Pengaruh hemodialisis terhadap penurunan kadar TNF-α dan prokalsitonin pada pasien penyakit ginjal kronis stadium V di unit hemodialisis RS dr. Moewardi Surakarta

Oleh :
Primahati Riana Rosy - S9607015 - Fak. Kedokteran

ABSTRAK Latar belakang. Penyebab kematian terbanyak (60%) penderita Penyakit Ginjal Kronik Stadium V (PGK St.V) adalah kejadian kardiovaskuler yang didasari oleh aterosklerosis. Prokalsitonin dan TNF-α merupakan biomarker inflamasi. Dimana pada pasien dengan Penyakit Ginjal Kronik Stadium V yang menjalani hemodialisis secara rutin mempunyai kadar Prokalsitonin dan TNF-α yang meningkat sehingga dapat memperbesar angka kesakitan dan kematian karena kejadian kardiovaskuler yang didasari oleh aterosklerosis. Tujuan Penelitian. Penelitian ini bertujuan untuk mengetahui pengaruh hemodialisis terhadap penurunan kadar TNF-α dan Prokalsitonin pada pasien PGK stadium V. Subjek dan Metode. Subyek adalah pasien yang menderita PGK St. V yang telah menjalani hemodialisis selama 3 bulan sampai 5 tahun di RSDM, memenuhi kriteria inklusi dan telah mengisi inform consent. Penelitian bersifat Observasional - Eksperimental dengan pendekatan pre dan post test. Hemodialisis menggunakan dialiser hollogram tipe membran low-flux selulosa diasetat. Pemeriksaan kadar TNF-α dalam serum darah diperiksa secara quantitative melalui metoda Human TNF-α/ TNFSF 1A Immunoassay dan kadar Prokalsitonin dalam serum diperiksa secara quantitative melalui Electrochemiluminescence dengan metode Enzyme Linked Fluorescent Assay (ELFA). Data yang diperoleh kemudian dilakukan Analisis statistik menggunakan SPSS.13. Dengan jumlah sampel < 50 dipakai uji normalitas statistik Shapiro-Wilk (Test of Normality). Uji- t berpasangan digunakan untuk menguji rata-rata variabel dua kali pengukuran. Signifikansi p<0,05 (terdapat perbedaan yang bermakna antara dua pengukuran variabel). Untuk mengetahui adakah korelasi dilakukan test Correlation Product Moment. Hasil. Didapatkan 12 sampel serum prehemodialisis dan 12 sampel serum pasca hemodialisis. Hasil rata-rata kadar TNF-α sebelum dilakukan dialisa adalah 8,72 ng/dL dan setelah dilakukan rata-rata kadar TNF-α meningkat menjadi 10,20 pg/dL. Nilai signifikansi 0,006 (p<0,05) menunjukkan suatu peningkatan yang bermakna antara sebelum dan sesudah dilakukan dialisis. Sedangkan rata-rata kadar Prokalsitonin sebelum dilakukan dialisa 0,83 ng/dL dan setelah dilakukan dialisis rata-rata kadar Prokalsitonin menurun menjadi 0,67. Nilai signifikansi 0,002 (p<0,05) menunjukkan suatu penurunan yang bermakna antara sebelum dan sesudah dilakukan dialisis. Tidak didapatkan korelasi diantara dua variabel tersebut. Kesimpulan. Pada penelitian ini hemodialisis dengan menggunakan dialiser hollogram tipe membran low-flux selulosa diasetat menyebabkan peningkatan kadar TNF-α yang bermakna P=0,006 dan menyebabkan menurunkan kadar Prokalsitonin yang bermakna P=0,002. Tidak terdapat korelasi antara kadar TNF-α dan kadar Prokalsitonin. Kata kunci : haemodialisis, TNF-α , Prokalsitonin, PGK St. V ABSTRACT Background. The cause of death of most (60%) people with Chronic Kidney Disease stage V (CKD St. V) is the cardiovascular event due to atherosclerosis. Procalcitonin and TNF-α is an inflammation biomarker, where patients with CKD St. V which routinely perform the hemodialysis possess increased level of Procalcitonin and TNF-α, therefore increasing morbidity and mortality rate as a consequence of the cardiovascular event due to atherosclerosis. Research Objectives. This study aims to determine the influence of hemodialysis towards reduction of TNF-α and Procalcitonin level in CKD stage V patients. Subject and Method. Subject is patients who suffered CKD St. V which has been undergoing hemodialysis for 3 months to 5 years in RSDM, meet the inclusion criteria and has have filled the inform consent. Research is Observational-Experimental with pre and post test approaches. Hemodialysis is performed with hologram dialyzer membrane low-flux cellulose diacetate type. Measurement of TNF-α level in blood serum was quantitatively examined through the method of Human TNF-α /TNFSF 1A Immunoassay, while Procalcitonin level in serum was quantitatively examined through the Electrochemiluminescence with Enzyme Linked Fluorescent Assay method (ELFA) using the Elecsys instruments in PRODIA laboratory. Data is then performed using the statistical analysis SPSS.13. With the number of samples <50 is used Shapiro-Wilk statistics test of normality. A paired T-test is used to test an average of two times the measurement of variables. Significance p<0.05 (which means there is a significant difference between two measurement variables). To find out the correlation, Product Moment Correlation test was performed. The Pearson formula is used when normal data obtained, whereas the Spearman formula is used when the data is not normal. Results. 12 prehemodialysis serum samples and 12 post hemodialysis serum samples obtained. Results of average TNF-α level before dialysis is 8.72 ng/dL and after hemodialysis for 4-hour mean of TNF-α level increased to 10.20 pg/dL. Significance value is 0.006 (p <0.05) showed a highly significant increase before and after hemodialysis. Mean of Procalcitonin level performed before dialysis is 0.83 ng/dL and after dialysis for 4 hours mean of Procalcitonin level is decreased to 0.67. Significance value is 0.002 (p <0.05) showed a significant decrease before and after hemodialysis. No correlation was found between these two variables. Conclusion. On this research hemodialysis using hologram dialyzers membrane low-flux cellulose diacetate type significantly increased TNF-α level (P = 0.006) and decreased the Procalcitonin level (P = 0.002). There is no correlation between TNF-α and Procalcitonin level. Keywords : haemodialysis, TNF-α, Procalcitonin, CKD Stage V.