ASSOCIATION BETWEEN THE OCCURRENCE OF CHRONIC KIDNEY DISEASE AND NSAIDS USE AMONG PATIENTS AT RSUP WAHIDIN SUDIROHUSODO AND RSI FAISAL IN MAKASSAR SOUTH SULAWESI

ANDI MAULANA K. P. L, Prof. Dr. Zullies Ikawati, Apt ; Prof. Rosnani Hashim, M.Sc., Ph.D

2017 | Tesis | S2 Magister Farmasi Klinik

Pendahuluan: NSAIDs adalah obat yang biasa digunakan sebagai analgetik dan anti inflamasi dengan menghambat enzim COX, terutama prostaglandin. Dengan mekanisme ini, NSAIDs memiliki efek samping utamanya ke fungsi ginjal. Penelitian ini bertujuan untuk melihat hubungan kemungkinan tingkat kausalitas antara CKD dan penggunaan NSAIDs. Metode: penelitian ini bersifat observational case-control dengan pengambilan data secara retrospektif dan menganalisa hubungan antara faktor resiko untuk CKD dan pengguna NSAIDs. Penelitian dilakukan di RSUP Wahidin Sudirohusodo dan RSU Faisal Islamic di kota Makassar. Dengan subjek yang memenuhi kriteria inklusi. Pengambilan sample dilakukan dengan cara consecutive sampling. Data didapatkan dengan melihat rekam medik pasien. Naranjo algorithm digunakan untuk mengkonfirmasi riwayat pasien pada saat wawancara. Hasil: Total subjek adalah 350 pasien dan terdiri dari 118 pasien menggunakan NSAIDs. Dalam kelompok pasien CKD adalah 175 subjek dan terdiri dari 35 pengguna NSAIDs. Data menunjukkan penggunaan NSAIDs jenis Meloxicam pada 48 pasien (40%) dan Asam Mefenamat pada 12 pasien (10%) dari 118 pasien yang menggunakan NSAIDs. Chi-Square p values <0.001 menunjukkan hubungan secara statistik yang signifikan pada pengguna NSAIDs dengan kejadian CKD dengan OR value 0.277. Namun, nilai OR kurang dari 1, yang menunjukkan kemungkinan insiden CKD terjadi sangat kecil dibandingkan kemungkinan tidak terjadinya CKD pada pasien yang menggunakan NSAIDs. Hasil perhitungan probabilitas untuk pasien mengalami CKD adalah 48.55% untuk pria dan 70.72% untuk wanita jika mereka menggunakan NSAIDs. Hasil wawancara menunjukkan 2 dari 118 pasien terindikasi certain dan definite mengalami ADR dari penggunaan NSAIDs. Kesimpulan: Faktor yang memiliki hubungan signifikan secara statistik dengan kejadian CKD adalah jenis kelamin, penyakit penyerta, penggunaan NSAIDs, dan dosis. Penggunaan NSAIDs tidak memiliki hubungan dengan kejadian CKD karena OR kurang dari 1, meskipun sekitar 1.69% kejadian CKD pada subjek disebabkan oleh penggunaan NSAIDs.

Introduction: NSAIDs are drugs often used as an analgesic or anti-inflammatory with inhibition on the COX enzyme, primarily on the inhibition of prostaglandin. With this mechanism, NSAIDs have side effects especially to kidney function. This study was aimed to observe the level of causal possibility between CKD and NSAIDs use. Method: This research is an observational case-control by collecting data retrospectively and analyzes the relationship between risk factor for CKD in NSAIDs users. The study was conducted at RSUP Wahidin Sudirohusodo and RSU Faisal Islamic in Makassar city, which fulfills inclusion criteria. Sampling was carried out by consecutive sampling. Data of NSAID use were obtained from medical records. Naranjo algorithm was used to confirm the patient’s data through interviews for medical history. Result: Total subjects were 350 patients and there were 118 patients used NSAIDs. Patients CKD were 175 subjects and there were 35 NSAIDs users in the group. The data showed that the most used NSAIDs were Meloxicam by 48 patients (40%) and Mefenamic acid by 12 patients (10%) of 118 patients using NSAIDs. Chi-Square p values <0.001 indicated a statistically significant association NSAIDs with CKD. There was OR value of 0.277. However, since the OR value is less than 1, then the probability of a CKD incidence is much smaller than the did not CKD occur when they use of NSAIDs. The probability measure of the patient CKD event was 48.55% for male and 70.72% for female if they used NSAIDs. Interview showed 2 from 118 patients indicated certain and definite ADR. Conclusion: The factors was statistically significant relationship with CKD event were gender, comorbidity, NSAIDs, and dosage. NSAIDs used were not associated with CKD event caused OR less than 1, although about 1.69% of CKD happen to subject is likely due to NSAIDs used.

Kata Kunci : NSAIDs, Chronic Kidney Disease, Causality, Risk Factor