Yenny Kandarini
Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran, Universitas Udayana, Denpasar, Bali

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Faktor determinan kesintasan hidup lebih dari lima tahun pada pasien hemodialisis reguler Sudjana, Karismayusa; Ayu, Nyoman Paramita; Kandarini, Yenny; Widiana, Raka; Sudhana, Wayan; Loekman, Jodi Sidharta; Suwitra, Ketut
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Abstract

Latar Belakang: Pasien hemodialisis regular memiliki risiko mortalitas yang lebih tinggi dibandingkan populasinormal. Angka kesintasam hidup lima tahun pasien hemodialisis regular adalah 35,8% namun angka ini bervariasi di tiap populasi dan dipengaruhi berbagai faktor.Tujuan: Penelitian ini bertujuan untuk mengetahui faktor determinan dari kesintasan hidup lebih dari lima tahun pada pasien hemodialisis regular.Metode: Penelitian ini menggunakan metode kasus-kontrol. Data diambil dari Indonesian Renal Registry Report di Rumah Sakit Umum Pusat Sanglah, Denpasar, Bali. 37 pasien yang menjalani hemodialisis regular selama lebih dari 5 tahun dicocokkan dengan 37 pasien yang menjalani hemodialisis regular selama kurang dari 5 tahun, berdasarkan umur. Data dianalisis dengan uji chi-square.Hasil: Prevalensi pasien yang menjalani hemodialisis regular selama lebih dari 5 tahun didapatkan 9,52%. Kamimenganalisa etiologi penyakit ginjal kronik (PGK), jenis kelamin, tekanan darah, anemia, dan status kecukupanhemodialisis. Perbedaan signifikan kedua kelompok didapatkan pada etiologi PGK (p = 0,021) dan anemia  p=0,0). Tidak didapatkan perbedaan signifikan pada jenis kelamin, tekanan darah, dan status kecukupan hemodialisis (p = 0,63, p = 0,64, dan p = 0,34).Simpulan: Penelitian kami menunjukkan bahwa faktor determinan yang berperan signifikan pada kesintasan hidup lebih dari 5 tahun adalah etiologi PGK dan status anemia.
Korelasi stadiumacute kidney injurydengankadar fosfat serum Suardana, I Ketut; Kandarini, Yenny; Suwitra, Ketut
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Hiperfosfatemia telah diketahui terjadi pada penyakit ginjal kronis (PGK). Terdapat hubungan linear antaraperburukan laju filtrasi glomerolus (LFG) dan peningkatan kadar fosfat serum pada PGK. Padaacute kidney injury(AKI) hubungan tersebut belum jelas. Beberapa penelitian pendahuluan melaporkan adanya peningkatan kadar fosfatserum pada pasien AKI. Tujuanpenelitian ini adalah mencari korelasi antara stadium AKI dan kadar fosfat serum.Dilakukanpenelitianpotonglintangdi RSUP Sanglah dari bulanJuni sampai Agustus2015 denganbesarsampel 53orang dipilihsecaraconsecutive sampling. Sampel yang memenuhikriteriadimintakankesediannyaberpartisipasidenganmenandatanganiinformed consent.Stadium AKI menggunakan kriteriadariKidneyDiseaseImprovingGlobalOutcome(KDIGO) tahun 2012, yaitu berdasarkan parameter kreatinin serum dan produksi urin.Kadar fosfat serumdiperiksa dengan metodemolibdate UVdi Laboratorium Prodia Denpasar. Hubungan stadiumAKI dan kadarfosfatserum dianalisis denganmenggunakan uji korelasi Spearman.Dari 53 pasienAKIterdiri dari 33(62,3%)orang pria,rerata umur 42(SB10,8)tahun.Berdasarkan kriteria KDIGO 2012 didapatkan 25 (47,2%) pasien AKI stadium 1, 12(22,6%) pasien AKI stadium 2 serta 16 (30,2%) pasien AKI stadium 3. Rerata kadar fosfat serum sebesar 4,7(SB2,10)mg/dl. Rerata kadar fosfat serum pada AKI tadium 1 sebesar 3,7(SB1,00)mg/dl, pada AKI stadium 2 sebesar4,6(SB1,20)mg/dl serta pada AKI stadium3 sebesar 6,5(SB2,70)mg/dl. Terdapat korelasi yang bermakna antarastadium AKIdankadarfosfat serum(r= 0,52,P<0,001).[MEDICINA.2016;50(3):17-22]. Hyperphosphatemia has been recognized in chronic kidney disease (CKD). There is linear correlation betweendecreased glomerular filtration rate (GFR) and increased serum phosphate level in CKD patients. This correlationisnot clear in acute kidney injury (AKI). Previous studies report that there is increasing of serum phosphate level inpatients with AKI.This study wasaimedto assess the correlation betweenseverity of AKIandserum phosphate level.Across-sectional study was performedat Sanglah Hospital from JunetoAugust 2015. Fiftythree patients wereselected with consecutive sampling technique. Eligiblesamples were requested for participation by signed informedconsent. Severity of AKI was defined byKidneyDiseaseImprovingGlobal Outcome(KDIGO) criteria2012, basedon serum creatinin and urine output. Serum phosphate level was measured usingmolibdate UVat Prodia laboratoryDenpasar.Correlationbetween severity of AKI and serumphosphate levelwas performed using spearman correlation.Thirty tree(62.3%) out of53samplesweremale, themean of age was42(SD10.8) years. Twenty five(47.2%)sampleswere categorized AKI stage I, 12samples(22.6%)stage 2  and16samples(30.2%)stage 3. Meanphosphatelevelwas4.7(SD2.10)mg/dl. Meanphophate levelwas3.7(SD1.00)mg/dlin AKI stage 1,4.6(SD1.20)mg/dlinAKI stage 2 and6.5(SD2.70)mg/dlin AKI stage 3. There wassignificantcorrelation between severity of AKI andserum phosphate levelhad been showed by this study (r = 0.52,P<0.001).[MEDICINA.2016;50(3):17-22].
seorang penderita tuberkulosis diseminata dengan komplikasi penyakit ginjal kronis Koncoro, Hendra; Kandarini, Yenny; Sudhana, Wayan; Widiana, I Gde Raka
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Tuberkulosis diseminata dapat melibatkan berbagai organ dan secara klinis timbul dengan bermacam-macam tanda dan gejala.Penyakit ginjal kronis merupakan salah satu komplikasi yang disebabkan oleh penyebaran hematogenik Mycobacterium tuberculosis ke traktus urogenital. Diagnosis dini dan inisiasi terapi yang tepat merupakan hal penting dalam pencegahan komplikasi lanjut penyakit ini. Dilaporkan sebuah kasus dengan tuberkulosis diseminata yang memperlihatkan keterlibatan paru dan organ ekstra-paru. Kasus ini memperlihatkan tuberkulosis paru, serviks, dan urogenital yang dikonfirmasi dengan pewarnaan sputum basil tahan asam, biopsi serviks, dan biopsi buli buli. Pewarnaan sputum basil tahan asam menunjukkan hasil 3+, sedangkan biopsi serviks dan buli buli menunjukkan radang kronik granulomatosa dengan multinucleated giant cell tipe Langhans. Kadar blood urea nitrogen (BUN) 11 mg/dL dan kreatinin serum 2,58 mg/ dL dengan hidronefrosis ringan kiri pada saat dirawat. Setelah diagnosis ditegakkan, pasien diterapi dengan obat anti-tuberkulosis dan membaik dengan kadar BUN 13,55 mg/ dL dan kreatinin serum 0,9 mg/ dL setelah satu bulan terapi.[MEDICINA.2016;50(3)63-70]
PREVALENSI DAN HUBUNGAN SINDROM METABOLIK DENGAN PENYAKIT GINJAL KRONIK PADA POPULASI DESA LEGIAN, KUTA BALI Ayu, Paramita; Kandarini, Yenny; Widiana, G Raka; Sudhana, W; Loekman, Jodhi S; Suwitra, K
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Metabolic syndrome may relate to pathogenesis of chronic kidney disease (CKD). There is scarce data with regard to thatphenomenon in Indonesian general population. We conduct a study to determine the prevalence of metabolic syndrome and itsrelationship with CKD individuals in general population of Legian Village, Bali. An analytical cross sectional study was carriedout in the community of Legian Village, a tourist destination in Bali. Samples were selected through simple random sampling.Two hundred and eighty four samples (117 males and 107 females, aged 46.1 ± 10.02 years) were included. Prevalenceof hypertension, hypertrigliseridemia, hypoHDL-cholesterol, central obesity, impaired fasting glucose (IFG), obese and CKDwas 14.1%, 38.4%, 25%, 18%, 11.6%, 51.8% and 11.6% respectively. Using bivariate analysis, there were strong and significantrelationship between hypertension (OR 2.6, 95%CI 1.12 to 6.19, p = 0.02) and IFG (OR 5.21; 95%CI 2.23 to 12.13, p = 0.00) withCKD. Using multivariate logistic regression entering those components of metabolic syndrome into the model, it was consistentlyfound that hypertension and DM is the associated factors for CKD in the population. There was increasing odds of CKD about1,0-fold every augment of metabolic syndrome components (OR 1.098; 95%CI 0.83 to 1.44). As our conclusion, hypertensionand IFG are associated factor for CKD in general population. Multiple components increased risk factor for CKD.
HUBUNGAN ANTARA KADAR LEPTIN DAN ADIPONEKTIN PLASMA PADA PASIEN DENGAN DIALISIS RUTIN Raka Widiana, I Gde; Kandarini, Yenny; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Leptin and adiponectin (ADPN) are adipokines with respective pro-atherogenic and anti atherogenic properties. In nonrenalpatients, both hyperleptinemia and hypoadiponectinemia are associated with cardiovascular complication. Relationshipsbetween serum leptin and ADPN in patients with dialysis is not consistently reported.Objective of this study is evaluate relationships between serum ADPN and leptin in patients with dialysis. A cross sectionalstudy was performed in and 54 HD and 22 CAPD patients.Seventy six patients were enrolled this study, M/F 41/76, aged 48.4±11.4 year, BMI 21.4±2.7 kg/m2, haemoglobin (Hb)7.9±1.5 mg/dL, blood sugar 94.8±33.5 mg/dL, albumin 4.1±0.4 g/dL, total-cholesterol 177.9±46.3 mg/dL, triglyserida 164.4±104.8mg/dL, SC 14.3±3.8 mg/dL, TNF 14.40±7.43 pg/mL, ADPN 17.6±7.6 µg/mL, leptin 13068±23589 µg/mL (log leptin 3.7±0.59µg/ml). Using Spearmans rho analysis there were negative correlation between log-leptin and ADPN (r= -0.39, p= 0.00), andpositive correlation between log leptin and Hb (r= 0.25, p= 0.04), insulin(r= 0.44, p = 0.00), total-cholesterol (r= 0.34, p = 0.003),triglyserida (r= 0.41, p= 0.00), and BMI (r= 0.41, p= 0.00), but there was no correlation between log-leptin and albumin, bloodsugar, SC and TNF alfa. Using multiple regression to analyze relationship between ADPN and leptin, insulin, Hb, and dialysismodality, we found log leptin independently correlated with ADPN (B= -0.402, p= 0.01, 95%CI B: -1.24 to -0.32). Using multipleregression to analized relationship between ADPN with log-leptin, BMI, total cholesterol, and triglyserida, we found log leptin(beta= -0.3, p= 0.01, 95%CI B: -0.98 to -0.13) and triglyserida independently correlated with ADPN (beta= -0.5, p= 0.00, 95%CIB: -0.008 to -0.003).Serum leptin and triglyseride relate with ADPN. Some metabolic parameters such as insulin resistance, anemia, dialysismodality, nutritional status (BMI and total cholesterol) have indirect relationship with ADPN may be through leptin secretion.
KEJADIAN PERITONITIS PADA PASIEN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: IDENTIFIKASI MIKROORGANISME DAN SENSITIFITAS ANTIBIOTIK Haryanti, Elizabeth; Kandarini, Yenny; Widiana, I Gde Raka; Sudhana, Wayan; Loekman, Jod; Suwitra, Ketut
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Patients treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) are constantly exposed to microbial invasionof the peritoneal cavity and rapid microbiological diagnosis of peritonitis is essential due to Hospitalization and imposes asignicant burden of morbidity. The aims of this study were to enumerate the association between microorganisms, sensitity,and resistence of antibiotic on CAPD patients with clinical peritonitis.We collected data through medical records by the number of CAPD patients with clinical peritonitis from June 2004 untilJune 2009. The study was analysis with one-way ANOVA. We found 23 patients clinical peritonitis out of 77 CAPD patients,with insidence was 14% per-year, aged 14 ? 65 y (15M; 8F). The chronic pyelonephritic was a leading (16/23) cause of endstages renal disease. Each patients underwent HD prior (5 ? 60 months) to CAPD, with survival time was 2 ? 51 months. Out of23 patients, 4 were returned to hemodialisis, 15 were died, due to cardiogenic shock 46.7%. Aseptic peritonitis was 31.3%, andthe common microorganism was staphylococcus 18.8%. Peritoneal !uid test showed mean score of sensitivity were tetracycline22.93, cipro!oxacin 19.36, piperacillin-tazobactam 17.36, thrimetropin/sulfamethoxazole 16.5, fosfomycin 15.78, consecutivelyand the rest were resistent. Staphylococus was strongly related to insidence peritonitis, and tetracycline was the most highlysensitive antibiotic in CAPD patients.
HUBUNGAN ANTARA PERUBAHAN VOLUME DARAH RELATIF DENGAN EPISODE HIPOTENSI INTRADIALITIK SELAMA HEMODIALISIS PADA GAGAL GINJAL KRONIK Agustriadi, Ommy; Suwitra, Ketut; Raka Widiana, Gde; Sudhana, Wayan; Sidharta Loekman, Jodi; Kandarini, Yenny
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Intradialytic hypotension (IDH) is a common complication in chronic hemodialysis (HD) patients, in turn would increase morbidity and mortality. Relative blood volume changes during HD play a role in IDH episode. Those changes can be assessed by total plasma protein measurement before and after HD. To determine relationship between relative blood volume changes (assessed by percentage of total plasma protein changes during HD) and IDH episode during HD in chronic renal failure, an analytical cross-sectional study was perferomed in 51 patients (28 males and 23 females, age 47.8 ±11.6 years) underwent chronic HD at Hemodialysis Unit of Sanglah Hospital Denpasar. Data were collected during single HD session. Blood pressure was measured every 30 minutes and relative blood volume changes assessed by measuring percentage of total plasma protein changes during HD. Among them, IDH episode experienced in 10 (19.6%) patients. Logistic regression analysis revealed a strong and significant relationship between relative blood volume changes and IDH episode during HD in chronic renal failure (Beta = 0.29; OR = 1.35; CI 95%: 1.1 - 1.6; p < 0.01) and it was found that every 1% changes in relative blood volume, would increase risk of hypotension episode by 35%. This relationship was still strong and significant (Beta = 0.46; OR = 1.58; CI 95%: 1.11 -2.25; p = 0.01) after adjusted by hemoglobin levels, intradialytic body weight changes, use of antihypertensive medi¬cations and diabetes melitus. Using ROC curve, found that optimal cut of point of intradialytic total plasma protein changes to predict an IDH episode during HD was 5.56% with 90.0% sensitivity and 80.5% specificity (95% CI: 0.83-0.99; p < 0.01). Our data revealed a strong and significant relationship between intradialytic relative blood volume changes assessed by intradialytic total plasma protein changes and IDH episode during HD in chronic renal failure.
PENGARUH SPIRONOLAKTON SEBAGAI TERAPI TAMBAHAN ACE INHIBITOR DAN/ATAU ANGIOTENSIN RECEPTOR BLOCKERS TERHADAP ALBUMINURIA PADA PENYAKIT GINJAL KRONIK PRADIALITIK STUDI KLINIS ACAK TERKONTROL BUTA GANDA -, Yuriawantini; Suwitra, Ketu; Raka Widiana, I Gde; Sidharta Loekman, Jodi; Sudhan, Wayan; Kandarini, Yenny
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Recently studies suggest that aldosterone contributes to progressive kidney disease. This has raised the possibility ofusing aldosterone antagonist in CKD. To evaluate effects of spironolactone 25 mg/day on albuminuria in CKD patients, thirtyCKD patients were enrolled in randomized double blind placebo controlled study. Permutted block randomization was done toreceive spironolactone 25 mg/day or placebo as control in addition to ACE inhibitors and/or ARBs. Albuminuria and bloodpressure were examined at baseline and 12 weeks. Albuminuria was measured as urinary albumin:creatinine ration and comparedas primary out come. During this study 15 patient were received conventional therapy and spironolactone 25 mg/day and 15patient were received placebo. One of patient dropped-out after 4 weeks due to hiperkalemia in spironolactone group and one ofpatient in the control group lost to follow-up. After 12 weeks of therapy, in spironolactone group albuminuria was decreased from510 (180.0 ? 798.0) to 254.0 (40.3 ? 491.8) mg/g, MD, 187.0 (29.0 ? 332.3) mg/g, p= 0.035 and in control group from 804.0 (52.0? 1126.0) to 637.0 (99.0 ? 1098.8) mg/g MD -10.5 (-186.5-86.0) mg/g, p= 0.490. There was significant difference of decreamentof albuminuria in both groups (Z=-0.69, p=0.046). There were no statistically different of serum potassium levels and bloodpressure in both groups after treatment. Baseline aldosterone levels were not significantly correlated with albuminuria (r = -0.128,p = 0.499). As Conclusion in this study is spironolactone reduces albuminuria in pradialytic CKD patients
HUBUNGAN PENYAKIT GINJAL KRONIS PREDIALISIS DENGAN BEBERAPA PARAMETER PENYAKIT ATEROSKLEROSIS ARTERI KAROTIS Sutarka, Nyoma; Suwitra, Ketut; Loekman, Jodi S; Sudhana, Wayan; Kandarini, Yenny; Martadiani, Elysanti Dwi; Margian, Nyoman
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Carotid artery intima media thickness (cIMT) is valid marker of subclinical atherosclerosis because it gives sign of earlyatherosclerosis process. We conduct this study to know the relationship between predialysis chronic kidney disease (CKD) withseveral parameters of carotid arterial atherosclerosis.A cross sectional study was done in patients with predialysis CKD who came to outpatient Clinic of Nephrology inSanglah General Hospital from May 2009. CKD criteria is based on KDQQI 2003. Estimated Glomerular Filtration Rate (eGFR)was calculated with Cockroft-Gault formula. Measurement of cIMT is done by USG B-Mode with USG Logig-5.There were 30 patients (20 with eGFR < 60 ml/mnt and 10 with eGFR 60 ml/mnt). Mean of cIMT in eGFR < 60ml/mnt: right/left cIMT1 0.24445 ± 0.3096/0.3210 ± 0.4006 mm; IMT2 0.2405 ± 0.3138/0.2825 ± 0.3971 mm; IMT3 0.2315 ±0.3026/0.2820 ± 0.3672 mm; bifurkatio IMT 0.3115 ± 0.4069/0.3515 ± 0.4991 mm; total IMT 0.6350 ± 0.1738/0.6938 ± 0.1912mm. For eGFR > 60 ml/mnt: right/left IMT1 0.1120 ± 0.1722/0.1030 ± 0.1398 mm; IMT2 0.0880 ± 0.1103/0.1130 ± 0.1718mm; IMT3 0.1010 ± 0.1408/0.1170 ± 0.1700 mm; bifurcatio IMT 0.1920 ± 0.3545/0.1980 ± 0.3527 mm, total IMT 0.6250 ±0.1269/0.6750 ± 0.1124 mm. There was signiÞ cant difference in eGFR < 60 ml/mnt the left IMT1 (MD: 0.21 CI95% 0.01 ! 0.42;p = 0.038). Five out of 20 patients with eGFR < 60 ml/mnt and 6 among 10 patients of eGFR 60 ml/mnt were found plaques.There are no signiÞ cant difference of plaque location, plaque width, and lumen diameter between carotid arterial with andwithout plaque. As a conclusion we found there is no signiÞ cant difference between predialysis CKD with several parameters ofcarotid arterial atherosclerosis but cIMT tends to be thicker on predialysis CKD patients with eGFR < 60 ml/mnt.
Soluble Transferrin Receptor and Soluble Transferrin Receptor/Log Ferritin Ratio are Correlated with Iron Status in Regular Hemodialysis Patients Yenny Kandarini; Gede Wira Mahadita; Sianny Herawati; Anak Agung Wiradewi Lestari; Ketut Suega; I Gde Raka Widiana
The Indonesian Biomedical Journal Vol 13, No 2 (2021)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v13i2.1412

Abstract

BACKGROUND: Monitoring of iron status in chronic kidney disease patients is important, however inflammation may hinder its monitoring. Soluble transferrin receptor (sTfR) is an alternative parameter to overcome this issue, whereas ferritin play a part in the inflammation process. Hence, the correlation between the sTfR ratio and the sTfR/log ferritin ratio with conventional iron status parameters in regular hemodialysis patients is necessary to be evaluated.METHODS: A cross-sectional was conducted in the current study. As many as 5 mL of blood (2 mL for sTfR and 3 mL for serum iron and ferritin levels) was collected. sTfR level was the blood-soluble transferrin receptor level measured by the enzyme-linked immunosorbent assay (ELISA). The amount of ferritin and serum iron was determined using the immunochemiluminescent process. To evaluate the correlation, the Pearson correlation test was used.RESULTS: A total of 80 subjects was included in this study. The mean of hemoglobin was 10.25±1.66 g/dL, serum iron was 58.19±26.56 g/dL, and the median ferritin was 520.4 (49.9-3606) ng/mL. The sTfR was significantly associated only with serum iron levels with a correlation coefficient of r=-0.242; p=0.031. The sTfR/log ferritin was significantly associated with serum iron l evels (InSI)(r=-0.255, p=0.022); and transferrin saturation (r=-0.295; p=0.008).CONCLUSION: sTfR/log ferritin has a negative and significant correlation with serum iron levels and transferrin saturation, while sTfR negatively correlated with serum iron levels. sTfR and sTfR/log ferritin may be considered as an alternative iron marker in inflammation setting such as CKD.KEYWORDS: sTfR/log ferritin, iron status, serum iron, ferritin, chronic kidney disease, hemodialysis