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Tambunan, Marihot
Pemakaian dialiser proses ulang dan hasil yang diperoleh di RSUPN-CM
"Latar Belakang: Biaya hemodialisis (HD) di Indonesia dirasakan cukup mahal. Bahkan di negara negara maju meskipun dibiayai oleh asuransi kesehatan, masih dianggap cukup mahal. Untuk mengatasi masalah tersebut, pemakaian Dialiser Proses Ulang (DPU) telah dilakukan di banyak negara. Selain dapat menekan biaya HD, pemakaian DPU diketahui juga dapat mengurangi gejala klinik dan meningkatkan biokompatibilitas dialiser. Namun demikian pemakaian DPU dapat berisiko terjadinya kontaminasi oleh bahan sterilan, bakteri / virus, kerusakan membran dialiser, dan penurunan volume kompartemen darah dialiser yang menyebabkan penurunan bersihan urea (Urea Reduction Ratio/URR).
Penetapan Masalah Penelitian: RSUPN-CM telah memakai DPU, tetapi sampai saat ini masih belum ada data yang pasti sampai berapa kali suatu DPU masih dapat dipakai ulang. Untuk itu ingin diketahui sampai berapa kali DPU masih dapat dipakai, berdasarkan kriteria volume kompartemen darah dan penampilan fisik dialiser. Selain itu ingin diketahui juga hasil bersihan urea (URR) dan adakah efek samping pada pemakaian DPU.
Metode Penelitian: Penelitian dilakukan secara quasi experiment pada 20 pasien gagal ginjal tahap akhir, yang menjalani HD kronik memakai DPU, di unit HD RSUPN-CM. Dilakukan pengukuran volume kompartemen darah dan peniaian fisik dialiser pada setiap proses pengulangan. Juga diperiksa kadar ureum serum dan URR pra dan pasca HD awal, dengan DPU pemakaian ke 5,7,9. Diteliti adakah efek samping yang timbul karena pemakaian DPU. Volume kompartemen darah dialiser yang masih memenuhi syarat pemakaian adalah 80% volume awal. URR yang memenuhi target dialisis adalah 80%. Data dikumpulkan,diolah dan disajikan dalam bentuk teks, tabel dan gambar, secara deskriptif.
Hasil Penelitian: Subyek penelitian sebanyak 20 prang, terdiri dari 12 orang laki-laki (60%) dan 8 orang perempuan (40%). Rerata umur subyek 51 tahun. Penyebab gagal ginjal terbanyak adalah Glomerulonefritis sebanyak 10 orang (50%) dan yang tersedikit adalah Nefropati Diabetik sebanyak 1 orang (5%). Volume kompartemen darah pada pemakaian DPU masih diatas 80%. Tidak ditemukan perubahan URR pada pemakaian ulang ke 5,7,9. URR HD awal,pemakaian DPU ke 5,7,9 seluruhnya dibawah 80% Rerata jumlah pemakaian DPU adalah 7 kali, pemakaian yang tertinggi 9 kali dan yang terendah 3 kali.Penyebab penghentian pemakaian DPU adalah perubahan fisik dialiser sebanyak 12 dialiser,subyek tidak bersedia melanjutkan karena sudah 9 kali pemakaian ulang sebanyak 7 prang, dialiser bocor sebanyak 1 dialiser. Tidak ditemukan efek samping pada pemakaian DPU.
Simpulan: Rerata pemakaian DPU di RSUPN-CM yang masih dapat dipertanggung jawabkan dari segi kiinik adalah sebanyak 7 kali. Rerata pasti yang dapat dipertanggung jawabkan secara statistik masih belum dapat dijawab.Volume kompartemen darah DPU masih di atas 80% volume awal. Tidak ditemukan perubahan URR pada pemakaian DPU sampai pemakaian ulang 9 kali. Penyebab penghentian pemakaian DPU yang terbanyak adalah perubahan fisik dialiser, karena terbentuknya bekuan darah pada dialiser. Tidak ditemukan efek samping pada pemakaian DPU di RSUPN-CM."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2004
T21410
UI - Tesis Membership  Universitas Indonesia Library
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Hasan Basri, 1967-
Perbaikan pola sirkadian tekanan darah donor ginjal dengan ambulatory blood pressure monitoring pada 12 minggu pasca nefrektomi = Normalization of blood pressure circadian rhythm in kidney donors within 12 weeks post nephrectomy
"[ABSTRAK
Latar Belakang : Isu yang berkembang pada donor ginjal hidup adalah penurunan fungsi ginjal dan terjadinya hipertensi setelah dilakukan nefrektomi. Satu minggu setelah nefrektomi pola tekanan darah sirkadian berubah menjadi non dipper. Selanjutnya terjadi kompensasi sehingga fungsi ginjal akan stabil dalam 12 minggu. Namun belum diketahui apakah perbaikan fungsi ginjal akan diikuti oleh pola tekanan darah sirkadian kembali menjadi dipper.
Tujuan : Untuk mengetahui perubahan pola sirkadian tekanan darah donor ginjal hidup setelah 12 minggu nefrektomi unilateral.
Metode Penelitian : Studi Pre-experimental dengan before and after design. Subyek sebanyak 18 orang donor ginjal hidup sehat yang berusia 18-50 tahun . Peneltian dilakukan di RSCM pada bulan Januari 2015 sampai dengan Mei 2015. Tekanan darah diukur dengan 24 jam ABPM . Pemeriksaan kreatinin darah, eLFG epi dan uACR dilakukan sebelum nefrektomi, pada 1 minggu dan 12 minggu setelah nefrektomi.
Hasil :Terdapat 18 subyek yang memiliki pola dipper sebelum dilakukan nefrektomi unilateral. Tujuh belas subyek mengalami pola non dipper setelah 1 minggu nefrektomi. Pada 12 minggu setelah nefrektomi 16 diantaranya kembali menjadi pola dipper yang bermakna secara statistik (p<0.001).
Simpulan : Terdapat perubahan pola sirkadian tekanan darah non dipper kembali menjadi pola dipper pada donor ginjal hidup 12 minggu setelah nefrektomi unilateral.ABSTRACT Background : The issue of post nephrectomy in living kidney donor is kidney function decrease and hypertension. One week after nephrectomy circadian pattern of blood pressure becomes non dipper. Then there will be a compensatory of renal function that becomes stable within 12 weeks after nephrectomy. However, whether the improvement of renal function is followed by the circadian pattern of blood pressure becomes dipper is still unknown.
Aims : To know the changes circadian pattern of blood pressure among living kidney donors 12 weeks after unilateral nephrectomy.
Methods : A pre-experimental study with before and after design. The subjects were 18 healthy living kidney donors aged 18 to 50 years old , conducted in RSCM hospital between January 2015 to May 2015. Blood pressure was measured by 24 hours ABPM. Serum creatinine, e-GFR epi and uACR were taken before nephrectomy, 1 week and 12 weeks after nephrectomy.
Results : There were 18 subjects had dipper pattern before unilateral nephrectomy. Seventeen of them exhibited a pattern became non dipper on one week after nephrectomy. Sixteen subjects showed the pattern returned to dipper after 12 weeks nephrectomy that statistically significant (p<0.01)
Conclusions : The circadian pattern of blood pressure returned to dipper from non dipper on living kidney donors after 12 weeks unilateral nephrectomy., Background : The issue of post nephrectomy in living kidney donor is kidney function decrease and hypertension. One week after nephrectomy circadian pattern of blood pressure becomes non dipper. Then there will be a compensatory of renal function that becomes stable within 12 weeks after nephrectomy. However, whether the improvement of renal function is followed by the circadian pattern of blood pressure becomes dipper is still unknown.
Aims : To know the changes circadian pattern of blood pressure among living kidney donors 12 weeks after unilateral nephrectomy.
Methods : A pre-experimental study with before and after design. The subjects were 18 healthy living kidney donors aged 18 to 50 years old , conducted in RSCM hospital between January 2015 to May 2015. Blood pressure was measured by 24 hours ABPM. Serum creatinine, e-GFR epi and uACR were taken before nephrectomy, 1 week and 12 weeks after nephrectomy.
Results : There were 18 subjects had dipper pattern before unilateral nephrectomy. Seventeen of them exhibited a pattern became non dipper on one week after nephrectomy. Sixteen subjects showed the pattern returned to dipper after 12 weeks nephrectomy that statistically significant (p<0.01)
Conclusions : The circadian pattern of blood pressure returned to dipper from non dipper on living kidney donors after 12 weeks unilateral nephrectomy.]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Yohana Alfa Agustina
Nilai diagnostik rasio albumin protein, rasio albumin kreatinin dan morfologi eritrosit urin untuk membedakan hematuria glomerular dan non glomerular = Diagnostic value of albumin protein ratio albumin creatinine ratio and erythrocyte morphology to differentiate glomerular and non glomerular haematuria
"Hematuria merupakan kondisi yang paling sering dijumpai pada kelainan ginjal atau saluran kemih. Hematuria didefinisikan sebagai adanya > 2 eritrosit/LPB atau > 12/?l pada pemeriksaan sedimen urin. Bagi klinisi, sangat penting mengetahui asal perdarahan tersebut karena berhubungan dengan prognosis dan tatalaksana pasien. Membran filtrasi glomerular bersifat selektif. Albumin merupakan komponen protein terbanyak di plasma, bermuatan negatif, tidak dapat melewati membran filtrasi glomerular karena adanya muatan negatif pada endotel glomerular. Pada kerusakan glomerular dapat terjadi gangguan muatan listrik endotel dan kerusakan struktur membran filtrasi sehingga menyebabkan proteinuria dan hematuria. Eritrosit juga berbentuk iregular akibat kerusakan dinding yang dikenal sebagai eritrosit dismorfik. Penelitian ini ingin melihat sensitifitas dan spesifisitas pemeriksaan urinalisis otomatis Sysmex UN-3000 dengan metode flow cytometry yang dapat menentukan morfologi eritrosit urin serta titik potong rasio albumin protein yang dapat membedakan asal hematuria. Desain penelitian ini adalah potong lintang dengan 44 subjek hematuria glomerular dan 43 subjek dengan hematuria non glomerular. Dengan menggunakan mesin Sysmex UN-3000 didapatkan sensitivitas 93,2 , spesifisitas 90,6 , nilai duga positif sebesar 91,1 , dan nilai duga negatif sebesar 92,87 untuk membedakan asal hematuria. Titik potong untuk rasio albumin kreatinin untuk membedakan asal hematuria adalah 310,39 mg/ gram kreatinin dengan sensitivitas 84,1 dan spesifisitas 83,7 . Titik potong untuk rasio protein kreatinin untuk membedakan asal hematuria adalah 723 mg/ gram kreatinin dengan sensitivitas 77,3 dan spesifisitas 76,7 . Titik potong rasio albumin protein untuk membedakan asal hematuria adalah 0,525 dengan sensitifitas 93,2 dan spesifisitas 74,4 . Pemeriksaan morfologi urin urin dengan metode flow cytometry dan pemeriksaan kadar rasio albumin protein urin mendapatkan hasil yang baik dan dapat membantu klinisi untuk membedakan sumber hematuria tersebut.
Haematuria is the most common condition in renal or urinary tract disorders. Haematuria is defined as 2 erythrocytes LPB or 12 l on urine sediment examination. For the clinician, it is important to know the origin of the bleeding because is related to the prognosis and management of the patient. The glomerular filtration membrane is selective. Albumin is the most abudant protein component in the plasma, negatively charged, unable to pass through the glomerular filtration membrane due to a negative charge on glomerular endothelium. In case of glomerular damage, disruption of endothelial electrical charges occurs and causing damage structure membrane of the glomerular filtration causing proteinuria and hematuria. Erythrocyte morphology also becomes irregular and known as dysmorphic erythrocytes. This study want to find the sensitivity and specificity of automatic urinalysis examination Sysmex UN 3000 with flow cytometry method that can determine the morphology of erythrocytes and the cut off point of albumin protein ratio which can differentiate the source of hematuria. The design of this study was cross sectional with 43 subjects of non glomerular hematuria and 44 subjects with glomerular hematuria. The sensitivity of erythrocyte morphology was 93,2 , specificity 90,6 , positive predictive value 91,1 , and negative predictive value 92,87 . The cut off point for albumin creatinine ratio was 334,4 mg g creatinine with 84,1 sensitivity and 83,7 specificity. The cutoff point for the protein creatinine ratio was 723 mg g of creatinine with 77,3 sensitivity and 76,7 specificity. The cut off point of the albumin protein ratio was 0,525 with 93,2 sensitivity and 74,4 specificity. Examination of erythrocyte morphology in urine with Flow Cytometry method and examination of albumin protein ratio have good results and can help clinicians to distinguish the source of hematuria. "
Depok: Fakultas Kedokteran Universitas Indonesia, 2018
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Rizki Yaruntradhani Pradwipa
Hubungan antara penggunaan penghambat kanal kalsium dengan hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialisis = Association between the use of calcium channel blocker and pulmonary hypertension in end stage renal disease patients with hemodialysis
"Latar belakang: Hipertensi pulmonal (HP) telah banyak dilaporkan terjadi pada populasi hemodialisis (HD). Namun data mengenai insidensi HP serta bagaimana mekanisme terjadinya masih sangat sedikit. Beberapa faktor risiko dan protektif terjadinya HP telah diidentifikasi melalui studi-studi di mancanegara. Penelitian ini bertujuan untuk mengevaluasi hubungan penggunaan penghambat kanal kalsium dengan kejadian hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialisis.
Metode: Penelitian potong lintang dilakukan terhadap 100 pasien HD rutin di unit HD RSCM yang sedang mengkonsumsi penghambat kanal kalsium jenis dihidropiridin (nifedipin, amlodipin, felodidpin) 1x sehari per oral selama minimal 1 tahun. Hipertensi pulmonal dinilai dengan menggunakan ekokardiografi doppler yang dilakukan 1 jam pasca HD oleh satu orang operator independen yang tidak mengetahui latar belakang klinis pasien. Selanjutnya dilakukan analisis uji statistik chi square dengan batas kemaknaan < 0.05, serta analisis multivariat dengan regresi logistik antara variabel penghambat kanal kalsium dengan hipertensi pulmonal untuk mendapatkan Crude OR, antara variabel perancu dengan hipertensi pulmonal untuk mendapatkan nilai P < 0.25, dan antara variabel penghambat kanal kalsium dengan variabel perancu untuk mendapatkan fully adjusted OR.
Hasil: Dari 100 subyek penelitian, HP didapatkan pada 27 subjek (27%). Pada kelompok pasien HP, 21 subjek (29.2%) memiliki akses fistula AV di brakial, TAP rata-rata 36 ± 20.6 mmHg, curah jantung ³ 5 l/min sebanyak 13 subjek (28.8%) dengan fraksi ejeksi ³ 50% sebanyak 18 subjek (20.7%). Etiologi PGK terbanyak pada kelompok HP adalah nefropati DM dengan 10 subjek (37%). Setelah dilakukan adjustment dengan disfungsi diastolik ventrikel kiri, fraksi ejeksi dan diabetes melitus sebagai faktor perancu, penggunaan penghambat kanal kalsium berhubungan dengan penurunan risiko terjadinya hipertensi pulmonal (adjusted OR 0.258; IK 95% 0.085 – 0.783; nilai P 0.017).
Kesimpulan: Penggunaan penghambat kanal kalsium berhubungan dengan penurunan risiko terjadinya hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialis.
Background and Aim of Study: Pulmonary hypertension (PH) has been reported in hemodialysis (HD) patients. However data regarding its incidence and mechanism are scarce. Many published journal abroad had been identify the risk and protective factors in this syndrome. This study evaluated the use of Calcium Channel Blocker (CCB) on Pulmonary Hypertension at End-Stage Renal Disease (ESRD) patients who undergo hemodialysis.
Methods: A Cross – Sectional study conducted on hundreds HD patients in RSCM who consumed CCB for at least a year with oral single dose. PH was screened by Doppler echocardiography one hour following dialysis done by one independent operator without knowing clinical background of the patients. Furthermore, statistical analysis was done using chi square and define as significance if the value is <0.05. Moreover, multivariate analysis with logistic regression between CCB and PH variable in order to get Crude OR, between confounder variables and PH in order to get P value < 0.25, and between CCB and confounder variables in order to get fully adjusted OR.
Results: Out of 100 HD patients, PH was detected in 27 patients (27%). Of those with PH, brachial AV shunt was seen in 21 patients (29.2%), mean PAP was 36 ± 20.6 mmHg, and cardiac output ³ 5 l/min was seen in 13 patients (28.8%) with EF ³ 50% seen in 18 patients (20.7%). The common etiology of CKD in group of PH was diabetic nephropathy seen in 10 patients (37%). The used of CCB is associated with lower risk of PH (adjusted OR 0.258; 95% CI 0.085 – 0.783; P value 0.017) after adjusted with variable left ventricular diastolic dysfunction, ejection fraction, and diabetes melitus as confounders.
Conclusion: This study demonstrates that the use of CCB is associated with lower risk of PH in ESRD patients with hemodialysis."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
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Ferry Valerian Harjito
Kesintasan 1 tahun resipien transplantasi ginjal di RSUPN Cipto Mangunkusumo = One year survival of kidney transplant recipients in Cipto Mangunkusumo Hospital
"Latar Belakang: Transplantasi ginjal adalah modalitas terapi pengganti ginjal yang paling baik bagi pasien dengan Penyakit Ginjal Tahap Akhir (PGTA). Saat ini di Indonesia transplantasi ginjal dengan donor hidup mulai semakin sering dilakukan, terutama di RSUPN Cipto Mangunkusumo, di mana dalam beberapa tahun terakhir lebih dari 50% kasus transplantasi ginjal di Indonesia dilakukan di rumah sakit ini. Walaupun demikian, data mengenai hasil transplantasi di Indonesia, baik kesintasan 1 tahun graft maupun pasien, serta faktor yang diduga mempengaruhinya masih belum ada. Diharapkan hasil transplantasi di rumah sakit ini dapat menggambarkan hasil secara keseluruhan di Indonesia.
Metode: Studi kohort retrospektif pada resipien transplantasi ginjal di RSUPN-CM dari Januari 2010 hingga Mei 2014. Data didapatkan dari penelusuran rekam medis serta menghubungi pasien secara langsung. Masing-masing resipien diikuti sejak tanggal transplantasi hingga kematian atau Mei 2015. Proporsi kesintasan graft dan pasien pada 1 tahun post transplantasi dan pada akhir studi didokumentasikan. Kurva Kaplan-Meier digunakan untuk menggambarkan kesintasan pasien secara keseluruhan. Studi deskriptif dilakukan dengan melihat perbedaan proporsi variabel serta perbedaan rerata atau median pada pasien yang mengalami kegagalan graft 1 tahun serta tidak, serta pasien yang bertahan hidup atau meninggal.
Hasil: Berdasarkan hasil consecutive total sampling didapatkan 157 resipien yang menjalani transplantasi ginjal di RSUPN-CM, 137 resipien di antaranya memenuhi kriteria penelitian, seluruhnya mendapatkan ginjal dari donor hidup. Usia resipien rata-rata adalah 47,9 ± 13,9 tahun, rerata IMT 22,8 ± 3,7 kg/m2, dan proporsi resipien dengan diabetes 35,8%. Didapatkan 7 pasien mengalami disfungsi graft primer (kegagalan transplantasi), sehingga 130 pasien diikuti untuk melihat kesintasan jangka panjang. Pada akhir tahun pertama, didapatkan angka death-censored graft survival adalah 95,4%, all-cause graft survival 85,4%, kesintasan pasien 88,5%, dan death with a functioning graft sebesar 10%. Pada akhir studi, didapatkan angka kesintasan tersebut berturut-turut adalah 94,6%, 80%, 82,3%, dan 14,6%, dengan median waktu pengamatan 24 bulan (1 ? 64 bulan). Kurva Kaplan Meier menunjukkan angka mortalitas tertinggi didapatkan pada bulan-bulan awal post transplantasi. Kegagalan graft dan kematian didapatkan lebih banyak pada resipien yang berusia lebih tua, mengidap diabetes melitus, serta memiliki indeks komorbiditas yang tinggi. Penyebab kematian utama adalah infeksi (11,5%) diikuti dengan kejadian kardiovaskular (3,8%).
Simpulan: Death-censored graft survival 1 tahun resipien transplantasi ginjal di Indonesia sudah sangat memuaskan. Angka death with functioning graft masih cukup tinggi, sehingga menurunkan all-cause graft survival dan kesintasan pasien 1 tahun. Walaupun demikian, secara keseluruhan hasil ini masih sebanding dengan negara-negara berkembang lainnya.
Background: Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia.
Methods: A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately.
Results: Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%).
Conclusions: The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Tambunan, Marihot
Perbedaan pola sirkadian tekanan darah pada pasien penyakit ginjal kronik pra dan pasca transplantasi ginjal di RSCM = The difference of circadian pattern of blood pressure in patients with chronic kidney disease before and after kidney transplantation in Cipto Mangunkusumo hospital
"[ABSTRAK
Pola sirkadian tekanan darah (TD) adalah gambaran TD 24 jam berupa kurva TD yang meningkat pada pagi hari, menurun pada siang / sore hari dan terendah pada malam hari / waktu tidur. 24 hours Ambulatory Blood Pressure Monitoring (24 hrs ABPM) merupakan alat pengukur TD yang lebih akurat dan dapat memperlihatkan pola sirkadian TD 24 jam. Turunnya TD 10 - 20% pada malam hari disebut dipper, jika turun < 10% disebut nondipper. Meningkatnya TD 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Faktor utama penyebab hipertensi pada PGK 5D adalah menurunnya Laju Filtrasi Glomerulus (LFG) dan meningkatnya cairan ekstraselular. Transplantasi ginjal akan memperbaiki TD dan nondipper dengan membaiknya LFG, meningkatnya produksi urin dan menurunnya cairan ekstraseluler. Namun demikian satu bulan Pasca Transplantasi Ginjal kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD.
Tujuan : Mengetahui perbedaan pola sirkadian TD, data dipper / nondipper dan rerata TD 24 jam pada pasien PGK Pra dan satu bulan Pasca Transplantasi Ginjal. Metode Penelitian : Studi Pre experimental dengan before and after design. Subjek penelitian pasien PGK 5D / Pra Transplantasi Ginjal berusia 18 ? 60 tahun, dilakukan di RSCM pada bulan Oktober sampai dengan Desember 2014. Jumlah subjek sebanyak 15 orang. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG, pengukuran TD 24 jam dengan 24 hrs ABPM, Pra dan satu bulan Pasca Transplantasi Ginjal. Analisis statistik dengan uji McNemar dan uji t dependen.
Hasil : Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan Pasca Transplantasi Ginjal seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan Pasca Transplantasi Ginjal nondipper (homogen). Terdapat penurunan rerata TD sistolik 24 jam pasien PGK satu bulan Pasca Transplantasi Ginjal yang tidak signifikan (p > 0,05) dan penurunan rerata TD diastolik 24 jam yang signifikan (p < 0,05).
Simpulan : Belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal. Terdapat penurunan rerata TD sistolik 24 jam yang tidak signifikan dan penurunan rerata TD diastolik 24 jam yang signifikan pada pasien satu bulan Pasca Transplantasi Ginjal.
ABSTRACT
The circadian pattern of blood pressure (BP) is a 24 hours blood
pressure (24hrs BP) curve which increases in the morning, decreases in the
afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory
Blood Pressure Monitoring (ABPM) is a BP measuring device that is
accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%
at night is called as a dipper, while less than 10% is called as a nondipper. The
increasing of 24 hrs BP and nondipper are the risk factor for
cardiovascular morbidity and mortality. The prevalence of
hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis
(CKD 5D) are still very high. The main factors causing hypertension in CKD 5D
are decreased Glomerular Filtration Rate (GFR) and increased extracellular
fluid. Kidney transplantation will improve BP and nondipper
by GFR improvement, increases urine production and decreases extracellular
fluid. However, one month after kidney transplantation, the dose
of immunosuppressant drugs is relatively high, which is an obstacle to decrease
BP.
Aim: To determine differences in the circadian pattern of BP, the data
of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one
month after kidney transplantation.
Methods: Design of the study is before and after design. Subjects of the study
were patients with CKD 5D before kidney transplantation, aged 18-60 years,
were conducted in Cipto Mangunkusumo Hospital during October to
December 2014. 15 subjects were included in the study. 24 hrs urine
collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all
subjects, before and one month after kidney transplantation. McNemar test and t
dependent test were used in statistical analysis.
Results: Before kidney transplantation, 12 of 15 subjects were nondippers while
the others 3 subjects were dippers. After kidney transplantation, all subjects (15
patients) were nondippers. McNemar test can not be used because all subjects one
month after kidney transplantation were nondippers (homogeneous). The
decreasing of the mean of 24 hrs systolic BP was found in all CKD one
month after kidney transplantation, but statistically not significant (p>0.05),
while decreasing of the mean of 24 hrs diastolic BP was statistically significant
(p<0.05).
Conclusion: There were still no improvement in nondipper patients
one month after kidney transplantation. There were a decrease in the mean of 24
hrs systolic BP but statistically not significant and a decrease in the mean of 24
hrs diastolic BP which is statistically significant in patients one month after
kidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours blood
pressure (24hrs BP) curve which increases in the morning, decreases in the
afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory
Blood Pressure Monitoring (ABPM) is a BP measuring device that is
accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%
at night is called as a dipper, while less than 10% is called as a nondipper. The
increasing of 24 hrs BP and nondipper are the risk factor for
cardiovascular morbidity and mortality. The prevalence of
hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis
(CKD 5D) are still very high. The main factors causing hypertension in CKD 5D
are decreased Glomerular Filtration Rate (GFR) and increased extracellular
fluid. Kidney transplantation will improve BP and nondipper
by GFR improvement, increases urine production and decreases extracellular
fluid. However, one month after kidney transplantation, the dose
of immunosuppressant drugs is relatively high, which is an obstacle to decrease
BP.
Aim: To determine differences in the circadian pattern of BP, the data
of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one
month after kidney transplantation.
Methods: Design of the study is before and after design. Subjects of the study
were patients with CKD 5D before kidney transplantation, aged 18-60 years,
were conducted in Cipto Mangunkusumo Hospital during October to
December 2014. 15 subjects were included in the study. 24 hrs urine
collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all
subjects, before and one month after kidney transplantation. McNemar test and t
dependent test were used in statistical analysis.
Results: Before kidney transplantation, 12 of 15 subjects were nondippers while
the others 3 subjects were dippers. After kidney transplantation, all subjects (15
patients) were nondippers. McNemar test can not be used because all subjects one
month after kidney transplantation were nondippers (homogeneous). The
decreasing of the mean of 24 hrs systolic BP was found in all CKD one
month after kidney transplantation, but statistically not significant (p>0.05),
while decreasing of the mean of 24 hrs diastolic BP was statistically significant
(p<0.05).
Conclusion: There were still no improvement in nondipper patients
one month after kidney transplantation. There were a decrease in the mean of 24
hrs systolic BP but statistically not significant and a decrease in the mean of 24
hrs diastolic BP which is statistically significant in patients one month after
kidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours blood
pressure (24hrs BP) curve which increases in the morning, decreases in the
afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory
Blood Pressure Monitoring (ABPM) is a BP measuring device that is
accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%
at night is called as a dipper, while less than 10% is called as a nondipper. The
increasing of 24 hrs BP and nondipper are the risk factor for
cardiovascular morbidity and mortality. The prevalence of
hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis
(CKD 5D) are still very high. The main factors causing hypertension in CKD 5D
are decreased Glomerular Filtration Rate (GFR) and increased extracellular
fluid. Kidney transplantation will improve BP and nondipper
by GFR improvement, increases urine production and decreases extracellular
fluid. However, one month after kidney transplantation, the dose
of immunosuppressant drugs is relatively high, which is an obstacle to decrease
BP.
Aim: To determine differences in the circadian pattern of BP, the data
of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one
month after kidney transplantation.
Methods: Design of the study is before and after design. Subjects of the study
were patients with CKD 5D before kidney transplantation, aged 18-60 years,
were conducted in Cipto Mangunkusumo Hospital during October to
December 2014. 15 subjects were included in the study. 24 hrs urine
collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all
subjects, before and one month after kidney transplantation. McNemar test and t
dependent test were used in statistical analysis.
Results: Before kidney transplantation, 12 of 15 subjects were nondippers while
the others 3 subjects were dippers. After kidney transplantation, all subjects (15
patients) were nondippers. McNemar test can not be used because all subjects one
month after kidney transplantation were nondippers (homogeneous). The
decreasing of the mean of 24 hrs systolic BP was found in all CKD one
month after kidney transplantation, but statistically not significant (p>0.05),
while decreasing of the mean of 24 hrs diastolic BP was statistically significant
(p<0.05).
Conclusion: There were still no improvement in nondipper patients
one month after kidney transplantation. There were a decrease in the mean of 24
hrs systolic BP but statistically not significant and a decrease in the mean of 24
hrs diastolic BP which is statistically significant in patients one month after
kidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours blood
pressure (24hrs BP) curve which increases in the morning, decreases in the
afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory
Blood Pressure Monitoring (ABPM) is a BP measuring device that is
accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%
at night is called as a dipper, while less than 10% is called as a nondipper. The
increasing of 24 hrs BP and nondipper are the risk factor for
cardiovascular morbidity and mortality. The prevalence of
hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis
(CKD 5D) are still very high. The main factors causing hypertension in CKD 5D
are decreased Glomerular Filtration Rate (GFR) and increased extracellular
fluid. Kidney transplantation will improve BP and nondipper
by GFR improvement, increases urine production and decreases extracellular
fluid. However, one month after kidney transplantation, the dose
of immunosuppressant drugs is relatively high, which is an obstacle to decrease
BP.
Aim: To determine differences in the circadian pattern of BP, the data
of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one
month after kidney transplantation.
Methods: Design of the study is before and after design. Subjects of the study
were patients with CKD 5D before kidney transplantation, aged 18-60 years,
were conducted in Cipto Mangunkusumo Hospital during October to
December 2014. 15 subjects were included in the study. 24 hrs urine
collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all
subjects, before and one month after kidney transplantation. McNemar test and t
dependent test were used in statistical analysis.
Results: Before kidney transplantation, 12 of 15 subjects were nondippers while
the others 3 subjects were dippers. After kidney transplantation, all subjects (15
patients) were nondippers. McNemar test can not be used because all subjects one
month after kidney transplantation were nondippers (homogeneous). The
decreasing of the mean of 24 hrs systolic BP was found in all CKD one
month after kidney transplantation, but statistically not significant (p>0.05),
while decreasing of the mean of 24 hrs diastolic BP was statistically significant
(p<0.05).
Conclusion: There were still no improvement in nondipper patients
one month after kidney transplantation. There were a decrease in the mean of 24
hrs systolic BP but statistically not significant and a decrease in the mean of 24
hrs diastolic BP which is statistically significant in patients one month after
kidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours blood
pressure (24hrs BP) curve which increases in the morning, decreases in the
afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory
Blood Pressure Monitoring (ABPM) is a BP measuring device that is
accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%
at night is called as a dipper, while less than 10% is called as a nondipper. The
increasing of 24 hrs BP and nondipper are the risk factor for
cardiovascular morbidity and mortality. The prevalence of
hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis
(CKD 5D) are still very high. The main factors causing hypertension in CKD 5D
are decreased Glomerular Filtration Rate (GFR) and increased extracellular
fluid. Kidney transplantation will improve BP and nondipper
by GFR improvement, increases urine production and decreases extracellular
fluid. However, one month after kidney transplantation, the dose
of immunosuppressant drugs is relatively high, which is an obstacle to decrease
BP.
Aim: To determine differences in the circadian pattern of BP, the data
of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one
month after kidney transplantation.
Methods: Design of the study is before and after design. Subjects of the study
were patients with CKD 5D before kidney transplantation, aged 18-60 years,
were conducted in Cipto Mangunkusumo Hospital during October to
December 2014. 15 subjects were included in the study. 24 hrs urine
collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all
subjects, before and one month after kidney transplantation. McNemar test and t
dependent test were used in statistical analysis.
Results: Before kidney transplantation, 12 of 15 subjects were nondippers while
the others 3 subjects were dippers. After kidney transplantation, all subjects (15
patients) were nondippers. McNemar test can not be used because all subjects one
month after kidney transplantation were nondippers (homogeneous). The
decreasing of the mean of 24 hrs systolic BP was found in all CKD one
month after kidney transplantation, but statistically not significant (p>0.05),
while decreasing of the mean of 24 hrs diastolic BP was statistically significant
(p<0.05).
Conclusion: There were still no improvement in nondipper patients
one month after kidney transplantation. There were a decrease in the mean of 24
hrs systolic BP but statistically not significant and a decrease in the mean of 24
hrs diastolic BP which is statistically significant in patients one month after
kidney􀀃transplantation., Background: The circadian pattern of blood pressure (BP) is a 24 hours blood
pressure (24hrs BP) curve which increases in the morning, decreases in the
afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory
Blood Pressure Monitoring (ABPM) is a BP measuring device that is
accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%
at night is called as a dipper, while less than 10% is called as a nondipper. The
increasing of 24 hrs BP and nondipper are the risk factor for
cardiovascular morbidity and mortality. The prevalence of
hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis
(CKD 5D) are still very high. The main factors causing hypertension in CKD 5D
are decreased Glomerular Filtration Rate (GFR) and increased extracellular
fluid. Kidney transplantation will improve BP and nondipper
by GFR improvement, increases urine production and decreases extracellular
fluid. However, one month after kidney transplantation, the dose
of immunosuppressant drugs is relatively high, which is an obstacle to decrease
BP.
Aim: To determine differences in the circadian pattern of BP, the data
of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one
month after kidney transplantation.
Methods: Design of the study is before and after design. Subjects of the study
were patients with CKD 5D before kidney transplantation, aged 18-60 years,
were conducted in Cipto Mangunkusumo Hospital during October to
December 2014. 15 subjects were included in the study. 24 hrs urine
collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all
subjects, before and one month after kidney transplantation. McNemar test and t
dependent test were used in statistical analysis.
Results: Before kidney transplantation, 12 of 15 subjects were nondippers while
the others 3 subjects were dippers. After kidney transplantation, all subjects (15
patients) were nondippers. McNemar test can not be used because all subjects one
month after kidney transplantation were nondippers (homogeneous). The
decreasing of the mean of 24 hrs systolic BP was found in all CKD one
month after kidney transplantation, but statistically not significant (p>0.05),
while decreasing of the mean of 24 hrs diastolic BP was statistically significant
(p<0.05).
Conclusion: There were still no improvement in nondipper patients
one month after kidney transplantation. There were a decrease in the mean of 24
hrs systolic BP but statistically not significant and a decrease in the mean of 24
hrs diastolic BP which is statistically significant in patients one month after
kidney􀀃transplantation.]"
2015
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UI - Tesis Membership  Universitas Indonesia Library
cover
Kuspuji Dwitanto Rahardjo
Akurasi diagnostik pemeriksaan fisik dibandingkan dengan usg paru untuk menentukan kongesti paru pada pasien hemodialisis kronik yang telah mencapai berat badan kering = The diagnostic accuracy of physical examination compared to lung ultrasound for determine lung congestion in hemodialysis patients reaching their dry weight
"Latar Belakang: Beberapa penelitian telah menunjukkan tingginya angka morbiditas dan mortalitas yang diakibatkan oleh kongesti paru pada pasien hemodialisis. Pemeriksaan yang dilakukan selama ini untuk menentukan pasien telah bebas kongesti paru atau dianggap mencapai berat badan kering adalah dengan menggunakan pemeriksaan fisik. Penilaian kemampuan pemeriksaan fisik untuk deteksi kongesti paru belum jelas.
Tujuan: Untuk membandingkan kemampuan pemeriksaan fisik dengan ultrasonografi paru dalam menilai kongesti paru pada pasien hemodialisis.
Metode: Penelitian potong lintang terhadap data primer pasien hemodialisis yang menjalani dialisis kronik di RSCM antara Juni sampai Juli 2015. Analisis dilakukan untuk mendapatkan proporsi, sensitifitas, spesifisitas, nilai duga positif, nilai duga negatif disertai dengan rasio kemungkinan positif.
Hasil: Jumlah sampel yang diteliti adalah 60 pasien. Pada pemeriksaan interobserver di 20 pasien didapatkan angka korelasi interobserver kappa 0,828. Pada pemeriksaan keseluruhan 63 pasien didapatkan kongesti paru pada 36 pasien (57,1 %), yaitu kategori ringan 24 (38,1 %) dan sedang 12 (19 %). Pada pemeriksaan DVJ dibandingkan dengan USG paru didapatkan angka Sensitivitas = 0,47 (IK95% 0,31-0,63), spesifisitas = 0,73 (IK95% 0,54-0,86), Nilai Duga Positif = 0,51 (IK95% 0,36-0,67), Nilai Duga Negatif = 0,70 (IK95% 0,49 - 0,84), Rasio Kemungkinan Positif = 1,75 (IK95% 0,88 - 3,47), Rasio Kemungkinan Negatif = 0,72 (IK95% 0,47 - 1,12). Sedangkan untuk pemeriksaan auskultasi paru didapatkan sensistivitas = 0,56 (IK95% 0,39 - 0,71), spesifisitas = 0,54 (IK95% 0,35 - 0,71), NDP = 0,61 (IK95% 0,44 - 0,76), NDN = 0,48(IK95% 0,31 - 0,66), RKP = 1,21 (IK95% 0,73 - 2,0) dan RKN = 0,82 (IK95% 0,49 - 1,38).
Simpulan: Akurasi pemeriksaan DVJ dan auskultasi paru fisik tidak baik dalam mendiagnosis kongesti paru. Proporsi kongesti paru pada pasien-pasien hemodialisis kronik yang telah mencapai berat badan kering di RSUPN CM adalah 57,1%.
Background: A few research has shown hemodialysis patient with lung congestion had a high morbidity and mortality. Patient was assumed to be lung congestion free if they had reached their dialysis dry weight. To achieve this usually physical examination were used. The accuracy of physical examination in detecting lung congestion has not been established yet.
Objective: To compare the capability of physical examination in compare with lung ultrasound in detection of lung congestion.
Methods: A cross sectional data collection was done in hemodialysis patients in RSUPN CM between June to July 2015. Analysis was done to obtain proportion,sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ration.
Results: Sixty patients were obtained as sample. From the inter observer of 20 patients we found the kappa was 0,828. From th all 60 patients, we found 36 patients (57,1 %) had lung congestion. Mild lung congestion were found in 24 (38,1 %) and 12 (19 %) had moderate degree. In the analysis comparing jugular venous pressure to lung ultrasound we found sensitivity = 0,47 (CI95% 0,31 - 0,63), specificity = 0,73(CI95% 0,54 - 0,86), Positive Predictive Value (PPV) = 0,51 (CI95% 0,36 - 0,67), Negative Predictive Value (NPV) = 0,70 (CI95% 0,49 - 0,84), Positive Likelihood Ratio (PLR) = 1,75 (CI95% 0,88 - 3,47), Negative Likelihood Ratio (NLR) = 0,72 (CI95% 0,47 - 1,12). For lung auscultation we found sensitivity = 0,56 (CI95% 0,39 - 0,71), specificity = 0,54 (CI95% 0,35 - 0,71), PPV = 0,61 (CI95% 0,44 - 0,76), NPV = 0,48 (CI95% 0,31 - 0,66), PLR = 1,21 (CI95% 0,73 - 2,0) and NLR = 0,82 (CI95% 0,49- 1,38).
Conclusions: Jugular venous distention and lung auscultation examination is not good in detection of lung congestion. The proportion of lung congestion in hemodialysis patients in RSUPN CM is 57,1%."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library