Hubungan stres oksidatif (malondialdehid plasma), marker inflamasi (interleukin-6 dan R-reactive protein plasma) dengan kualitas hidup pada penderita gagal ginjal kronik yang menjalani hemodialisis rutin

SEPTIYANI, LP. Ike Surya, Prof Dr. dr. Moch. Sjabani, M.Med.Sc, Sp.PD-KGH

2009 | Tesis | S2 Ilmu Kedokteran Klinik

Stres oksidatif terjadi apabila tidak terdapat keseimbangan antara radikal bebas dengan mekanisme pertahanan antioksidan. Malondialdehide (MDA) plasma merupakan produk peroksidase lipid yang sering digunakan untuk menilai stres oksidatif. Kadar MDA fisiologis kurang dari 4 umol/L. Diantara sitokin pro inflamasi, Interleukin-6 (IL-6) berperan pada patofisiologi inflamasi penyakit ginjal. Beberapa penelitian menunjukan hubungan yang kuat antara stres oksidatif, inflamasi kronis dengan mortalitas, morbiditas dan kualitas hidup penderita gagal ginjal kronik. Untuk mengetahui perbedaan kadar stres oksidatif, kadar inflamasi dengan kualitas hidup penderita gagal ginjal yang menjalani hemodialisis rutin di RSUP Dr. Sardjito Yogyakarta. Penelitian potong lintang (cross sectional study) terhadap 72 orang penderita hemodialisis rutin dengan kadar MDA plasma ≥ 4 umol/L (51 subyek) dan < 4 umol/L (21 subyek), kadar hs-CRP ≥ 10 mg/dL (26 subyek) dan < 10 mg/dL (46 subyek), kadar IL-6 ≥ 9.96 mg/L (47 subyek) dan < 9.96 mg/L (25 subyek), dengan kualitas hidup yang diukur dengan KDQOL-Short Form (SF)-36. Didapatkan perbedaan yang bermakna antara kadar IL-6 ≥ 9.96 mg/L dengan kualitas hidup untuk komponen gejala (p=0.013 95% CI 6.9 – 25.8), status kerja (p=0.04 95% CI 0.8 – 33.1, nyeri tubuh (p=0.013 95% CI 3.9 – 33.3), kekuatan (p=0.013 95% CI 2.6 – 21.6), dan kesehatan fisik (p=0.029 95% CI 0.4 – 7.3), dukungan sosial (p=0.032 95% CI 1.0 – 21.9). Didapatkan perbedaan yang bermakna antara kadar MDA plasma ≥ 4umol/L dengan komponen kepuasan penderita (p=0.013 95% CI 1.7 – 13.9). Kadar MDA ≥ 4 umol/L dan IL-6 ≥ 9.96 mg/L didapatkan perbedaan yang bermakna terhadap beberapa komponen kualitas hidup. Didapatkan bukti perbedaan antara kadar stres oksidatif, kadar inflamasi (MDA ≥ 4 umol/L dan Il-6 ≥ 9.96 mg/L) dengan kualitas hidup yang sekian lebih rendah pada penderita gagal ginjal kronik yang menjalani hemodialisis rutin.

Oxidative stress occurs when there is imbalance between free radical and antioxidant defend mechanism. MDA plasma is lipid peroxides product frequently used to evaluate oxidative stress. Physiologic of MDA levels is less than 4 umol/L. IL-6 is suggested to have in the patophysiology of inflammation in patients with kidney disease and have relationship with morbidity and mortality of chronic kidney disease. To evaluate the relationship of inflammation marker with quality of life chronic kidney disease patients undergoing routine haemodialysis in dr. Sardjito Hospital. Cross sectional study with 72 patients divided in MDA plasma levels ≥ 4 umol/L (51 subyek) and < 4 umol/L (21 subyek), hs-CRP levels ≥ 10 mg/dL (26 subyek) and < 10 mg/dL (46 subyek), IL-6 levels ≥ 9,96 mg/L (47 subyek) and < 9,96 mg/L (25 subyek), in relation with qualiy of life measured by modified kadoki OL/SF 36. There is significant correlation between IL-6 levels ≥ 9,96 mg/L, eith SF-36 score for symtomps (p=0.013 95% CI 6.9 – 25.8), work status (p=0.04 95% CI 0.8 – 33.1), pain (p=0.013 95% CI 3.9 – 33.3), energy (p=0.013 95% CI 2.6 – 21.6), and physical health score (p=0.029 95% CI 0.4 – 7.3), social support (p=0.032 95% CI 1.0 – 21.9). There is significant association between MDA plasma levels ≥ 4umol/L with SF-36 component satisfaction (p=0.013 95% CI 1.7 – 13.9). There is significant relationship between MDA plasma level ≥ 4umol/L and IL-6 ≥ 9,96 mg/L with SF-36 component sleep (p=0.007 95% CI 6.6 – 39.0). This study give proof prove the relationship between oksidative stress, inflammation marker with the lower quality of life on the chronic kidney disease patients undergoing routine haemodialysis.

Kata Kunci : Stres oksidatif,Inflamasi kronik,Hemodialisis rutin,MDA,hs,CRP,IL,6,oksidative stress, kronic inflammation, routine haemodialysis, MDA, hs-CRP, IL-6