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"Latar Belakang: Angka kematian pasien penyakit ginjal tahap akhir (PGTA) akibat penyakit kardiovaskular (PKV) sangat tinggi, khususnya pada pasien hemodialisis kronik (HDK), PKV juga dipengaruhi oleh kondisi malnutrisi dan inflamasi. Malnutrition Inflammation Score (MIS) dipakai sebagai prediktor morbiditas dan mortalitas pasien HDK. Asymmetric dimethylarginine (ADMA) dan symmetric dimethylarginine (SDMA) adalah hasil dari proteolisis protein termetilasi yang merupakan penanda inflamasi dan malnutrisi dan ditemukan meningkat pada pasien hemodialisis.Tujuan: Mencari korelasi rasio ADMA/SDMA terhadap MIS pada pasien Penyakit ginjal kronik (PGK) yang menjalani HDK 2x seminggu. Metode: Penelitian dengan desain potong lintang yang dikerjakan pada bulan Juli 2022 pada pasien HDK > 3 bulan. Kadar ADMA, SDMA, dan MIS diambil dan dicatat saat sebelum pasien memulai sesi hemodialisis. Analisis bivariat dilakukan dengan analisis Spearman dan Mann – Whitney dan analisis multivariat dengan regresi linier.Hasil: Sebanyak 23 sampel adalah laki-laki (48,9%) dengan rerata usia 51,2 tahun. Median Albumin adalah 4,0 g/dl dan median TIBC adalah 220 mcg/dl. Median ADMA adalah 82ng/ml, median SDMA 599 ng/ml, rasio ADMA/SDMA 0,14, dan skor MIS 4 (3-6). Skor MIS >5 adalah sebesar 34% dengan <5 sebesar 66%. Dalam analisis bivariat dan multivariat setelah dikontrol penggunaan penghambat ACE, tidak ditemukan hubungan antara rasio ADMA/SDMA dengan MIS (p=0,154).Simpulan: Tidak ditemukan korelasi antara rasio ADMA/SDMA terhadap MIS pada pasien PGK yang menjalani HDK 2x seminggu. 

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Background: The mortality rate of patients with nd tageidney isease (ESKD) due to cardiovascular disease (CVD) is very high, especially in chronic hemodialysis (HD) patients. CVD is also affected by malnutrition and inflammatory conditions. Malnutrition Inflammation Score (MIS) is used as a predictor of morbidity and mortality in HD patients. Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are the results of proteolysis of methylated proteins which are markers of inflammation and malnutrition and are found to be increased in hemodialysis patients.

Objective: To find a correlation between the ratio of ADMA/SDMA to MIS in chronic kidney disease (CKD) patients who underwent HD 2x a week.

Methods: A cross-sectional study conducted in July 2022 in HD patients > 3 months. ADMA, SDMA, and MIS levels were taken and recorded before the patient started the hemodialysis session. Bivariate analysis was performed using Spearman and Mann-Whitney analysis and multivariate analysis using linear regression.

Results: A total of 23 samples were male (48.9%) with an average age of 51.2 years. The median Albumin is 4.0 g/dl and the median TIBC is 220 mcg/dl. The median ADMA was 82 ng/ml, the median SDMA was 599 ng/ml, the ADMA/SDMA ratio was 0.14, and the MIS score was 4 (3-6). MIS score > 5 is 34% with < 5 is 66%. In bivariate and multivariate analysis after adjusted for the use of ACE inhibitors, no relations were found between the ADMA/SDMA ratio and MIS (p=0.154).

Conclusion: No correlation was found between the ratio of ADMA/SDMA to MIS in CKD patients who underwent HD 2x a week."

"Latar Belakang: Kadar asam urat darah berhubungan dengan peningkatan risiko penyakit kardiovaskular (PKV) serta meningkatkan angka kematian terutama pada populasi hemodialisis (HD) dan dialisis peritoneal (CAPD). Symmetric Dimethylarginine (SDMA) sudah sering dipakai dan diperiksa sebagai penanda PKV pada studi epidemiologi terutama pada populasi HD maupun CAPD. Pada populasi umum dewasa sehat dan HD, telah didapatkan adanya hubungan peningkatan kadar asam urat darah dengan peningkatan kadar SDMA. Namun pada populasi CAPD, peningkatan kadar asam urat darah terhadap peningkatan risiko yang terjadi masih menjadi kontroversi. Tujuan: Studi ini bertujuan untuk melihat hubungan antara kadar asam urat darah dengan kadar SDMA pada pasien penyakit ginjal kronik yang menjalani CAPD.Metode: Penelitian dengan desain potong lintang yang dikerjakan pada bulan Juni 2021 sampai bulan Agustus 2021 pada pasien CAPD kronik > 3 bulan. Subjek dengan obat penurun asam urat, wanita hamil dan menyusui, dan pasien dengan riwayat keganasan tidak diikutsertakan pada penelitian ini. Kadar asam urat dan SDMA diambil saat pasien kontrol ke poli CAPD. Analisis bivariat dilakukan dengan analisis Mann – Whitney dan analisis multivariat dengan regresi logistik.Hasil: Total 55 subjek diikutsertakan pada penelitian ini. Didapatkan rerata kadar asam urat7.30 +1.59 mg/dl dan sebanyak 33 subjek (60%) dengan kadar asam urat > 7 mg/dl. Rerata kadar SDMA didapatkan sebesar 633.73 +231.54 ng/mL. Subjek dengan kadar asam urat > 7 mg/dl memiliki peningkatan kadar SDMA secara signifikan bila dibandingkan pada kelompok asam urat <7 mg/dl (721.58 + 220.57 vs 501.95 +182; P < 0.001). Didapatkan cut – off SDMA 536 ng/ml berdasarkan kurva ROC dengan Sensitivitas 81.8%, Spesifisitas 63.6%, PPV 77.78% dan NPV 73.68%. Setelah dilakukan adjustifikasi terhadap faktor perancu didapatkan bahwa DM (OR: 7.844; CI95%: 1.899 – 32.395: P value: 0.004) dan dyslipidemia (OR: 6.440; CI95%: 1.483 – 27.970; P value: 0.013) sebagai faktor risiko.Simpulan: Terdapat hubungan kadar asam urat darah > 7 mg/dl dengan peningkatan kadar SDMA pada pasien yang menjalani CAPD. Diabetes melitus dan dyslipidemia merupakan faktor risiko yang berhubungan dengan peningkatan kadar asam urat dengan peningkatan kadar SDMA.

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Background and Objectives: Uric Acid (UA) levels are associated with increased risk of cardiovascular events and mortality in hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. Symmetric dimethylarginine (SDMA) is a known marker of cardiovascular disease in a number of epidemiological studies, including in the HD and CAPD patient population. In a study with a population of healthy young adults and HD there was a correlation between high blood uric acid levels and blood SDMA level. However, in CAPD population, there are still conflicting data on the mechanism of increased risks related to uric acid levels. This study aimed to assess the association between uric acid levels and SDMA in the subjects undergoing CAPD.

Materials and Methods: This was a cross – sectional study conducted in all the adults who underwent CAPD for at least three months in tertiary hospital in Jakarta, Indonesia. Subjects already on uric lowering therapy, pregnant or lactating women, and those with a history of malignancy were excluded. Uric acid and SDMA level were measured at the same time patients controlled to outpatient clinic. Bivariate analysis was performed using the Mann – Whitney test and multivariate analysis performed using logistic regression test.

Results: A total of 55 subjects were included. The median level of UA was 7.30 +1.59 mg/dl and 33 subjects (60%) had UA levels of 7 mg/dl or higher. The median SDMA level was 633.73 +231.54 ng/mL. Subjects with UA levels > 7 mg/dl had significantly higher SDMA levels compared to subjects with UA levels <7 mg/dl (721.58 +220.57 vs 501.95 +182; P < 0.001). The cut – off value of SDMA 536 ng/mL was obtained from the receiver operating characteristic (ROC) curve with sensitivity 81.8%, specificity 63.6%, PPV 77.78% and NPV 73.68%. After fully adjusted with the confounders, the determinant factors in this study were diabetes mellitus (OR: 7.844; CI95%: 1.899 – 32.395: P value: 0.004) and dyslipidemia (OR: 6.440; CI95%: 1.483 – 27.970; P value: 0.013) as risk factors.

Conclusion: In CAPD patients, UA levels above 7 mg/dl were associated with increased SDMA levels. This study demonstrates the determinant factors regarding association between UA level and SDMA in CAPD patients were diabetes mellitus and dyslipidemia. The cut – off value of SDMA above 536 ng/mL were significant to increased risk of cardiovascular events."