Hubungan Kadar High Sensitive C-Reactive Protein sebagai Penanda Inflamasi dan Nilai Red Distribution Width dengan Etiologi PGK pada Pasien Hemodialisis Reguler di RSUP H. Adam Malik Medan

Abstract

functional disorders of the kidney with irreversible and gradual characteristics with one of the modalities of renal replacement therapy such as hemodialysis. The role of inflammation in hemodialysis (HD) patients by uremic toxins and dialysis can be assessed by the marker of High Sensitive C Reactive Protein (HsCRP). This inflammation also causes dysregulation of the hormone erythropoietin which results in increased variability or heterogeneity of red cell distribution width (RDW). RDW is an index of red blood cell volume previously used as a marker of iron deficiency anemia. Previous studies have revealed an association between RDW and HsCRP levels in regular HD patients which leads to increased patient morbidity and mortality (Kara AV, 2019). Until now, there has been no study in Indonesia regarding the relationship between HsCRP levels and RDW in regular HD patients. This study aims to determine the relationship between HsCRP levels as a marker of inflammation and RDW in regular HD patients. Method: This study is a Pearson correlation test and T test with a cross sectional study design. The study was conducted in June 2020 - August 2020 at the HD unit of Haji Adam Malik Hospital in Medan with the approval of the USU Faculty of Medicine Research Ethics Commission. Data were analyzed using the SPPS program where p <0.05 was considered significant. Results: Of the 20 subjects taken based on consecutive sampling, the majority were male, 13 people (65%), the mean age was 50.30 ± 12.57 years with the most comorbid type 2 diabetes mellitus as many as 14 people (70%). The mean HsCRP level was 6.78 ± 3.91 mg / dL. The mean RDW value was 15.93 ± 1.87%. This study shows that there is a significant relationship between serum HsCRP levels and RDW values (r = 0.667; p= 0.001). RDW values were also significantly associated with hemoglobin levels (r = 0.497; p = 0.026) and creatinine (r= 0.519; p= 0.019). Conclusion: HsCRP, hemoglobin, and creatinine levels are significantly associated with RDW values in regular HD patients.

Pendahuluan. Penyakit ginjal kronis (PGK) ditandai dengan adanya gangguan structural dan fungsional ginjal dengan karakteristik ireversibel dan bertahap dengan salah satu modalitas terapi pengganti ginjal seperti hemodialisis. Peranan inflamasi pada pasien hemodialisis (HD) oleh toksin uremic dan dialisis dapat dinilai dengan penanda High Sensitive C Reactive Protein (HsCRP). Inflamasi tersebut juga menyebabkan disregulasi hormone eritropoietin yang mengakibatkan peningkatan variabilitas atau heterogenitas dari red cell distribution width (RDW). RDW merupakan indeks volume sel darah merah yang sebelumnya digunakan sebagai penanda anemia defisiensi besi. Penelitian terdahulu mengungkapkan adanya hubungan antara RDW dengan kadar HsCRP pada pasien HD regular yang berujung dengan peningkatan morbiditas dan mortalitas pasien (Kara AV, 2019). Hingga saat ini belum ada penelitian di Indonesia mengenai hubungan antara kadar HsCRP dengan RDW pasien HD reguler. Penelitian ini bertujuan untuk mengetahui hubungan kadar HsCRP sebagai penanda inflamasi dengan RDW pada pasien HD regular. Metode: Penelitian ini merupakan uji korelasi pearson dan uji T dengan desain cross sectional study. Penelitian dilaksanakan bulan Juni 2020- Agustus 2020 di unit HD RSUP Haji Adam Malik Medan dengan persetujuan Komisi Etik Penelitian FK USU. Data dianalisis dengan menggunakan program SPPS di mana p<0,05 dianggap signifikan. Hasil: Dari 20 subjek yang diambil berdasarkan consecutive sampling, mayoritas berjenis kelamin laki-laki 13 orang (65%), rerata usia 50,30 ± 12.57 tahun dengan komorbid terbanyak adalah diabetes mellitus tipe 2 sebanyak 14 orang (70%). Rerata kadar HsCRP 6.78 ± 3.91 mg/dL. Rerata nilai RDW 15.93 ± 1.87 %. Penelitian ini menunjukkan bahwa terdapat hubungan signifikan antara kadar HsCRP serum dengan nilai RDW (r= 0,667; p= 0,001). Nilai RDW juga secara signifikan berhubungan dengan kadar haemoglobin (r= 0,497; p= 0,026) dan kreatinin (r= 0,519; p= 0,019). Kesimpulan: Kadar HsCRP, haemoglobin, dan kreatinin secara signifikan berhubungan dengan nilai RDW pada pasien HD regular.