Hubungan Anemia dan Kadar Serum Hepcidin pada Pasien yang Menjalani Hemodialisa Reguler dengan Hepatitis C Kronik di RSUP H Adam Malik Medan

Abstract

Background : End stage renal disease patients who undergo hemodialysis therapy are the high-risk populations who are infected by hepatitis C virus. Some studies have been reported that hepcidin levels decreased in patients with chronic hepatitis C. Hepcidin serum concentrations are also reported to increase in patients with renal failure in the line with increased severity of renal failure, which can cause the accumulation of hepcidin which culminates in anemia because iron deficiency. This Study was to analyze the correlation of anemia and hepcidin serum levels on the patients who are undergoing regular hemodialysis with chronic hepatitis C. Methods : This study was an analytic observational with cross sectional design which was conduted on 24 patients end stage renal disease (ESRD) with chronic hepatitis C and 24 patients with ESRD without hepatitis who are undergoing regular hemodialysis theraphy in Haji Adam Malik Hospital, Medan in July – September 2016. . All study subjects were examined for full blood count and hepcidin serum levels. The result of the iron status were recorded from the patient’s medical record. Result : In this study, the mean hemoglobin was 8,15±1,44 g/dL, mean hematocrit 25,42±4,53%, median hepcidin levels 29,75 (4,92-359,49) in the patients ESRD with chronic hepatitis C and mean hemoglobin 8,21±1,50 g/dL, mean hematocrit 25,25±4,37%, median hepcidin levels 30,33 (11,65-141,53) in the patients ESRD without hepatitis. In Spearman’s rhotest was showed a positive correlation that significant between hepcidin and hemoglobin (r = 0,439, p = 0,032), hepcidin and hematocrit (r = 0,021, p = 0,024) in patients ESRD with chronic hepatitis C. Conclusion : This study showed there was a positive correlation between anemia and hepcidin serum levels in patients end stage renal disease with chronic hepatitis C.

Latar belakang :Pasien gagal ginjal terminal (GGT) yang menjalani terapi hemodialisa merupakan populasi yang berisiko tinggi tertular penyakit hepatitis C. Beberapa penelitian melaporkan bahwa kadar hepcidin menurun pada pasien hepatitis C kronik. Konsentrasi serum hepcidin juga dilaporkan meningkat pada pasien gagal ginjal sejalan dengan peningkatan keparahan gagal ginjalnya, yang dapat menyebabkan penumpukan kadar hepcidin yang berujung pada anemia karena kekurangan zat besi. Penelitian ini dilakukan untuk melihat apakah ada hubungan anemia dan kadar serum hepcidin pada pasien yang menjalani hemodialisa reguler yang menderita hepatitis C kronik. Metode : Penelitian ini merupakan analitik observasional dengan pendekatan potong lintang yang dilakukan pada 24 pasien GGT dengan hepatitis C kronik dan 24 pasien GGT non hepatitis yang menjalani terapi hemodialisa reguler di RSUP Haji Adam Malik Medan pada bulan Juli – September 2016. Semua subjek penelitian diperiksa darah lengkap dan kadar serum hepcidin. Hasil pemeriksaan status besi dicatat dari data rekam medik pasien. Hasil : Pada penelitian ini, didapati rerata hemoglobin 8,15±1,44 g/dL, rerata hematokrit 25,42±4,53%, nilai median kadar hepcidin 29,75 (4,92-359,49) pada pasien GGT dengan hepatitis C kronik dan rerata hemoglobin 8,21±1,50 g/dL, rerata hematokrit 25,25±4,37%, nilai median kadar hepcidin 30,33 (11,65-141,53) pada pasien GGT non hepatitis. Pada uji spearman’s rho didapat hubungan positif yang signifikan antara hepcidin dan hemoglobin (r=0,439, p=0,032), hepcidin dan hematokrit (r=0,021, p=0,024) pada pasien GGT dengan hepatitis C kronik. Kesimpulan : Terdapat hubungan positif antara anemia dan kadar serum hepcidin pada pasien gagal ginjal terminal dengan hepatitis C kronik..