived QOL were noted only between the preoperative stage (median: 50%, IQR: ±20) and 1 month after operation (median: 90%, IQR: 0), while in the following stage there was no significant improvement in median score at 3 month (median: 90%, IQR: ± 7,5) and 6 month (median: 90%, IQR: ± 10) after operation. There were statistically significant improvements in symptoms, effect of kidney disease, burden of kidney disease, work status, cognitive function, quality of social interaction, quality of sleeping, patient satisfaction, physical functioning, role-physical, general health, emotional well-being, role-emotional, and improvement in fatigue, score before and after kidney transplantation (p<0,01). This study also showed that there were no significant differences in social support (p=0,656), pain (p=0,274), sexual function (p=1), and social function score (p=0,01) before and after surgery. Successful rate of kidney transplantation in Indonesia was about 95%, it was equal to transplantation in other countries. Conclusions: This study showed that there were significant improvements in almost all aspect in recipient’s quality of life after kidney transplantation. Patient’s quality of life after kidney transplantation in Cipto Mangunkusumo Hospital Indonesia is as good as in other country. It could become the database for further studies in kidney transplantation centers."