Pengaruh Kombinasi Hemodialisis Hemoperfusi terhadap Penurunan Kadar Interleukin-6 pada Pasien Penyakit Ginjal Tahap Akhir yang Menjalani Hemodialisis Rutin: Multi Center Study

Rifka Oktaviana, Dr.dr. Metalia Puspitasari, M.Sc, SpPD, KGH .; dr. Yulia Wardhani, SpPD, KGH

2024 | Tesis-Spesialis | S2 Ilmu Penyakit Dalam

Latar Belakang: Pada Penyakit Ginjal Tahap Akhir (PGTA) terjadi kondisi inflamasi kronis yang ditandai dengan meningkatnya sitokin proinflamasi seperti IL-6 yang tidak hanya sebagai konsekuensi pada pasien PGTA, tetapi juga memicu progresivitas PGTA dan komplikasi lainnya. Hemoperfusi merupakan sebuah modalitas pemurnian darah ekstrakorporeal. Sudah ada beberapa penelitian di Indonesia yang meneliti terkait efek penggunaan hemodialisis dan hemoperfusi pada pasien PGTA, namun belum ada yang meneliti langsung terkait manfaat hemodialisis dan hemoperfusi dalam menurunkan kadar IL-6.Tujuan: Mengetahui pengaruh kombinasi hemodialisis hemoperfusi dapat menurunkan kadar IL-6 serta lebih baik dibandingkan dengan hemodialisis pada pasien gagal ginjal tahap akhir. Metode: Penelitian quasi-experimental dengan pretest-posttest design yang dilaksanakan di tiga rumah sakit pada Mei – September 2023. Partisipan dibagi menjadi dua kelompok yaitu (1) pasien hemodialisis rutin dan (2) pasien hemodialisis dan hemoperfusi 4x/bulan di 3 RS. Analisis distribusi frekuensi normalitas dan homogenitas data menggunakan analisis univariat. Analisis bivariat digunakan untuk membandingkan kadar IL-6 pre dan post tindakan serta perbedaan penurunan kadar IL-6 antara kombinasi HD+HP dengan HD. Hasil: Sebanyak 26 pasien yang diikutsertakan terbagi menjadi 14 orang kelompok hemodialisis (HD) dan 12 orang kelompok hemodialisis dan hemoperfusi (HD+HP). Penurunan IL-6 pre dan post tindakan signifikan pada kelompok HD+HP (p<0>0,05). Kesimpulan: Kombinasi hemodialisis dan hemoperfusi 4x/bulan tidak terbukti secara signfikan dapat menurunkan kadar IL-6 dan belum terbukti lebih baik dibandingkan dengan hemodialisis saja.

Backgorund: End Stage Renal Disease (ESRD) is associated with a chronic inflammatory condition marked by elevated pro-inflammatory cytokines such as IL-6. IL-6 not only results from ESRD but also exacerbates its progression and leads to other complications. Hemoperfusion is an extracorporeal blood purification method. While several studies in Indonesia have explored the effects of hemodialysis and hemoperfusion in ESRD patients, none have directly investigated the impact of these treatments on reducing IL-6 levels. Objective: This study aims to determine whether the combination of hemoperfusion and hemodialysis can reduce IL-6 levels and is better than hemodialysis in patients with end-stage renal failure. Method: A quasi-experimental study with a pretest-posttest design was conducted in three hospitals from May to September 2023. Participants were divided into two groups: (1) patients undergoing routine hemodialysis and (2) patients receiving hemodialysis and hemoperfusion four times a month in the same hospitals. Normality and homogeneity of data were assessed through frequency distribution analysis and univariate analysis. Bivariate analysis was used to compare pre- and post-treatment IL-6 levels as well as differences in IL-6 reduction between the HD+HP and HD groups. Result: A total of 26 patients were included, with 14 in the hemodialysis (HD) group and 12 in the hemodialysis and hemoperfusion group (HD+HP). A significant decrease in IL-6 levels was observed after treatment in the HD+HP group (p<0>0.05). Conclusion: The combination of hemodialysis and hemoperfusion 4x/month has not been proven to significantly reduce IL-6 levels and has not been proven to be better than hemodialysis alone.

Kata Kunci : PGTA, hemodialisis, hemoperfusi, IL-6