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Pande Made Wisnu Tirtayasa
Association between early resistive index measurement and early graft function and long term graft survival after kidney transplantation: an evidence-based clinical review
"ABSTRACT
Background: resistive index (RI) is highly utilised to assess the graft function using Doppler ultrasonography. The RI has been shown as the best ultrasound parameter to assess kidney allograft dysfunction. Several studies have established the role of the RI as a predictor of transplant failure. However, these studies were using RI measurement in the later stages post transplantation. The present study has conducted to identify the association between early RI measurement and early graft function represented as delayed graft function (DGF) and immediate graft function (IGF), as well as long-term graft survival. Methods: an evidence based clinical review of studies published before May 2018 was conducted from Medline, Science Direct, EMBASE and Cochrane databases. Studies on early measurement of RI whereby the primary or secondary goals of the study related to graft function and/or graft survival were included. Studies using late RI measurement and without RI value groups were excluded. The Mantzel Haenzel method was used to analyse pooled risk ratio and 95% confidence interval, while the heterogeneity of the study was calculated through I2 value. Data analysis was performed using Review Manager 5.3. Results: nine studies with a total of 1802 patients who had undergone a kidney transplant were analysed. DGF was found in 19% (193/1015) of the low RI group and in 42.8% (337/787) of the high RI group (RR 2.04 (95% CI 1.72 - 2.41), p < 0.00001, I2 = 28%). IGF was found in 39.5% (62/157) of the low RI group and in 10.5% (28/268) of the high RI group (RR 0.26 (95% CI 0.17 0.40), p < 0.00001, I2 = 0%). Long term graft survival, with follow up between 60 144 months, was found in 83% (701/845) of the low RI group and in 69.4% (395/569) of the high RI group (RR 0.82 (95% CI 0.72 0.93), p = 0.002, I2 = 63%). Conclusion: the results of this study emphasise the association between early measurement of RI and early graft function, and longterm graft survival. An elevated RI provides the chance of recognizing the patients with poor longterm prognosis, from the first moment after kidney transplant."
Jakarta: University of Indonesia. Faculty of Medicine, 2019
610 UI-IJIM 51:1 (2019)
Artikel Jurnal  Universitas Indonesia Library
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Manafe, Aco
DR. Ide Anak Agung Gde Agung : keunggulan diplomasinya membela republik
Jakarta: Inti Lopo Indah, 2007
920 ACO d (1)
Buku Teks SO  Universitas Indonesia Library
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Stella Aprilia
Association Between Pre-Operative Glycated Hemoglobin Level And Early Outcomes After Cardiac Bypass Graft Surgery In Non-Diabetic Patients With Coronary Artery Disease = Hubungan Antara Kadar Hemoglobin Terglikasi Pra Operasi dan Luaran Awal Pasca Bedah Pintas Arteri Koroner pada Pasien Non Diabetes dengan Penyakit Jantung Koroner
"Latar belakang: Hubungan antara HbA1c dengan kejadian mortalitas dan morbiditas pada pasien diabetes yang menjalani CABG telah dijelaskan dalam banyak penelitian sebelumnya. Namun, peran HbA1c pada populasi pasien non-diabetes dengan PJK yang menjalani BPAK belum pernah dilakukan, khususnya di Indonesia. Penelitian ini bertujuan untuk mengetahui apakah kadar HbA1c praoperasi memiliki hubungan dan dapat memprediksi keluaran awal pascaoperasi setelah BPAK pada pasien non-diabetes dengan penyakit arteri koroner. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien non-diabetes dengan penyakit jantung koroner yang menjalani BPAK sejak Januari 2022 hingga Desember 2023 di Pusat Jantung Nasional Harapan Kita. Kemudian, data kadar HbA1c praoperasi serta keluaran pascaoperasi yaitu mortalitas intrahospital dan morbiditas pascaoperasi seperti durasi penggunaan ventilator mekanik, lama rawat inap di ICU, lama rawat inap di rumah sakit, Major Adverse Cardiovascular Event (MACE), dan infeksi luka operasi diambil dari rekam medis pasien. Data variabel kontinu dinilai dengan menggunakan uji T atau uji Mann-Whitney U, sedangkan data nominal dinilai menggunakan uji Chi square atau Fischer. Analisis multivariat akan dilakukan lebih lanjut untuk hasil yang signifikan. Hasil: Sebanyak 391 subjek memenuhi kriteria dalam penelitian ini. Usia rata-rata subjek adalah 58,69 ± 8,29 tahun. Subjek dengan prediabetes (n = 268) memiliki perbedaan yang signifikan  secara statistik dalam median durasi ventilator dibandingkan dengan kelompok HbA1c normal (p = 0,009). Namun, tidak didapatkan hubungan yang signifikan antara HbA1c praoperasi dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Simpulan: Tidak terdapat hubungan antara HbA1c praoperasi pada pasien non-diabetes dengan PJK yang telah menjalani BPAK dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Pasien HbA1c normal praoperasi diasosiasikan signifikan secara statistik mempunyai durasi ventilasi mekanik yang lebih pendek dibandingkan pada pasien prediabetes dengan PJK yang telah menjalani BPAK.
Background: The association between HbA1c with mortality and morbidity events in diabetic patients undergoing CABG have been explained in many previous studies. However, the predictive value of this in the non-diabetic patient population has not received sufficient attention, especially in Indonesia. This study investigated whether the pre-operative HbA1c level had an association and could predict early post-operative outcomes after CABG in non-diabetic patients with coronary artery disease. Methods: This retrospective cohort study involved non-diabetic patients with coronary artery disease who underwent CABG from January 2022 until December 2023 at National Cardiovascular Center Harapan Kita. Pre-operative HbA1c level and post-operative incidence of intrahospital mortality and morbidities such as mechanical ventilator duration, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections were collected. Continuous variable is assessed using T test or Mann- Whitney U test. Nominal data are assessed using Chi square or Fischer test. Multivariate analysis will be conducted further for significant results. Results: Three hundred-ninety-one subjects were involved in this study. The mean age of all subjects was 58.69 ± 8.29 years. Subjects with pre-diabetes (n = 268) have statistically significant difference in median ventilator duration compared to normal HbA1c group (p = 0.009). However, there was no significant association between pre-operative HbA1c and early post-operative intrahospital mortality, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections in this population. Conclusion: Pre-operative glycated hemoglobin level is not associated with early mortality, length of ICU stay, length of hospital stay and MACE. However, there is statistically significant lower mechanical ventilator duration in normal HbA1c compared to pre-diabetic patients with CAD who have undergone CABG."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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UI - Tugas Akhir  Universitas Indonesia Library
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Dimas Trisetyo Nugroho
Analisis Kejadian Trombosis Dini Konduit Vena Pasca-Bedah Pintas Arteri Koroner dengan Teknik On-Pump dan Off-Pump Pada Populasi Non-Resisten Aspirin = Early Vein Graft Thrombosis Analysis after On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery in Non-Resistant Aspirin Patients
"Latar belakang : Konduit vena lebih rentan mengalami trombosis dini dalam satu tahun pertama pasca bedah pintas arteri koroner sehingga meningkatkan risiko morbiditas maupun mortalitas. Penelitian ini bertujuan untuk meneliti ada tidaknya perbedaan kejadian trombosis dini konduit vena pascabedah pintas arteri koroner (BPAK) dengan teknik on-pump dan off-pump pada pasien non-resisten aspirin.
Metode : Dilakukan suatu studi kohort prospektif pada pasien yang menjalani operasi BPAK elektif di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dari bulan September 2019 hingga September 2020. Penelitan ini membandingkan kejadian trombosis pada satu bulan pascabedah pada kelompok on-pump dan off-pump dengan menggunakan pemeriksaan MSCT, serta membandingkan nilai MGF dan PI pada kedua kelompok tersebut.
Hasil : Sebanyak 60 konduit vena dari 28 pasien yang menjalani BPAK dilibatkan dalam penelitian ini. Sebanyak masing-masing 30 konduit pada kelompok off-pump dan on-pump. Hasil penelitian ini menunjukan tidak ada perbedaan bermakna pada kejadian trombosis dini antara kedua kelompok. Kejadian trombosis dini pada BPAK on-pump sebanyak 13,3% dan pada BPAK off-pump 13,3% (p=1). Evaluasi nilai MGF dan PI juga menunjukan hasil tidak berbeda bermakna antara kedua teknik operasi maupun pada kelompok konduit yang paten atau oklusi.
Simpulan : Tidak ada perbedaan bermakna pada kejadian trombosis dini antara BPAK baik secara on pump maupun off pump
Introduction : Early thrombosis is more common in vein grafts and may occur within the first year after coronary artery bypass graft surgery and can increase morbidity and mortality rate. This study aims to establish whether there is a difference of the incidence of early thrombosis after on-pump and off-pump CABG in non-aspirin resistant patient population.
Method : Patients who undergone elective CABG surgery from September 2019 to September 2020 in single center was included in this prospective cohort study. This study compares the incidence of vein graft thrombosis at one month postoperative in both groups on pump and off pump using MSCT, and compares MGF and PI value of in on pump and off pump group also in patent and occluded vein grafts.
Results : A total of 60 vein grafts (30 on-pump and 30 off-pump) from 28 patients were analyzed in this study. There was no significant difference on the incidence of early vein graft thrombosis between two groups (13,3% in on pump vs 13,3% in off pump, p:1). MGF and PI value showed no difference in both techniques also no difference in patent group and occluded group
Conclusion : There is no significant difference in early vein graft thrombosis after on-pump or off-pump CABG."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Hazia Hanifa Bilqis
Hubungan faktor donor dan faktor resipien dengan delayed graft function pada resipien transplantasi ginjal laparoskopi di RSCM = Association between donor and recipient factors with delayed graft function in laparoscopic transplant recipient in Cipto Mangunkusumo National Hospital
"ABSTRACK
Transplantasi ginjal dapat mengalami komplikasi delayed graft function yang merupakan salah satu bentuk gangguan ginjal akut. Terdapat banyak faktor yang dapat memengaruhi delayed graft function, yakni faktor intraoperatif dan ekstraoperatif. Studi ini meneliti faktor-faktor yang dapat menyebabkan delayed graft function pada faktor ekstraoperatif khususnya dari segi donor dan resipien. Tujuan: Mengetahui hubungan antara faktor donor (usia, hubungan kekerabatan dengan resipien) dan faktor resipien (usia, penyebab gagal ginjal) dengan kejadian delayed graft function pada resipien. Metode: penelitian ini menggunakan metode studi potong lintang dan melibatkan 483 sampel yang merupakan pasien transplantasi ginjal di RSCM periode November 2011-September 2018. Hasil: chi square dan fisher menunjukkan bahwa terdapat hubungan yang bermakna antara usia donor (p=0,023), usia resipien (p=0,006), dan hubungan kekerabatan donor dan resipien (p=0,008) dengan delayed graft function. Tidak terdapat hubungan antara penyebab gagal ginjal diabetes mellitus, hipertensi, infeksi, penyakit autoimun, dan penyebab lain gagal ginjal. Diskusi: Dari analisis multivariat didapatkan adanya hubungan bermakna antara hubungan kekerabatan donor dan resipien dengan delayed graft function (p= 0,011. Disimpulkan bahwa hubungan kekerabatan donor dan resipien merupakan faktor yang paling berhubungan dengan terjadinya delayed graft function pada resipien transplantasi ginjal RSCM dibandingkan dengan faktor usia donor, usia resipien, dan penyebab gagal ginjal resipien.
ABSTRACT
Background: Kidney transplant patients may have complications, such as delayed graft function which is one of acute kidney injury. There are a lot of factors that can affect delayed graft function, such as intraoperative and extraoperative factors. In this study we discussed more about extraoperative factors, specifically from donor and recipient factors. Objective: To determine the association between donor factors (age, relation with recipien)t, recipient factors (age, cause of kidney failure) and delayed graft function in transplant recipient. Methods: Cross-sectional study design was used in this study  by collecting 483 patient data of medical record from data recapitulation of renal transplant by Departement of Urology, Cipto Mangunkusumo National Hospital, from November 2011-September 2018. Results: Bivariat analysis with chi square and fisher test result showed that there was a significant association between donor age (p=0,023), recipient age (p=0,006) and donor and recipient relation status (p=0,008) with delayed graft function. There were no significant association between recipient age, and causes of kidney failure. Discussion: From the multivariate analysis it was found that there was a significant association between donor and recipient relation status (p=0,011) with delayed graft function.From these result we concluded that donor and relation status are the most  associated factor with delayed graft function in recipients."
2018
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UI - Skripsi Membership  Universitas Indonesia Library
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Hanifa Ahdan Badrani
Hubungan faktor intraoperatif dan delayed graft function pada resipien transplantasi ginjal laparoskopi di RSCM = Association between intraopative factors and delayed graft funtion in LLDN transplant recipient in Cipto Mangunkusumo National Referral Hospital
"ABSTRACT
Pada pasien penyakit ginjal tahap akhir, transplantasi ginjal merupakan pilihan terbaik bagi pasien; akan tetapi, delayed graft function dapat menjadi komplikasi bagi pasien yang dapat berkembang menjadi rejeksi (penolakan) terhadap organ donor, sehingga menggagalkan transplantasi. Tujuan: Mengetahui hubungan antara faktor intraoperatif (warm ischemia time 1, cold ischemia time, warm ischemia time 2, waktu urin keluar, dan kompleksitas pembuluh darah) dan kejadian delayed graft function pada resipien. Metode: Peneliti melakukan studi potong-lintang dengan mengambil 611 data rekam medis pasien dari data rekapitulasi transplantasi ginjal di Departemen Urologi, Rumah Sakit Cipto Mangunkusumo, dari rentang waktu November 2011-September 2018. Peneliti kemudian melakukan analisis bivariat dan multivariat untuk menentukan signifikansi hubungan variabel. Hasil: Dari lima variabel yang diteliti, tidak terdapat satu pun variabel yang memiliki hubungan signifikan (p = 0,996; p = 0,125; p = 0,677; p = 0,332; p = 0,748; secara berurutan) dengan kejadian delayed graft function, dari total 545 pasien yang diteliti. Diskusi: Hubungan variabel yang tidak signifikan dapat dijelaskan oleh jenis donor pada penelitian ini yang sepenuhnya donor hidup, sehingga meminimalkan dampak buruk dari stress iskemik dan reperfusion injury yang disebabkan oleh faktor intraoperatif.
ABSTRACT
For patients with end-stage renal disease, transplantation is the best option for renal replacement therapy; however, Delayed Graft Function can complicates the transplantation, and even progresses into organ rejection, resulting in a failed transplantation. Objective: The purpose of this study was to determine the association between intraoperative factors (warm ischemia time 1, cold ischemia time, warm ischemia time 2, time of first urine output, and blood vessels complexity) and delayed graft function in transplant recipient. Methods: Researcher used cross-sectional study design by collecting 611 patient data of medical record from data recapitulation of renal transplant by Departemen of Urology, Cipto Mangunkusumo National Referral Hospital, from November 2011-September 2018. Selected patient data were then analyzed using bivariate and multivariate analysis. Results: From five variables in this study, none of them have significant association (p = 0,996; p = 0,125; p = 0,677; p = 0,332; p = 748; respectively) with delayed graft function, from a total of 545 patients. Discussion: The insignificant association of variables may be explained by the type of donor in this study, that is compromised entirely of living donor, which reduce the negative impact of ischemic stress and reperfusion injury caused by the intraoperative factors."
2018
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UI - Skripsi Membership  Universitas Indonesia Library
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Pediatric clinical practice guidelines & polices: a compendium of evidence - based research for pediatric paratice
New York American Academy of Pediatric 2002,
618.921 Ame p
Buku Teks  Universitas Indonesia Library
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Aditya Noor Dwiprakoso
Hubungan Nilai Pulmonary Artery Resistance Index dengan Morbiditas dan Mortalitas Dini Pascaoperasi Tutup Defek Ventrikel pada Usia Dewasa = Association between Pulmonary Artery Resistance Index with Morbidity and early Mortality after Ventricular Septal Defect Closure in Adults
"Latar belakang: Defek septum ventrikel (DSV) merupakan salah satu PJB dengan jumlah kasus terbanyak. Hipertensi pulmonal merupakan salah satu komplikasi yang dapat terjadi dengan prevalensi antara 2-10% dari seluruh kasus DSV. Pasien yang datang ke Rumah Sakit Pusat Jantung Nasional Harapan Kita (RSPJNHK) sudah dengan kondisi hipertensi pulmonal dan usia dewasa. Adanya perubahan pedoman internasional AHA/ESC dalam menentukan kelayakan operasi pada pasien DSV. Perlu dilakukan penelitian mengenai hubungan nilai pulmonary artery resistance index (PARI) yang menjadi prediktor keluaran pada pasien yang dilakukan operasi penutupan DSV.
Metode: Penelitian ini adalah studi kohort retrospektif berdasarkan data sekunder dari bagian rekam medis RSPJNHK Indonesia pada dewasa yang telah menjalani operasi tutup defek ventrikel pada periode 2015-2022. Variabel yang dinilai antara lain nilai pulmonary artery resistance index (PARI), lama penggunaan mesin jantung paru, lama penggunaan klem silang aorta, terhadap lama rawat, komplikasi pascaoperasi, dan kematian dini.
Hasil: Terdapat 66 subjek pada penelitian ini. Usia rerata subjek studi ini 22,5 tahun. Pada penelitian ini terdapat peningkatan yang bermakna pada durasi ventilator (p = 0,012) dan lama rawat ICU (p = 0,031) pada kelompok nilai PARI >5 WU dibandingkan dengan kelompok PARI < 5 WU. Keluaran kelompok nilai PARI <5 WU lebih baik dibandingkan kelompok PARI >5 WU dengan mortalitas (0% vs 15,6%, p = 0,02), kejadian aritmia (14,7% vs 15,6 %; p = 0,59), dan krisis hipertensi pulmonal (0% vs 9,4%, p = 0,1)
Simpulan: Terdapat hubungan antara nilai PARI dengan durasi ventilator mekanis dan lama rawat di ICU, namun tidak terdapat hubungan dengan aritmia dan kejadian krisis hipertensi pulmonal pascaoperasi. Terdapat hubungan yang bermakna antara nilai PARI dan mortalitas dini pascaoperasi penutupan defek septum ventrikel pada dewasa.
Background: Ventricular septal defect (DSV) is one of the most common CHDs. Pulmonary hypertension is one of the complications that can occur with a prevalence of between 2-10% of all DSV cases. Patients who come to Harapan Kita National Heart Center Hospital (RSPJNHK) already have pulmonary hypertension and are adults. There are changes in AHA/ESC international guidelines in determining the feasibility of surgery in DSV patients. It is necessary to conduct research on the relationship between the value of the pulmonary artery resistance index (PARI) which is a predictor of outcome in patients undergoing DSV closure surgery.
Method: This study is a retrospective cohort study based on secondary data from the medical record section of the Harapan Kita National Cardiovascular Center Hospital in adult patients who had undergone ventricular septal defect closure surgery in the 2015-2022 period. The variable assessed included pulmonary artery resistance index (PARI), duration of cardiopulmonary bypass, duration of aortic cross clamp, on length of stay, postoperative complications, and mortality.
Result: There were 66 subjects in this study. The mean age of the subjects was 22.5 years. In this study, there was a significant increase in ventilator duration (p = 0,012) and ICU length of stay (p = 0,031) in the PARI value >5 WU group compared to the PARI <5 WU group. The outcome of the PARI <5 WU group was better than the PARI >5 WU group with mortality (0% vs 15,6%, p = 0,02), arrhythmic events (14,7% vs 15,6 %; p = 0,59), and pulmonary hyperetension crisis (0% vs 9,4%, p = 0,1).
Conclusion: There is an association between PARI and duration of mechanical ventilation and length of ICU stay, but no association with arrhythmias and the incidence of postoperative pulmonary hypertensive crisis. There is a significant association between PARI and early mortality after ventricular septal defect closure surgery in adults."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Drajad Priyono
Korelasi renal resistive index dengan eGFR (CKD EPI) pada penyakit ginjal diabetik = Correlation between renal resistive index and eGFRg (CKD EPI) in diabetic kidney disease
"Latar Belakang : Ultrasonografi dua dimensi sampai saat ini masih digunakan untuk mendeteksi penyakit ginjal kronik , namun hasil yang didapat sering tidak memuaskan terutama pada penderita penyakit ginjal diabetik karena hasil yang didapatkan seringkali normal. Pemeriksaan ultrasonografi color doppler dengan renal resistive index(RI) banyak digunakan sebagai alat diagnostik dan prognostik bebagai kondisi vaskuler ginjal baik pada transplantasi maupun pada penyakit ginjal kronik, namun manfaat pemeriksaan RI pada penyakit ginjal diabetik masih belum jelas.
Tujuan : Mengetahui korelasi Renal Resistive Index dengan e GFR (CKD-EPI) pada penderita penyakit ginjal diabetik.
Metode Penelitian : Studi Potong Lintang dengan subjek penelitia pasien PGD stadium 1-5, dilakukan di RSCM pada Bulan Januari-Februari 2015. Jumlah subjek sebanyak 34 orang. Dilakukan Pemeriksaan USG 2 Dimensi dan USG doppler dan pemeriksaan eGFR (CKDEPI). Analisa statistik dengan Spearman?s correlation.
Hasil : Rerata Usia subjek penelitian 55,8 tahun, Rerata RI pada stadium 1 adalah 0,65, stadium 2 ,0,64, stadium 3 rerata RI adalah 0,72, stadium 4 adalah 0,78 dan stadium 5, rerata RI 0,8. Korelasi antara RI dan e GFR (CKD-EPI) pada penderita penyakit ginjal diabetik adalah r=-0,84 dengan p=0.000, R2 =0,714.
Simpulan : Terdapat korelasi negatif yang kuat antara Renal resistive index dengan eGFR(CKD-EPI) pada penyakit ginjal diabetik.
Background : Two dimension ultrasonografi is still be used to detect chronic kidney disease but the result is not satisfying because the image shows normal on early phase of diabetic kidney disease. Doppler ultrasound with using renal resistive index (RI) Doppler ultrasound with renal resistive index (RI) used as diagnostic and prognostic tool in every vasculer condition of kidney in transplantation or chronic kidney disease, but the advantages of RI in diabetic kidney disease still unclear.
Objective : To Determine correlation between renal resistive index (RI) and e GFR (CKDEPI) in diabetic kidney disease.
Methods : A cross sectional Study, All patients with diabetic kidney disease stage 1-5 (n=34). Patients were examined using doppler ultrasound to look for renal resistive index and e GFR using CKD-EPI method, from January to February 2015 in Cipto Mangunkusumo Hospital Jakarta. Statistically analyzed by Spearman's Correlation.
Results : The mean Age of the patients was 55,8 yr. The mean RI in stage 1 was 0,65, stage 2 was 0,64, stage 3 was 0,72, stage 4 was 0,78 and stage 5 was 0,8. The correlation between RI and e GFR (CKD-EPI) in diabetic kidney disease, r= -0,84 with p=0,000, R2=0,714.
Conclusion :There is a strong negative correlation between RI and e GFR (CKD-EPI) in diabetic kidney disease."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tesis Membership  Universitas Indonesia Library
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Arif Adimulya Tasela
Hubungan indeks Resistif renal dengan kejadian gagal ginjal akut pada pasien yang menjalani bedah pintas arteri koroner = Relationship between renal resisitive index and incidence of acute kidney injury in patient undergoing coronary artery bypass graft
"Latar belakang: Gagal ginjal akut (GGA) menjadi salah satu komplikasi serius yang dapat terjadi setelah prosedur bedah pintas arteri koroner (BPAK). GGA paska
operasi 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 pada
nilai 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%)
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%)"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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