Hubungan antara anemia dan kelemahan otot pada penderita gagal ginjal kronik yang menjalani Hemodialisis rutin

DENTO, M. Heru, Prof.Dr.dr. H.M. Sja'bani, M.Med.Sc.,SpPD-KGH

2007 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar belakang : Gagal ginjal kronik (GGK) merupakan penyakit gangguan fungsi ginjal yang bersifat progresif dan irreversible, yang akhirnya akan menjadi gagal ginjal terminal. Anemia merupakan salah satu gejala yang sering dijumpai pada penderita GGK, terutama bila kadar kreatinin serum lebih dari 3,5 mg%. Penderita yang menjalani dialisis rutin diketahui mempunyai keterbatasan dalam latihan fisik. Konsumsi keseluruhan oksigen tubuh rata-rata hanya setengah dibandingkan individu normal. Penderita sering mengeluh kelemahan otot lebih sering daripada keterbatasan kardiopulmoner. Beberapa penelitian melaporkan ditemukannya atrofi otot dan kelemahan otot pada penderita hemodialisis. Tujuan : Mengetahui seberapa besar hubungan antara anemia dan kelemahan otot yang timbul pada penderita gagal ginjal kronik yang menjalani hemodialisis rutin. Metode dan Subyek penelitian : Penelitian potong lintang (cross sectional) yang dilakukan di Instalasi Hemodialisis RS Dr. Sardjito Yogyakarta pada bulan Juni 2003- Januari 2004. Subyek penelitian adalah penderita GGK yang menjalani hemodialisis rutin yang dibagi menjadi dua kelompok, kelemahan otot dan non-kelemahan otot, kemudian dilakukan pengukuran kekuatan ototnya dengan alat ENMG. Data kontinu disajikan dalam bentuk rerata±SD dan data kategorikal disajikan dalam bentuk proporsi. Perbedaan rerata kedua kelompok MVC dinilai dengan Mann-Whitney U-test (data tidak terdistribusi normal). Perbedaan proporsi kedua kelompok MVC dinilai dengan dinilai dengan Uji Chi-Square atau Uji Fisher-Exact Hasil : Sampai akhir penelitian didapatkan 68 sampel, dengan 5 subyek drop out karena meninggal dunia dan pindah layanan dialisis. Pada kelompok anemia terdapat laki-laki 44 (64,71 %) dan perempuan 24 (35,29%), rerata kadar Hb 9,29±94 g/dL dengan interval kepercayaan 8,82-9,75. Sementara itu pada kelompok kelemahan otot rerata kadar Hb 9,2 9,2±2,0 g/dL dengan penderita anemia 34 (70,8%) dan non-anemia 14 (29,2%) sedangkan pada kelompok non-kelemahan otot rerata kadar Hb 9,5±1,7 g/dL dengan penderita anemia 13 (65,0%) dan non-anemia 7 (35,0%) dengan p 0,635. Simpulan : Anemia secara statistik tidak bermakna sebagai penyebab timbulnya kelemahan otot pada penderita gagal ginjal kronik yang menjalani hemodialisis.Hal-hal yang berperan secara bermakna dalam timbulnya kelemahan otot pada penderita gagal ginjal kronik adalah : Hemodialisis yang adekuat dan banyaknya menjalani hemodialisis.

Background: Chronic kidney disease (CKD) is a progressive and irreversible renal dysfunction disease that ends to terminal renal failure. Anemia is a symptom that often found in CKD patients, especially if the serum creatinine levels more than 3.5 mg%. Routine dialyzed patients were known have limitations in physical exercises. Average of total body oxygen consumption was only a half of that of normal individual. The patients had more often muscle weakness complaints than cardiopulmonary limitations. Some studies report muscle atrophy and weakness finding in hemodialysis patients. Objective. To determine the association of anemia with muscle weakness in CKD patients with routine hemodialysis. Subject and Methods. Study design was cross sectional study. Study was conducted in Hemodialysis Installation of Dr. Sardjito Hospital, Yogyakarta from June 2003 to January 2004. Subjects were CKD patients with routine hemodialysis who were divided to 2 groups, muscle weakness and non muscle wekness. We examined muscle strength with ENMG tool. Continuous data were presented as mean ± SD and categorical data as proportion. Mean difference of continuous data between 2 MVC group were analyzed by Mann-Whitney U-test (distribution data were not normal) and proportion difference of categorical data between 2 MVC group were analyzed by Chi-Square test or Fisher-Exact test. Results. There were 68 patients, 5 patients were drop out (because of death and move out from Dr. Sardjito dialysis service). Forty four (64.71%) patients were male and 24 (35.29) patients were female. Mean of Hb was 9.29±0.94 g/dL (95% CI: 8.82-9.75). Mean of Hb in weak muscle group was 9.2±2.0 g/dL, 34 (70.8%) patients were with anemia and 14 (29.2%) without anemia. Mean of Hb in normal muscle group was 9.2±1.7 g/dL, 13 (65.0%) patients were with anemia and 7 (35.0%) patients without anemia, with p value=0.635. Conclusion. There was no significantly difference of anemia proportion in patients with muscle weakness and without muscle weakness group who have routine hemodialysis.

Kata Kunci : Hemodialisis Rutin,Anemia dan Kelemahan Otot, Anemia, muscle weakness, chronic kidney disease, routine hemodialysis