Hubungan Antara Kombinasi Hemodialisis (HD) / Hemoperfusi (HP) dengan Gangguan Mineral Tulang Pasien Hemodialisis Reguler

Abstract

Latar Belakang: Pada pasien dengan Penyakit Ginjal Kronik (PGK) bisa terjadi gangguan mineral tulang, ditandai dengan peningkatan kadar fosfat serum, penurunan kadar kalsium serum dan disertai dengan peningkatan hormon paratiroid. Hemoperfusi efektif membuang toksin atau molekul berukuran sedang besar akan tetapi tidak efektif membuang toksin molekul kecil, fosfat dan hormon paratiroid termasuk molekul ukuran sedang-besar, oleh karena itu dilakukan kombinasi Hemodialisis/ Hemoperfusi. Kidney Disease Outcomes Quality Initiative (KDOQI) merekomendasikan penilaian gangguan mineral tulang pasien hemodialisis regular dengan menilai Kalsium serum, fosfor serum, dan paratiroid hormon. Tujuan: Untuk mengetahui hubungan kombinasi HD/HP dengan gangguan mineral tulang pasien hemodialisis reguler. Metode: Penelitian kohort prospektif dari bulan Desember 2013 hingga Maret 2014 terhadap pasien hemodialisis reguler dan dilakukan anamnesis, dan pemeriksaan kalsium serum, fosfor serum, dan paratiroid hormon. Hasil: Dari 20 subjek yang diamati 1 subjek keluar dari penelitian. Didapatkan rerata fosfat serum sebelum penelitian 7,80±2,47 mg/dl dan sesudah 6,98±2,94 mg/dl didapatkan penurunan kadar fosfat serum seperti yang diharapkan tetapi tidak bermakna secara statistik, rerata hormon paratiroid sebelum 524,20±493,18 pg/ml, rerata hormon paratiroid sesudahnya 630,75±666,08 pg/ml yang secara statistik tidak signifikan. Bila dibedakan berdasarkan etiologi PGK dan lama HD didapatkan hasil yang signifikan pada kadar hormon paratiroid berdasarkan lama HD dimana pada pasien HD reguler lebih dari 5 tahun rerata setelah kombinasi lebih tinggi dari pasien kurang dari 5 tahun (1315,03±612,68 vs 502,45 ± 609,21; p=0,049). Kesimpulan: Dengan kombinasi HD/HP terdapat penurunan kadar fosfat serum sesudah HD/HP, dan peningkatan kadar hormon paratiroid sesudah tindakan HD/HP tetapi secara signifikan tidak bermakna

Background: Bone mineral disorder usually found in patients with Chronic Kidney Disease (CKD), characterized by elevated levels of serum phosphate, decreased levels of serum calcium and accompanied by an increase in parathyroid hormone. Haemoperfusion effectively remove or large-medium sized molecules but does not effectively remove small molecule toxins, phosphate and parathyroid hormone including medium-large molecular size, therefore, be a combination of hemodialysis / haemoperfusion. Kidney Disease Outcomes Quality Initiative (KDOQI) recommend the assessment of bone mineral disorder in regular hemodialysis patients to assess serum calcium, serum phosphorus, and parathyroid hormone. Tujuan: To determine the correlation of the combination of HD / HP with bone mineral disorder in regular hemodialysis patients. Methode: This prospective cohort study from December 2013 until March 2014 against regular hemodialysis patients and performed anamnesis, and examination of serum calcium, serum phosphorus, and parathyroid hormone. Result: From 20 subjects who were observed and 1 subject out of the study. serum phosphate obtained before the study 7.80 ± 2.47 mg / dl and after 6.98 ± 2.94 mg / dl obtained serum phosphate levels decrease as expected, but not statistically significant, parathyroid hormone before 524.20 ± 493.18 pg / ml, parathyroid hormone after 630.75 ± 666.08 pg / ml which was not statistically significant. When differentiated based on etiology of CKD and longer HD obtained significant results in parathyroid hormone levels based on the longer HD which regular HD patients more than 5 years after combination is higher than patients less than 5 years (1315.03 ± 612.68 vs 502.45 ± 609.21; p = 0.049). Conclusion: By a combination HD / HP there is a decreased in serum phosphate levels after HD / HP, and increased parathyroid hormone levels after action HD / HP but statistically not significant.