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Published by Indonesian Society of Nephrology (InaSN)

ISSN : - EISSN : eISSN265 DOI : http://inakidneyhypertension.co.id

Core Subject : Health, Science,

Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

Indonesian Journal of Kidney and Hypertension is an open accessed online scientific journal managed and published by Perhimpunan Nefrologi Indonesia/Indonesian Society of Nephrology (Pernefri/InaSN). This journal aims to publish peer-reviewed scientific articles to provide novel scientific information in nephrology and hypertension. Authors are encouraged to submit research articles, case reports, evidence-based case report, and review articles that focus in the field of nephrology and hypertension. The subjects eligible for publication include, but not limited to: Chronic kidney disease Electrolyte and pH imbalance Hyperparathyroidism CKD-MBD Anemia Acute kidney injury Renal replacement therapy (dialysis, transplant) Hypertension Onconephrology Nephrotic and nephrtitic syndromes Glomerulonephritis and other glomerulopathy

Arjuna Subject : Kedokteran - Nephrology

Articles 25 Documents

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Sclerostin Serum Concentration in Patients with Predialysis Ckd Stage 3-5 Lukman Pura; Ria Bandiara; Rubin S Gondodiputro
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2018): September - December 2018
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Sclerostin is a glycoprotein expressed by osteocytes and plays a role in bone turnover in themetabolism of the bone. Sclerostin blocks the formation of a ligand with its receptor on theWnt/β-catenin pathway, and influences the activity of osteoblasts. Sclerostin also influencesmineral and bone disturbances in CKD via the interaction between kidney, bone and vascularaxis. The concentration of sclerostin will rise especially in patients with ESRD undergoingdialysis. Concentration of sclerostin has not been reported yet in non-dialysis CKD patientstage 3-5 and the aim of this study is to see sclerostin concentration on those population. Methods This is a descriptive and cross-sectional study designed to measure sclerostinconcentration in non dialysis patients with CKD stage 3-5. The sclerostin concentration ismeasured using an enzyme-linked immunosorbent assay kit. CKD stages are diagnosed usingthe KDIGO-2012 criteria which measures the estimated GFR (eGFR) with the formulation of EPICKD. Fifty six patients with CKD stage 3-5 were enrolled in this study and one way ANOVA comparative test followed with a post hoc analysis using Benferroni test to analysethe data. Results The mean concentration level of serum sclerostin in this population is (79.7+ 41.2) pmol/L, and in patients with CKD stage 3, CKD stage 4, and CKD stage 5 are (59.6 +28.5) pmol/L, (71.9 + 42.2) pmol/L and (96.7 + 39.8) pmol/L respectively. The comparativetest of mean concentrations of the serum sclerostin between stages of CKD are statisticallysignificant with a p=0.022. The post hoc analysis of serum sclerostin concentration betweenCKD stage 3 and CKD stage 5 have a significant difference with a mean of 37 pmol/L andp=0.037. Conclusion, The serum sclerostin concentration rise in accordance with the declineof kidney function in patients with pre-dialysis CKD stage 3-5.

Correlation between hemoglobin, serum albumin, body mass index, hemodialysis shift time and hemodialysis adequacy with quality of life in hemodialysis patients Darryl Virgiawan Tanod; Linda Rotty; Stella Palar; Emma Moeis
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2018): September - December 2018
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Background CKD Patients on routine hemodialysis (HD) are prone to medical complications and conditions that are potentially detrimental to the quality of life (QoL), such as anemia, malnutrition, low body mass index (BMI), HD shift time, and HD adequacy measured by Kt/V. CKD patients undergoing routine HD mostly have lowered QoL and are at higher risk for malnutrition, inflammation, hospitalization, and mortality, compared to the general population. This study intends to find out whether there is a correlation between these factors and the quality of life of patients undergoing routine hemodialysis. Methods The design of this study is a cross-sectional analysis of observational data. Hemodialysis patients from general hospital Prof. dr. R. D. Kandou Manado for 3 months from August to October 2017 were included. Fifty-two patients meet the inclusion and exclusion criteria. The correlation between quality of life with anemia, serum albumin, BMI, adequacy of HD, using Pearson correlation test (if normality test fulfilled) or Spearman correlation test (if the normality test not fulfilled) and Independent Samples T-test to assess the quality of life with HD shift time. Results This study found no correlation between hemoglobin levels (p=0.244, r=-0.098), BMI (p=0.473, r=-0.010), HD timing (p=0.082) and quality of life of the patients, but a significant correlation between serum albumin (p=0.020, r=0.286), HD adequacy measured by Kt/V (p=0.030, r=0.257) and subjects’ quality of life. Conclusion This study showed that serum albumin and Kt/V values had a significant correlation with quality of life, while hemoglobin, BMI and dialysis shift time are not related to the quality of life.

The role of soluble urokinase-type Plasminogen Activator Receptor (suPAR) in Chronic Kidney Disease Ade Yonata; Ian Effendi; Zulkhair Ali; Novadian Suhaimi; S Suprapti
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2018): September - December 2018
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Kidney disease affects 800 million children and adults worldwide, and the numbers keep increasing. A better understanding of the pathogenesis in kidney diseases, especially on a biomolecular level, is much needed to identify novel biomarkers and therapeutic targets for kidney diseases. The glomerular filtration barrier comprises endothelial cells, the glomerular basement membrane, and podocytes. The podocyte has a central role in part of the glomerular filtration barrier. The normal functioning of podocytes is particularly important in preventing the heavy proteinuria seen in nephrotic syndrome or diabetic nephropathy, or in the disease process of focal segmental glomerulosclerosis. The podocyte is injured by circulating factors, which finally results in deranged podocyte motility. Soluble urokinase-type plasminogen activator receptor (suPAR) is a circulating form of glycosyl-phosphatidylinositol uPAR domain membrane protein and is known to play a role in the pathogenesis in kidney diseases, specifically focal segmental glomerulosclerosis and diabetic nephropathy. suPAR binds to αvβ3 integrin on podocyte foot processes and causes podocyte structure disorganization leading to glomerular filtration disruption and hence proteinuria. suPAR is also a potential biomarker to predict the incidence of CKD.

Effect of Calcineurin Inhibitor on Blood Glucose Level in Non-Diabetic Kidney Transplant Patients A Aditiawardana; Fauzia N Liani; Chandra Irwanadi; Nunuk Mardiana; P Pranawa
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2018): September - December 2018
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Background Calcineurin inhibitor (CNI) is a class of immunosuppressant agent used in kidney transplant management, known to pose risk for new-onset diabetes after transplant (NODAT). Tacrolimus and cyclosporine cause NODAT through multiple mechanisms, such as decreasing insulin secretion, increasing insulin resistance, and a direct effect on the pancreatic beta cell. Method This is a retrospective study on patients receiving immunosuppressant agents for kidney transplant patients in Surabaya. The immunosuppressant agents studied were CNI (tacrolimus and cyclosporine) in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroid. The blood glucose measured were fasting blood glucose (FBD) and 2-hour postprandial blood glucose (2PPBG). Objective Aim of this study is to determine the effect of calcineurin inhibitor (CNI) on glucose regulation in the nondiabetic renal transplant patient. Result Fifty-six subjects were included in the study, divided into two groups. One group of 28 patients (50%) received tacrolimus-MMF-MP and the other group received cyclosporine-MMF-MP. A significant increase in fasting blood glucose (pre-intervention level 86 ± 6 mg/dl vs post-intervention level 109 ± 34 mg/dl with p = 0.01) and 2-hour postprandial blood glucose (pre-intervention level 117 ± 20 mg/dl vs post-intervention level 150 ± 43 mg/dl with p < 0.001) was found in the tacrolimus group. A significant increase was also found in the cyclosporine group, both in fasting blood glucose (pre-intervention value 85 ± 7 mg/dl vs post-intervention value 97 ± 22 mg/dl with p = 0.002) and 2-hour postprandial blood glucose (pre-intervention value 119 ± 18 mg/dl vs post-intervention value 148 ± 55 mg/dl with p = 0.001). Tacrolimus was found to have a relative risk of NODAT up to 1.2 fold compared to cyclosporine. Conclusion Tacrolimus poses 1.29 relative risk of NODAT compared to cyclosporine. However, both drugs significantly increase fasting blood glucose and 2-hour postprandial blood glucose in non-diabetic patients receiving kidney transplantation.

Prognostic factors and impact of peritoneal dialysis-related early peritonitis on mortality in Sardjito General Hospital, Yogyakarta, Indonesia Metalia Puspitasari; Heru Prasanto; Iri Kuswadi
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2018): September - December 2018
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Background Peritonitis has been reported to be associated with high mortality. However, information on the impact of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. ObjectiveTo determine the association between peritoneal dialysis-related early peritonitis and mortality. To determine prognostic factors on mortality in peritonitis patients with peritoneal dialysis. Methods A retrospective observational cohort study was conducted over 5 years at a single PD unit in Sardjito Hospital. Inclusion criteria: First onset of peritonitis patients with peritoneal dialysis from 2013 -2017, age ≥ 18 years old. Exclusion criteria: Incomplete medical records. A total of 48 patients on CAPD with peritonitis was divided into the early onset of peritonitis (< 20 months) and late onset of peritonitis ( ≥ 20 months. Kaplan-Meier survival curve was used to display cumulative relative risk as a parameter of prognostic factors. Results A total of 48 patients (early onset of peritonitis, n = 31; late onset of peritonitis, n = 17) were analyzed in our study with a mean of age50.6 years consisted of males 64.6%. There was a significant difference in patients’ mortality between the early and late onset of peritonitis. The Kaplan-Meier analysis revealed that log-rank test, p<0.05 with a mean survival time of patients with early peritonitis and late peritonitis was 236 days (95% CI: 162-309 days) and 1702 days (95% CI: 1067-2338 days) consecutively. Compared to those who were normoweight, underweight or overweight patients had increased risk of mortality, (RR 1.14 and 1.15; p=0.003, respectively). There was a significant association between diabetes mellitus and lower serum creatinine levels, and the risk of mortality (RR 1.43, p=0.03 and mean difference -6.01, p< 0.001, respectively). Conclusions Early peritonitis patients have a poor prognosis compared to the late peritonitis group. Patients with shorter time to first peritonitis were prone to having a higher mortality rate. Diabetes mellitus, underweight or overweight, and lower serum creatinine are prognostic factors of mortality in peritonitis patients.

Does High Ultrafiltration Volume Correlate to Occurrence of Desaturation in Patients Undergoing Hemodialysis? Lee Thung Sen; Ni Made Hustrini
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2019): January - April 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Background: Hemodialysis is a metabolically stressful condition for patients that leads to reduced oxygen saturation and tissue perfusion. One of the identified drivers is a high ultrafiltration volume (UFV). Concurrently, central venous oxygen saturation (ScvO2) is a marker for global tissue hypoxia that has been used in cases of sepsis and trauma to guide fluid therapy. In dialysis patients with a central venous catheter (CVC) access ScvO2 is accessible. Here we intend to delineate the relationship of UFV to desaturation during dialysis through the measurement of ScvO2. Methods: PICO was formulated from a clinical case, and a literature search was conducted in Pubmed, Embase, Scopus, and Cochrane. Selected studies were then critically appraised using harm/etiology worksheet from CEBM1 for validity, importance, and applicability. Results: Studies by Harrison, et al., Zhang, et al. and Rotondi, et al. were chosen for answering our PICO. Harrison, et al. reported a relation of r: -0.680, p:0.015 between UFV and ScvO2. While, Zhang, et al. utilized retrospective data of Critline Monitor (CLM) reading of dialysis patients and reported a negative 0.3% slope of ScvO2 over corrected UFV (cUFV). Whilst, Rotondi, et al. demonstrated that in 20 patients separated equally to exclusively dialysis or ultrafiltration and both caused lowering of ScvO2, but only the former was statistically significant. Discussion: The mechanism of relationship may include incapability of plasma refill rate to compensate for the fluid shift during ultrafiltration, resulting in lower cardiac preload and stroke volume which is detrimental in patients who are natively prone to suffer from reflex bradycardia and intradialytic hypotension. Studies have shown that episodes of hypoxemia in dialysis patients translate to worse prognosis. Conclusion: ScvO2 is inversely proportional to UFV. As such, monitoring for ScvO2 in dialysis patients will be beneficial to prevent end-organ ischemia.

Correlation of Glycated Albumin and Glycated Hemoglobin with Glycemic Control in Patients with Diabetic Chronic Kidney Disease on Hemodialysis Zulkhair Ali; Rostika Dewi; Alwi Shahab; Irsan Saleh
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2019): January - April 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Background and aims. Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD) worldwide and is the primary etiology of ESRD in Indonesia. It is estimated that there are 10 million patients with DM in Indonesia and about 25-40% of diabetics develop diabetic nephropathy (DN) within 25 years. Poor glycemic control is associated with increased mortality in a large observational study among diabetics on hemodialysis. Glycated hemoglobin, or known as HbA1c, was the currently recommended biomarker to monitor long-term glycemic control in diabetes mellitus guideline. However, it becomes underestimated in patients with DN on hemodialysis (DN-HD), because of 20- 50% reduction of erythrocyte lifespan, clinical use of iron therapy, and effects of recombinant human erythropoietin. Glycated albumin (GA), ketoamine formed via a non-enzymatic glycation reaction of serum albumin, is free from interference by erythrocyte lifespan or erythropoietin therapy and subsequently can be used as an alternative biomarker to monitor glycemic control in DN-HD. As albumin has a half-life of only 14-21 days* compared to Hb 60-100 days in well ESKD patients, thus GA may provide a better reflection of recent diabetic control than HbA1c. The aim of this study was to analyze the correlation between GA and HbA1c with glycemic control in DN-HD. Methods The study was an analytical observational study with a cross-sectional design. The subjects were consecutive patients with DN-HD who visited Hemodialysis Unit at Mohammad Hoesin General Hospital Palembang during August-November 2014. The glycemic control index was determined by the average value of 2 times a week pre-HD random blood glucose for 4 weeks (aRBG). Results. The subjects were 25 patients with an average age of 56.16±7.49 years old. The average value of GA was 26.94±7.74%. GA was strongly correlated with aRBG with r=0.776; p=0.000. After correcting for age, sex, and BMI, the correlations became significantly very strong (r=0.809, p<0.001). The simple linear regression for the relationship between GA and aRBG was aRBG=4,62×GA+42.74 (R2 =0.602, P><0.001), estimating that a 1% increase of GA was associated with 4.62mg/dL increase of aRBG. After correcting for age, sex, & BMI, the correlations between HbA1c and aRBG were significant (r=0.852, p><0.001). Conclusion. GA was strongly correlated with glycemic control in patients with DN-HD and HbA1c was correlated better. > <0.001). The simple linear regression for the relationship between GA and aRBG was aRBG=4,62×GA+42.74 (R2=0.602, P<0.001), estimating that a 1% increase of GA was associated with 4.62mg/dL increase of aRBG. After correcting for age, sex, & BMI, the correlations between HbA1c and aRBG were significant (r=0.852, p<0.001). Conclusion. GA was strongly correlated with glycemic control in patients with DN-HD and HbA1c was correlated better.

The Role of Methylglyoxal Accumulation on Cognitive Function Impairment of Chronic Hemodialysis Patients: an Observational Study Harnavi Harun; Roslaini Roslaini; Syaiful Azmi; Rose Dinda Martini
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2019): January - April 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (480.665 KB)

Background: Cognitive function decline is prevalent on routine hemodialysis patients. Many factors contribute to the increased risk of cognitive function impairment, one of them is the accumulation of uremic toxins. Methylglyoxal (MG) has been identified as one of the uremic toxins found in dialysis patients by the European Uremic Toxin Group. It has also been found much higher on CKD patients; over five times higher in non-dialysis CKD and 18-40 times higher in CKD patients on dialysis, and cause impaired cognitive function in rats with diabetes. Aim: To find the correlation between blood MG levels and cognitive function of patients who underwent routine hemodialysis. Methods: This study is an observational cross-sectional study done in Hemodialysis Unit of Dr. M Djamil General Hospital, Padang, West Sumatera, Indonesia. Fifty-seven subjects aged 40-60 years old were included in this study, where the blood MG levels were obtained. Cognitive function was measured using the Mini Mental State Examination (MMSE) questionnaire. Result: Among 57 subjects, 29 (50.8%) were male, and 33 (57.9%) were 50-60 years old. The subjects’ mean methylglyoxal levels were 10.8 (SD ± 3.2) µmol/L. The subjects’ mean MMSE score was 26 (SD ± 1.8), with 35% of the subjects had low (<25) scores. Spearman correlation analysis showed a statistically significant negative correlation between methylglyoxal level and MMSE score (r = -0.6, p >< 0.001). Conclusion: High levels of methylglyoxal negatively correlates with cognitive function in chronic hemodialysis patients. Future research should include analysis regarding age, gender, hypertension, and other confounding factors.

The Role of Low Blood Glucose Level of Mothers with Severe Preeclampsia in Fetal Growth Restriction: a Mini-Study Asri Prameswari
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2019): January - April 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (297.853 KB)

Background. The number of patients with severe preeclampsia continues to increase worldwide. Blood glucose is significantly decreased in severe preeclampsia patients, starting at the sudden onset of high blood pressure. This depicts the state of low placental energy status in preeclampsia patients with intrauterine growth restriction (IUGR), due to either glycolysis or ischemia disorders resulting from decreased maternal placental blood flow. Aim. To observe the relationship between mother’s random blood glucose level with fetal growth restriction complications during acute onset of severe preeclampsia. Methods. A cross-sectional study, random sampling involving twenty-one pregnant women with severe preeclampsia who underwent cesarean section at Permata Bunda Hospital, Malang, Indonesia. Data were taken from medical records, which included: mother’s random blood glucose, blood pressure, proteinuria, and complete blood count. Fetal data includes body weight and length. The data were obtained at the subjects’ initial admission in the emergency room during the acute phase of the preeclampsia. Result. Maternal blood glucose had a negative and significant relationship with systolic blood pressure (r = -0.843, p < 0.0001) and with newborn body weight (r = 0.465, p = 0.034) in the acute onset of severe preeclampsia. Conclusion. The blood glucose level of patients at the acute onset of preeclampsia is inversely correlated with systolic blood pressure. The blood glucose level is also correlated with fetal weight. However, due to the chronic nature of IUGR, future studies should analyze the relationship between blood glucose, blood pressure, and fetal growth through multiple stages of pregnancy

Risk Factors for New-Onset Diabetes After Transpant in Kidney Transplant Recipients Dana Pramudya; Aditiawardana Aditiawardana; Artaria Tjempakasari; Chandra Irwanadi; Nunuk Mardiana; Pranawa Pranawa; Widodo Widodo
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2019): January - April 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (443.476 KB)

Background New-onset diabetes after transplant (NODAT) is one of the metabolic complications of kidney transplant surgery. The incident of NODAT varies highly, from 5% up to 53%. Some factors increase the risk for NODAT, such as age, gender, immunosuppressant drugs, among others. The progressivity of NODAT leads to increased cardiovascular risks, making the identification of risk factors crucial. Method Medical records of 56 patients who have undergone kidney transplant throughout 1998 - 2015 were evaluated. Data obtained from the records include age, gender, history of hypertension, dyslipidemia, the use of calcineurin inhibitors (CNI), and familial history of diabetes. Bivariate analysis with crosstabs (for nominal data) was used to analyze the data, with a threshold of p < 0.25 and followed up with multivariate analysis using logistic regression. Result The mean age of subjects was 53.85±12.92 years, with 80.4% of the subjects were male. Pre-transplant hypertension was 46.4%. The CNI used were tacrolimus in 46.4% and cyclosporine in 53.6% of patients. Around 25% of patients have a familial history of diabetes and the mean triglyceride level was 165.83±77.5 mg/dl. NODAT occurred in 18 patients and the majority of occurrence happened in the first year post-transplant. Bivariate analysis shows no significant risk factors, however clinically significant risk factors were gender (male), the CNI drug used (tacrolimus), and familial history of diabetes. Further multivariate analysis showed OR for gender (male) with OR 6.532 (0.735- 58.051), age with OR 5.249 (0.658-41.853)}, and the use of tacrolimus with OR 3.217 (0.895-11.571). Conclusion In this study, the clinically significant risk factors for NODAT were male gender, age, and the use of tacrolimus. However, these risk factors did not show statistical significance. Further study with bigger sample size is needed.

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Maimun Syukri

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maimun_62@unsyiah.ac.id

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+6221-3149208

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Jl. Salemba Raya No. 22 RT 006/06, Kenari, Senen Jakarta Pusat DKI Jakarta 10430 Indonesia

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