Proporsi Hiperurisemia pada Populasi Hipertensi Essensial Suku Aceh di Kabupaten Aceh Utara

Abstract

Background Hyperuricemia (HU) can be the consequence of increased uric acid production and/or decreased renal capacity to excrete uric acid. Prevalence of essential hypertension (EH) in Aceh Utara district ± 30.6% with both geographical and demographical factors of the original Acehnese uniqueness and they have been known to be consumptive of both high salt and high purine diet. Objective The aim of this research was to assess the role of serum uric acid (SUA) level and HU in EH population of Acehnese at Aceh Utara district and to evaluate correlations between SUA level and systolic/diastolic blood pressure (SBP/DBP), severity and duration of EH, creatinine and estimated glomerular filtration rate (eGFR). Methods This research was an analytical observational study using cross-sectional approach. It had been done at the internal medicine outpatient clinic Cut Meutia Hospital Lhok Seumawe and public health centre at Aceh Utara district from December 2010-January 2011 after being approved by the Ethics Committee of Health Research Medical Faculty University of Sumatera Utara. The Subjects were enrolled using consecutive sampling method with inclusion and exclusion criteria. The Subjects filled-out a short informed consent sheet and their weight, height, and blood pressurewere measured.Blood sample were taken to assess SUA level, lipid profile, urea, creatinine, and eGFR. There were 137 samples and were divided into 2 groups consisting of 69 patients in the EH group and 68 healthy subjects in the normotensive (NT) group. The data analysis was carried out with the 15.0 version of the SPSS program. A p value < 0.05 was considered to be statistically significant. Results The mean of SUA level in both men and women were higher significantly in the EH group(7.71 ± 0.74 mg/dl and 6.85 ± 0.67 mg/dl, respectively) than the NT group(5.79 ± 0.94 mg/dl and 4.6 ± 1.04 mg/dl respectively, p=0.0001). The HU proportion in the EH group were also higher significantly than the NT group (87.2% and 12.8% respectively, p=0.0001). The EH patient had 5.4 times higher risk to experience HU than the NT subject (OR=5.4, 95% CI=2.52-11.54, p= 0.0001). The mean of SUA levelwere higher significantlyas level of SBPincreased in men (p=0.016). The mean of SUA level were higher significantlyas level of DBP increased in both men and women (p= 0.0001 and p=0.007, respectively).The HU proportion were also higher significantly as level of DBP increased (p=0.001). There were significant positive correlations between SBP and SUA (r = 0.587 ; p = 0.0001), DBP and SUA (r = 0.650; p = 0.0001), creatinine and SUA (r = 0.749 ; p = 0.0001),and significant negative correlation between SUA and eGFR (r= -0.407; p=0.001). Conclusion The mean of SUA level and HU proportion were significantly higher in EH group. We found significant correlation between EH and HU. The SUA levelhad significant positive correlations with severity of EH and creatinine, and significant negative correlation with eGFR. TheSUA level seemed to be a major risk factor for cardiovascular and renal damage in EH

Latar Belakang Hiperurisemia (HU) terjadi akibat peningkatan produksi asam urat (AU) dan/atau menurunnya kapasitas ginjal dalam mengekskresikan AU. Prevalensi hipertensi essensial di Aceh Utara ± 30.6% dengan karakteristik faktor geografis dan demografis suku Aceh asli yang khas diketahui sering mengkonsumsi diet tinggi garam dan purin. Tujuan Penelitian Untuk menilai peranankadar asam urat serum (AUS) dan HU pada populasi HE suku Aceh di kabupaten Aceh Utara dan menilai hubungan antara kadar AUS dengan tekanan darah sistolik (TDS), tekanan darah diastolik (TDD), beratnya hipertensi, lama menderita hipertensi, kadar kreatinin dan laju filtrasi ginjal (LFG). Metode Penelitian Penelitian ini merupakan penelitian observasional analitik dengan pendekatan potong lintang dilaksanakan di Poliklinik penyakit dalam RSUD Cut Meutia dan puskesmas jejaring di kabupaten Aceh Utara propinsi Nanggroe Aceh Darussalam pada bulan Desember 2010 –Januari 2011 setelah mendapat persetujuan dari Komisi Etik Penelitian Kesehatan FK USU. Sampel diperoleh menggunakan sistem consecutive sampling dengan beberapa kriteria inklusi dan eksklusi. Subjek penelitian mengisi lembar informed consent kemudian diukur berat dan tinggi badan serta tekanan darah. Peneliti memeriksa sampel darah dan urine untuk mengetahui kadar AUS, profil lemak, ureum, kreatin, LFG. Penelitian ini telah mengikutsertakan 137 sampel yang telah dianalisis yang dibagi menjadi dua kelompok yaitu 69 sampel kelompok hipertensi essensial (HE) dan 68 sampel kelompok normotensi (NT). Data dianalisis melalui program SPSS 15.0 for Windows, nilai p signifikan bila < 0.05. Hasil Penelitian Rerata kadar AUS pria dan wanita pada kelompok HE(masing masing adalah7.71 ± 0.74 mg/dl dan 6.85 ± 0.67 mg/dl)signifikan lebih tinggi dibanding dengan kelompok NT (masing masing adalah5.79 ± 0.94 mg/dl dan 4.6 ± 1.04 mg/dl, p= 0.0001). Proporsi HU signifikan lebih tinggipada kelompok HE dibanding dengan kelompok NT (masing masing adalah 87.2% dan 12.8%, p=0.0001). Pasien dengan HE memiliki risiko 5.4 kali lebih besar untuk mengalami HU dibanding subjek NT (OR=5.4, CI 95% = 2.52-11.54, p= 0.0001). Rerata kadar AUS pria signifikan lebih tinggi sesuai dengan derajat hipertensi TDS (p=0.016). Rerata kadar AUS pria dan wanita lebih tinggi signifikan sesuai dengan derajat hipertensi TDD (p=0.0001 dan p=0.007). Proporsi HU signifikan lebih tinggi sesuai dengan derajat hipertensi TDD (p=0.001). Terdapat korelasi positif yang signifikan antara TDS dengan kadar AUS (r = 0.587 ; p=0.0001), antara TDD dengan kadar AUS (r= 0.650 ; p = 0.0001, antara kadar kreatinin dengan kadar AUS (r = 0.749 ; p = 0.0001) dan korelasi negatif yang signifikan secara statistik antara LFG dengan kadar AUS (r = - 0.323 ; p = 0.007). Kesimpulan Rerata kadar AUS dan proporsi HU signifikan lebih tinggi secara statistik pada kelompok HE. Terdapat hubungan yang signifikan secara statistik antara HE dengan kadar AUS. Kadar AUS berkorelasi positif signifikan dengan TDS, TDDdan kadar kreatinin, dan berkorelasi negatif dengan LFG. Kadar AUS tampaknyadapatberperansebagaifaktorrisiko mayor terhadappenyakitkardiovaskulerdankerusakan ginjalpada HE