Role of Oxidative Stress on Chronic Kidney Disease Progression

Chronic kidney disease (CKD) is a worldwide health problem with a high incidence not only in western countries but also in Indonesia as well. The majority of patients with CKD died due to cardiovascular disease than CKD progression itself. In addition to traditional risk factors, cardiovascular disease in CKD might also due to non-traditional risk factors. Oxidative stress, as non-traditional risk factors, is not only able to explain the high incidence of cardiovascular disease in CKD, but also become a new target in therapeutic intervention. Oxidative stress in patients with CKD appears due to increased oxidant activity and decreased antioxidant system. Hemodialysis (HD) with the use of a cellulose and semi-cellulose membrane also contribute to increase oxidant that can activate the complement pathway. It stimulates inflammation that will further expand the production of oxidants and will ultimately increase oxidative stress. Key words: chronic kidney disease, oxidant, oxidative stress

The Role of Inflammation in Chronic Kidney Disease

The morbidity and mortality rate of patients with chronic kidney disease (CKD) remain high despite progressive development in CKD management. Microinflammation is an important component of CKD, and has an important role in the pathophysiology of cardiovascular disease (CVD) complications, as well as protein energy deficiency (PED) and mortality. Various factors contributes to the inflammatory state of CKD, including increased production and decreased excretion of pro-inflammatory cytokines, oxidative stress, acidosis, chronic vascular access infection, fat metabolism dysregulation, and intestinal dysbiosis. The inflammatory process has been shown to be directly correlated with glomerular filtration rate (GFR) in CKD and reaches its peak in end-stage renal disease (ESRD). A number of dialysis-related factors such as bioincompatible membranes and dialysate quality also have important roles in the inflammatory process. Meanwhile, the role of genetic and epigenetic factors is being widely studied. Efforts in reducing inflammation such as lifestyle modification, medication, and dialysis optimization have been performed and tested into a controlled clinical trial

Genotip virus hepatitis C pada penderita yang menjalani hemodialis sebagai populasi beresiko tinggi tertular virus hepatitis C di Surabaya, Indonesia

Infeksi Virus Hepatitis C (VHC) masih menjadi masalah kesehatan di dunia termasuk di Indonesia. Dari tahun ke tahun, tdar banyak tl:rdell:ksi pcngidap penderita infeksi kronik VHC di seluruh dunia. Virus Hepatitis VHC dapat ditularkan secam parenteral. I\;nderita penyakit yang sedang menjaiani hemodialisis merupakan salah satu kelc.'n1pok penderita yang beresiko tinggi tertular infeksi VHC. Genotip tertentu VHC dilaporkan ikut bcrperan pada perjalanan infeksi virus hepatitis tersebut. Saat ini diketahui ada 6 genotipVHC didunia dan masing-masing genotip terdiri dari beberapa sUbtipe dengan penyebaran yang berbeda pada daerah geografi yang berbeda. Dikemukakan bahwa pada keadaan akut infeksi VHC sering tanpa gejala, sehingga sekitar 85% dari penderita yang terinfeksi VHC menjadi kronis. Prevalensi infeksi VHC cukup tinggi dan bervariasi pada penderita yang sedang menjalani hemodialisasi di berbagai negara dan infeksi VHC ini akan memperpendek umur penderita yang sedang menjalani hemodialisis. Dengan mempertimbangkan hal-hal tersebut diatas, maka dirasakan perlu dilakukan penelitian Genotip Virus Hepatitis C pad a penderita yaog sedang menjalani hemodialisis sebagai populasi beresilw tinggi tertular VHC di Surabaya, Indonesia

PERAN FAKTOR RISIKO KARDIOVASKULAR NON-TRADISIONAL DALAM PATOGENESIS DAN PROGRESIFITAS PENYAKIT GINJAL KRONIK

Penyakit ginjal kronik memiliki sifat progresif dan berkembang perlahan. Pada awalnya, kerusakan pada sebagian ginjal akan dikompensasi oleh bagian ginjal yang lain. Perlu diketahui bahwa setiap ginjal memiliki lebih dari satu juta nefron (unit fungsional terkecil ginjal), sehingga ginjal memiliki kapasitas cadangan yang besar. Seringkali individu tidak merasakan gejala gangguan ginjal hingga kehilangan fungsi ginjal sekitar 90%, yakni pada PGK stadium akhir. Namun jika kerusakan awal tersebut tidak terdeteksi dan tidak mendapat penanganan yang memadai, PGK akan berkembang dan menyebabkan kerusakan lebih lanjut. Kerusakan diawali dengan terjadinya hiperfiltrasi glomerular, mikroalbuminuria, albuminuria, fibrosis tubulo interstisial, dan glomerulosklerosis yang pada akhirnya mengakibatkan penurunan fungsi ginjal hingga mengalami gagal ginjal (Levey et al., 2010). Maka pantaslah apabila PGK dijuluki sebagai the silent killer

Anti-HIV dan Subtipe HIV pada pasien Hemodialisis (Anti-HIV and HIV Subtype in Hemodialysis Patients)

Anti-Human Immunodeficiency Virus (Anti-HIV) was performed from 100 plasma Chronic Kidney Disease (CKD) stage 5 patients with continuous hemodialysis (HD) at the Hemodialysis Instalation Dr Soetomo hospital, Surabaya, Indonesia, using three (3) kind of reagents: Tri-line HIV Rapid test Device from Acon for HIV 1/2/O as strips form, Foresight HIV 1/2/O Antibody EIA Test Kit from Acon and Anti-HIV 1+2/Subtype O ELISA from Axiom. HIV RNA and HIV subtype were detected by Reverse Transcription Polymerase Chain Reaction (RT-PCR) based on HIV gag region and analysis of DNA result. Seventy three % patients were hemodialysed twice in a week and only 14% with duration more than five (5) years. Most of the patients (43%) were hemodialysed between 100−300 times. From the 100 plasma samples was obtained only one (1%) man patient plasma sample with positive anti-HIV. A weak positive of RT-PCR result was not succeed to be sequenced for determining the HIV subtype. This cause was suspected due to low levels of HIV RNA in blood. The results of this study was expected can be used as an additional management consideration of hemodialysis patients at the Hemodialysis Unit

Comparison of Total Antioxidant Capacity (TAC)'S Patients of Chronic Kidney Disease Undergoing Hemodialysis and Non-Hemodialysis

Background: Total antioxidant capacity (TAC) is one of the biomarkers to determine a person's health condition through antioxidant and oxidant activity or oxidative stress so that it can help in determining the therapy needed. However, currently, TAC levels in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and non-hemodialysis (non-HD) are still controversial, so further research is needed. Objective: To analyze the comparison of TAC in HD and non-HD CKD patient. Material and Method: This was an analytical cross-sectional study with clinical observation in CKD patient. A total of 71 CKD patients consisting of 28 CKD HD patients and 43 non-HD CKD patients were enrolled in this study. Data about the characteristics of the subjects were taken using the anamnesis method, while data about TAC were taken using the colorimetric method with COBAS C-501 0837-19 series and 0835-13 series to measure TAC levels in the serum of CKD patients. The data that has been obtained were analyzed using independent sample t-tests. Result: TAC levels were significantly higher in CKD patients undergoing HD compared to non-HD CKD patients (p <0.05). There are data on albumin as an antioxidant and MDA as an oxidative stress biomarker that affects TAC levels. Conclusion: TAC levels found to be higher in hemodialysis CKD patient compared to non-hemodialysis CKD patient

Peran Resiliensi, Positive Social Relationships, dan Health Belief terhadap Kesejahteraan Emosi Pasien Hemodialisis

Individu didiagnosis dengan penyakit ginjal stadium akhir dan harus menjalani perawatan hemodialisis memiliki implikasi bahwa menjadi tergantung pada pengobatan seumur hidup. Sejumlah studi melaporkan pasien hemodialisis mengalami beban simtom dan terganggunya well-being akibat penyakit maupun perawatan hemodialisis. Penelitian ini bertujuan untuk menguji peran resiliensi, positive social relationships, dan health belief terhadap emotional well-being pasien hemodialisis. Subjek penelitian yaitu pasien penyakit ginjal stadium akhir yang menjalani hemodialisis secara rutin di Instalasi Hemodialisis RSU Dr. Soetomo, Surabaya yang dipilih melalui purposive sampling, artinya dipilih berdasarkan pertimbangan kriteria tertentu dan kesediaan berpartisipasi. Penelitian ini melibatkan pasien hemodialisis sejumlah 55 orang terdiri dari 34 laki-laki dan 21 perempuan, berusia 26 – 60 tahun. Menggunakan metode kuantitatif dengan melakukan survei, pengumpulan data dilakukan menggunakan lima Skala yakni Scale of Positive and Negative Experience (SPANE) dan Satisfaction with Life Scale (SWLS), 10-Item Connor-Davidson Resilience Scale (10-Item CD-RISC), Medical Outcomes Study Social Support Survey (MOS-SSS), dan Skala Health Belief. Analisis data dilakukan dengan analisis statistik uji regresi ganda. Hasil uji regresi ganda menunjukkan bahwa hipotesis ditolak, artinya resiliensi, positive social relationships, dan health belief secara simultan tidak dapat memprediksi emotional well-being pasien hemodialisis (F = 2,363, p 0,05). Secara parsial, berdasarkan nilai t diketahui hanya resiliensi memberi kontribusi signifikan terhadap emotional well-being (t = 2,342, p 0,05), sementara positive social relationships dan health belief masing-masing memberi kontribusi tidak signifikan terhadap emotional well-being. Penelitian berikutnya diharapkan dapat membantu meningkatkan coping resources yakni resiliensi yang bermanfaat mendorong perkembangan emosi positif, serta dapat membantu memberi edukasi terkait penyakit ginjal dan hemodialisis sehingga pasien memiliki pemahaman, respon permasalahan, dan belief yang lebih positif.Kata kunci: emotional well-being, pasien hemodialisi

8-Hydroxydeoxyguanosine Urine and Total Nitric Oxide Serum in Chronic Kidney Disease

Oxidative stress is essential to chronic kidney disease (CKD). Several markers include 8-Hydroxydeoxyguanosine (8-OHdG) and Nitric Oxide (NO). Reactive oxygen species (ROS) and Reactive Nitrogen Species (RNS) increased in CKD and had a role in renal impairment progressivity. There are some controversies regarding oxidative markers in CKD patients in several studies. This study aimed to understand oxidative markers 8-OHdG and NO and explained the correlation of both markers in hemodialysis and non-hemodialysis CKD patients. Twenty hemodialysis patients and forty-nine non-hemodialysis patients were enrolled in this cross-sectional study. Urine patients were collected to measure 8-OHdG using the enzyme-linked immunoassay (ELISA) method, and NO was measured from serum patients using the Griss Saltzman method. Based on Bivariate Pearson analysis, there was no significant correlation between 8-OHdG urine and total NO serum in the hemodialysis group (p= 0,510, p>0.05) and in the non-hemodialysis group (p= 0.801, p>0,05). In this study, DNA oxidative marker, 8-OHdG, was not correlated with NO in CKD patients

Association of High Blood Pressure with Elevated Oxidative Stress, Inflammatory Marker and Albuminuria in Chronic Kidney Disease Patients

Background: Activation of renin-Angiotensin system in hypertension was believed to be major determinant in endothelial dysfunction, micro-inflammation, and reactive oxygen species generation. This study aimed to investigate the interaction of increased blood pressure with cardiovascular risk factors in chronic kidney disease (CKD). Materials & methods: The study was an observational study with cross-sectional design that consecutively enrolled CKD patients in Universitas Airlangga Hospital and two other hospitals in Surabaya, Indonesia. The resting blood pressure and kidney functions of the participants were examined. Malondialdehyde (MDA) and total antioxidant capacity (TAC) was measured in serum and used as oxidative stress markers. Serum hs-C-reactive protein (CRP), lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio were utilized as inflammatory markers, while urine albumin-to-creatinine ratio (ACR) was used as renal disease marker. The participants were grouped based on their systolic and diastolic blood pressure (SBP and DBP). The difference of marker levels between groups was tested using Mann-Whitney test. The correlation between SBP and DBP with inflammation, oxidative stress, and albuminuria was determined using Spearman’s test. Results: As many as 71 patients with CKD were enrolled in this study. As much as 37% of the participants had high SBP and 14% had high DBP. High SBP positively associated with MDA (P<0.05), hs-CRP (P<0.05), platelet-to-lymphocyte ratio (P<0.05), and ACR (P<0.0001) and negatively with lymphocyte-to-monocyte ratio (P<0.05) and TAC (P<0.0001). High DBP associated positively with ACR (P<0.05) and negatively with TAC (P<0.05). Conclusions: High systolic or diastolic blood pressure was significantly associated with inflammation, oxidative stress and albuminuria. Optimal blood pressure control may be one of strategies to prevent inflammation and oxidative stress among CKD patients