C-Reactive Protein and Leukocyte as Predictors of Complications in Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is the narrowing of peripheral blood vessels which prevalence is high in the elders. In 2010, it was estimated that 202 million people were suffering from PAD, most of which are in developing countries, especially the Southeast Asia region. Inflammation markers such as leukocyte and C-Reactive Protein (CRP) can predict the incidence of PAD but their use in determining prognosis remains unclear. Complications in PAD include amputation, increased cardiovascular events, and even death. Aim: This study aims to determine the relationship between leukocyte and CRP level on complications in PAD, in the forms of amputation, cardiovascular events, and mortality. Methods: This is a meta analysis study which uses online literature sourced from Pubmed, Science Direct, Cochrane, and Google Scholar. Results: Based on the data analysis, there is a significant relationship between CRP with the incidence of amputation (HR 1.24, 95%CI: 1.02-1.49, p=0.03) and hs-CRP with cardiovascular events (HR 1.33, 95%CI: 1.10-1.60, p=0.003). Leukocyte on the other hand shows no significant relationship with the incidence of amputation (OR 1.10, 95%CI: 0.98-1.23, p=0.10) and mortality (OR 1.14, 95%CI: 0.97-1.35, p=0.12

Factors Affecting Gastrointestinal Disorders in Patients Undergoing Regular Hemodialysis

Background: Chronic Kidney Disease (CKD) is an immense health issue. The prevalence is increasing each year worldwide, including Indonesia. Consistent with this trend, the prevalence of hemodialysis (HD) as a therapy is also increasing. CKD as well as HD often result in some complications, one being gastrointestinal disorders. Many factors are  correlated  with the incidence of gastrointestinal disorders in CKD patients undergoing HD. Objective: This research is held to observe the factors affecting gastrointestinal disorders in regular HD patients. Method: This is an observational analytical research with cross-sectional study at RS Khusus Ginjal Rasyida Medan. The datas used in the research are primary datas, obtained from Gastrointestinal Symptoms Rating Scale (GSRS) questionnaire to assess severity of gastrointestnal disorders in HD patients, and secondary datas, obtained from medical records of age, smoking history, use of aspirin, HD duration, BUN, and Kt/V (as a parameter of HD adequacy). Then the datas are analyzed univariately, bivariately, and mutivariately using biner logistic regression model. It is considered significant if the obtained p value is <0,05 (p<0,05). Result: All patients (100%) suffer from gastrointestinal disorders, with the most common being mild ones (67,1%). Final multivariate analysis shows that the duration of HD, BUN level, and Kt/V are significantly  correlated  with worsening gastrointestinal disorders (OR:14,157 ,95%CI 2,851 ± 71,183, p=0,001; OR: 8,352, 95%CI 0,914 ± 76,344, p= 0,060; OR:8,219 ,95%CI 0,893 ± 75,674, p= 0,063). Conclusion: The duration of HD, BUN level, and Kt/V are  correlated  with worsening gastrointestinal disorders in HD patients

Association between KLOTHO Gene G395A Polymorphism and Carotid Artery Calcification in regular Hemodialysis Patients

BACKGROUND: The vascular calcification process in chronic kidney disease (CKD) is a complication caused by mineral and bone abnormalities and becomes the risk of cardiovascular disease and mortality in CKD patients. KLOTHO is an inhibitor of calcification and its expression has been observed to decrease in CKD patients. The KLOTHO gene G395A polymorphism is a genetic variation that is common in Asian populations and is associated with vascular dysfunction in hemodialysis patients. OBJECTIVE: The objective of the study was to determine the association between the KLOTHO gene G395A polymorphism and carotid artery calcification in regular hemodialysis patients. METHODS: This study was an analytical study with a cross-sectional design and was carried out at Rasyida Kidney Hospital Medan. Venous blood sample was taken from the patients who met the inclusion criteria for examination of the KLOTHO gene -395 polymorphism and carotid ultrasonography was assessed to evaluate the thickness of the tunica media-intima as a marker of vascular calcification. RESULTS: The majority of the study subjects were men, as many as 35 patients (50.7%). From the results of the KLOTHO gene -395 polymorphism, it was found that the majority of subjects had GG genotypes as many as 36 people (52.2%) followed by GA genotypes as many as 30 people (43,5%) and AA genotypes as many as 3 (4,3%). There was a statistically significant of the association between KLOTHO gene -395 polymorphism and the incidence of carotid artery calcification (p = 0,015). CONCLUSION: There was an association between the KLOTHO gene G395A polymorphism and carotid artery calcification in regular hemodialysis patients

High Fetuin-A Level as a Protective Factor to Abdominal Aortic Calcification in Indonesian Regular Hemodialysis Patients

BACKGROUND: Although the prevalence of cardiovascular disease decreases in the general population, this pattern is not followed in hemodialysis patients. Hence cardiovascular events still occur in 50% of cases resulting in hemodialysis patients. One of the risk factors is vascular calcification. The pathogenesis is not yet fully understood, but recent years studies have shown that vascular calcification in chronic kidney disease (CKD) occurs as a result of the interaction of stimulatory and inhibitory factors. One of the inhibitory factors is Fetuin-A. Until now there has been no data on levels of Fetuin-A as a risk factor for abdominal aortic calcification in Indonesia. AIM: To determine the effect of Fetuin-A levels on abdominal aortic calcification in regular hemodialysis patients. METHODS: This study was a cross-sectional study on 76 regular hemodialysis patients at Rasyida Renal Hospital Medan. Fetuin-A level was examined by enzyme-linked immunosorbent assay (ELISA). Assessment of abdominal aortic calcification was done by lateral lumbar X-ray. RESULTS: Most patients (68.4%) had abdominal aortic calcification, in both layers; intima and media (44.7%). Abdominal aortic calcification was associated with Fetuin-A level and age. Multivariate analysis showed that high Fetuin-A levels were significantly associated with abdominal aortic calcification. CONCLUSION: High Fetuin-A level appeared to be a protective factor against abdominal aortic calcification in regular hemodialysis patients in Indonesia

The Relationship between Obstructive Sleep Apnea (OSA) and Adherence of Antihypertensive Consumption in Regular Hemodialysis Patient

Background. Based on the Indonesian Renal Registry (IRR) data in 2015, the highest incidence of comorbidities in hemodialysis patients in Indonesia was hypertension (50%). Obstructive Sleep Apnea (OSA) is one of the causes of secondary hypertension, the characteristics of hypertension in OSA are more resistant to treatment. One of the causes of resistant hypertension is patient non-compliance with the consumption of antihypertensive drugs. Aim. To determine the relationship of adherence of consumption of antihypertensive drugs with obstructive sleep apnea in regular HD patients. Method. This cross-sectional study involved 89 outpatients in HD units at the Rasyida Kidney Hospital in 2018. Data was obtained through interview using the STOP-BANG questionnaire to assess the of risk of OSA and using Morisky Medication Adherence Scale (MMAS) questionnaire to measure the compliance of  drug consumption. Results.The prevalence of OSA  in HD patients was (39.3%). There was no significant relationship between adherence with drug consumption and OSA risk, but in bivariate analysis, age (p = 0.0001), body mass index (BMI) (p = 0.001), and gender (p = 0.03) were significantly related to OSA. In multivariate, age and BMI were significantly associated with OSA (OR: 6.449, 95% CI 2.246 ± 18.520, p = 0.001; OR: 6.130, 95% CI 2.105 ± 17.849, p = 0.001). Conclusion. OSA was not statistically related to adherence to antihypertensive drug consumption in HD patients but was significantly associated with age and BMI.     Keyword. Adherence to antihypertensive consumption, hemodialysis, obstructive sleep apnea

The Influence of −174 G/C Interleukin 6 Promoter Gene Polymorphism to Interleukin 6 Concentration in the End Stage Renal Disease Patients with Dialysis: A Single-center Experience in Indonesia

BACKGROUND: Chronic kidney disease (CKD) is classified as a multifactorial disease as a combination of genetic and environmental factors that affect the onset and progression of end-stage renal disease (ESRD). In the last decades are recognized that inflammation, where the critical modulator is cytokines, can occur before the onset of kidney disease and can be a causative factor in the development of CKD. Interleukin (IL)-6 has several polymorphisms in the promoter region, such as 174 G-C, 634 C-G, 572 G-C, and 597 G-A. G/C single nucleotide polymorphism of the IL-6 gene at position 174 in the promoter region is reported to affect the level of IL-6 expression. Unfortunately, there is a lack of data about the genotype frequencies of -174 G/C IL-6 promoter gene polymorphism in Indonesian with ESRD. AIM: This study aimed to analyze whether −174 G/C IL-6 promoter gene polymorphism influences the concentration of IL-6 in ESRD patients with dialysis in Indonesia. METHODS: We recruited 95 outpatients who were undergoing regular hemodialysis for ≥3 months at the Rasyida Renal Hospital, Medan, in this cross-sectional study. IL-6 genotype polymorphism was analyzed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The enzyme-linked immunosorbent assay method was performed to assess the quantitative IL-6 serum. RESULTS: PCR-RFLP examination showed the frequency distribution of the IL-6 genotype -174 G/C gene; 72 (75.8%) respondents had GG genotypes; 22.1% of respondents had the CG genotype, and (2.1%) had the CC genotypes. Patients with the CC genotype were statistically significant to have higher IL-6 concentration compared to other genotypes (p < 0.001). Likewise, with diabetic patients, statistics showed higher IL-6 concentration compared to non-diabetics patients (p < 0.001). CONCLUSION: This is the first study showing that -174 G/C IL-6 promoter gene polymorphism influences the IL-6 concentrations in ESRD patients with dialysis in Indonesia. Multicenter studies are needed to validate these findings

Fibroblast Growth Factor-23 (FGF-23) in Patients with Regular Hemodialysis: A Risk Factor for Restless Legs Syndrome

Background: Restless Legs Syndrome (RLS) is one of the most common sleep disturbance problems in dialysis patients. In this study, we would like to explore some of bone and mineral marker disorder especially fibroblast growth factor-23 (FGF-23)and its correlation with RLS in regular hemodialysis patients. Methods: This is a cross sectional study design involving 71 respondents with chronic kidney disease that already had regular hemodialysis at Haji Adam Malik Hospital Medan. Status of RLS in this patients were being evaluated according to the International Restless Leg Syndrome Study Group (IRLSG) by interviewing and laboratory examination of FGF-23, hemoglobin (Hb), serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TSAT), serum ferritin, calcium (Ca) and phosphate (P) level. Results: Of all study subjects, 26 respondents (34.6%) diagnosed with RLS. Bivariate analysis result showed that there is a relationship between FGF-23, hemoglobin, phosphate, and transferrin saturation level with RLS. Logistic regression analysis used to see the most dominant factor of all. Conclusion This study conclude that increase in FGF-23 levels can increase the risk of RLS. However, FGF-23 is not the most dominant risk factor for RLS in regular hemodialysis patients

The Relationship Between Quality of Sleep and Quality of Life of Patients in Medan, Indonesia

BACKGROUND: Hypertension is one of the most common diseases around the world, which is the most risk factor related to cardiovascular disease. The quality of life of hypertensive patients is influenced by various factors, namely age, sex, educational background, ethnicity and nutritional status. Another factor that is also important is the quality of sleep.AIM: We aimed the assessment of sleep quality using a PSQI questionnaire, and quality of life assessment with the SF-36 questionnaire.METHODS: This study was a cross-sectional study of 45 respondents at the H. Adam Malik Central General Hospital in Medan in 2018. Assessment of sleep quality was performed through the PSQI questionnaire (Pittsburgh Sleep Quality Index), and quality of life assessment was carried out with the SF-36 questionnaire.RESULTS: The prevalence of impaired sleep quality in hypertensive patients was 35.6%. Most patients have a good quality of life, with 71.1%. In this study, sleep quality was found to be related to the quality of life (p = 0.037). Furthermore, variables related to sleep quality were sex (gender) (p = 0.003) and education (p = 0.005). In multivariate analysis, the quality of life is predominantly influenced by sleep quality (p = 0.025).CONCLUSION: The quality of life of hypertensive patients is influenced by the quality of sleep

AHSG Thr256Ser Gene Polymorphism as a Predictor of Low Serum Fetuin-A Levels in Indonesian Maintenance Hemodialysis Patients

BACKGROUND: Vascular calcification (VC) is a risk factor for cardiovascular morbidity and mortality in maintenance hemodialysis (MHD) patients. The effect of alpha2-Heremans Schmid glycoprotein (AHSG) Thr256Ser gene polymorphism toward serum fetuin-A levels as one of the VC inhibitors in MHD patients is still unclear. OBJECTIVE: This study aims to investigate the relationship between AHSG Thr256Ser gene polymorphism toward serum fetuin-A levels in MHD patients in Indonesia. METHODS: The research study design used was cross-sectional. Serum fetuin-A levels were assessed by enzyme-linked immunosorbent assay method, and polymerase chain reaction-restriction fragment length polymorphism determined AHSG Thr256Ser gene polymorphism. Multivariate linear regression analysis was used to analyze the factors related to serum fetuin-A levels. p < 0.05 was considered as statistically significant. RESULTS: Median value of serum fetuin-A levels was 235.0 pg/ml (ranging 78–756) with mean 259.99 ± 119.36 pg/ml. Out of 106 patients involved, the distribution of AHSG Thr256Ser genotype frequency was 54 (50.9%) respondents had CG genotype, 46.2% had CC genotype, and the others (2.8%) had GG genotype. Patients with homozygous C allele (CC genotype) were 0.1 times more protected (CI 95%: 0.1–0.3) to have low serum fetuin-A levels, compared with patients with G allele either in a homozygote (GG genotype) or in the heterozygote (CG genotype). From the multivariate analysis results, it can be obtained a formulation in predicting serum fetuin-A level, which is: Serum fetuin-A level prediction = 276,59 + 150,49 DM - 0,26 serum interleukin -6 level - 43,58 AHSG Thr256Ser gene polymorphism CONCLUSIONS: AHSG Thr256Ser gene polymorphism had a significant relationship with serum fetuin-A levels in MHD patients in Indonesia. Subjects with G allele (CG and GG genotypes) had lower serum fetuin-A levels than those with CC genotype

Factors That Influence Behavior of Chronic Kidney Disease Prevention in Medan Citizens

Chronic kidney disease is defined as the abnormality of kidney structure and function., which stays for more than 3 months long, with health implications. Today, chronic kidney disease is giving a great contribution to the world’s burden. Chronic kidney disease also affects 8%-16% of the world’s population. The huge number of chronic kidney disease cases has proven to be caused by the lack of knowledge regarding the signs and risk factors of chronic kidney disease. This is observational analytical research with a cross-sectional design. The data used in this research are primary data, obtained from questionnaire instruments on Medan citizens. The data is analyzed univariately, bivariate, and multivariately. Out of 100 respondents, it is acquired that adult (p<0,001), male gender (p<0,001), and higher education (p<0,001) were the only factors significantly associated with good knowledge, good attitude, and positive behavior. Lastly, respondents with good knowledge (p=0,002) (PR = 8,017 (90% CI: 2,759-23,296)) and, good attitude (p<0,001) (PR= 13,668 (90% CI: 4,269-43,767)) will have a positive behavior&nbsp