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All Journal journal of internal medicine Jurnal Penyakit Dalam Udayana
Jodi Sidharta Loekman
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Immunology & microbiology Medicine & Pharmacology Public Health

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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.
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
KOMPLIKASI PASKA TRANSPLANTASI GINJAL Juliana, I Made; Sidharta Loekman, Jodi
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Abstract

Renal transplantation is the take over of kidney from healthy person and then be transplanted to the other person who hassevere and permanent kidney function disorder. Renal transplantation is the most effective treatment for terminal stage of chronickidney disease. The survival of patients who underwent renal transplantation depend on some factors including screening ofpatients, pretransplantation management, surgery technic and management of patients after renal transplantation. Complicationsafter renal transplantation devide to surgery complications and non surgery (medical) complications. Surgery complications aremayor complication such as bleeding and anaestesion drug effect and the other complications due to transplantation process.Medical complications are rejection (hyperacute, acute and chronic rejection), infection, cardiovascular disease, anemia,hypertension, diabetes mellitus, dislipidemia, hyperhomocysteinemia, malignancy, lymphoproliferative disease and psychologicaleffect. Rejection is the most important complication. If hyperacute rejection ocured, kidney transplant must be take over to avoidmore severe systemic inflammation respon. New generation of humanized IL-2 receptor antibody, daclizumab (zenapax) candecrease the incident of hyperacute rejection. Acute rejection can be treated with steroid, polyclonal antilymphocyte globulin,monoclonal antibody OKT3 and plasma exchange. Chronic rejection was difficult to treat. Immunosupresion agen have no muchrole because destroyed were occured. Prevention just to manage risk factors and then wait the other transplantation. For the othercomplications, the management based on etiology and the type of complication.
Co-Authors I Gde Raka Widiana I Made Juliana Ketu Suwitra Ketut Suwitra Nyoman Paramita Ayu Ommy Agustriadi Sudjana, Karismayusa Wayan Sudhan Wayan Sudhana Yenny Kandarini Yuriawantini -