Asosiasi Kadar Interleukin-6 dengan Kejadian Pruritus pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisa Reguler

Abstract

Introduction: Chronic kidney disease (CKD) patient who undergo hemodialysis often have several complaints where pruritus is experienced in 20% - 90% of patients. Inflammation is thought to play an important role in pruritus in hemodialysis patients. Among many pro-inflammatory cytokines, research shows that Interleukin-6 (IL-6) is the central regulator of the inflammatory process, and is found in dermal nerve fibers. Method: This research is an analytical test with cross-sectional design to determine the relationship between IL-6 levels and the incidence of pruritus in CKD patients undergoing regular hemodialysis. Patients were asked to fill out the Pauli-Magnus questionnaire. Test for serum IL-6, calcium and phosphate level was performed. Subsequently after the data is collected, data processing and analysis are executed. Result: Of the 100 patients, it was found that age and frequency of hemodialysis and IL-6 levels were statistically significant associated with the incidence of pruritus (p0,003; p=0,021 and p=0,001). Age group of 45 -55 years vs. <45 years, frequency of hemodialysis 3 times/week vs 2 times/ week, history of consumption of phosphate binding drugs containing calcium, and IL-6 levels; all had a statistically significant relationship to the incidence of pruritus in CKD patients(p=0,043; p=0,010; p=0,008, and p=0,001). Conclusion: From this study it can be concluded that there is a correlation between IL-6 levels and the incidence of pruritus in CKD patients who undergo regular hemodialysis. The cut-off value of IL-6 as a predictor of pruritus in CKD patients undergoing regular hemodialysis was 101.550 mg/ml with a sensitivity of 98.1% and specificity of 95.8%

Pendahuluan : Pasien penyakit ginjal kronik (PGK) yang menjalani hemodialisis seringkali mempunyai beberapa keluhan dimana pruritus diperkirakan terjadi pada 20% – 90% pasien. Inflamasi diduga memainkan peran yang penting dalam pruritus pada pasien hemodialysis. Di antara sejumlah sitokin pro-inflamasi, penelitian menunjukkan bahwa IL-6 merupakan regulator sentral dari proses inflamasi, dan dijumpai pada serabut saraf dermal. Metode: Penelitian ini merupakan studi uji analitik dengan desain cross-sectional untuk mengetahui hubungan antara kadar IL-6 dengan kejadian pruritus pada pasien PGK yang menjalani hemodialisis regular. Pasien diminta mengisi kuesioner Pauli-Magnus dan dilakukan pemeriksaan serum IL-6, kalsium, dan fosfat. Kemudian setelah data terkumpul, dilakukan pengolahan dan analisis data. Hasil: Dari 100 pasien, didapatkan bahwa usia dan frekuensi hemodialisis serta kadar IL-6 berhubungan signifikan secara statistik terhadap kejadian pruritus (p0,003; p=0,021 dan p=0,001). Usia 45 -55 tahun vs usia <45 tahun, frekuensi hemodialisis 3x/minggu vs 2x/minggu, riwayat konsumsi obat pengikat fosfat mengandung kalsium, serta kadar IL-6 memiliki hubungan yang signifikan secara statistik terhadap kejadian pruritus pada pasien penyakit ginjal kronik (p=0,043; p=0,010; p=0,008, dan p=0,001). Kesimpulan: Dari penelitian ini dapat disimpulkan bahwa terdapat hubungan antara kadar IL-6 dengan kejadian pruritus pada pasien penyakit ginjal kronik yang menjalani hemodialisis regular. Nilai cut-off IL-6 sebagai prediktor kejadian pruritus pasien penyakit ginjal kronik yang menjalani hemodialisis regular sebesar 101,550 mg/ml dengan sensitivitas 98,1% dan spesifisitas 95,8%.