Efektivitas Kombinasi Terapi Hemodialisis Hemoperfusi dalam Memperbaiki Kadar Hormon Paratiroid Pada Pasien Hemodialisis Rutin: Multi Center Study

Dwita Dyah Adyarini, Dr. dr Metalia Puspitasari, M.Sc, SpPD KGH; dr Ira Puspitawati, M.Kes, SpPK-K

2024 | Tesis-Subspesialis | SUBSPESIALIS ILMU PENYAKIT DALAM

Pendahuluan. Berbagai penelitian menunjukkan bahwa Hemodialisis (HD) saja memiliki tingkat pembersihan racun uremik molekul sedang dan besar yang rendah yang salah satunya hormon paratiroid. Hiperparatiroidisme akan meningkatkan risiko penyakit mineral dan tulang, risiko tinggi terjadinya neuropati perifer, peningkatan kalsifikasi katup, pruritus, anemia dan peningkatan kejadian gagal jantung dan hipertensi. Penerapan klinis berbagai teknologi pemurnian darah ekstrakorporeal menunjukkan bahwa tingkat pembersihan racun uremik molekul menengah dan besar tertinggi diperolah dari kombinasi Hemodialisis dengan hemoperfusi, diikuti oleh hemoperfusi dan hemodialisis.

Tujuan. untuk mengetahui efektivitas terapi kombinasi Hemodialisis Hemoperfusi dalam memperbaiki kadar Hormon Paratiroid pada pasien HD rutin. 

Metode. Penelitian quasi eksperimental dengan desain nonequivalent control group test pada pasien HD rutin di RSUP Dr Sardjito, RSPAD Gatot Soberoto (Jakarta), RS Ciputra (Jakarta) dan memenuhi kriteria inklusi dan ekslusi. Kriteria Inklusi adala pasien berusia 18-75 tahun, telah menjalanai HD konvensional rutin > 24 bulan, mendapat heparin standar, Qb>200 mL/menit dan menggunakan akses AV shunt dan AV fistula. Kriteria ekslusinya dalah kondisi Sepsis, ,memiliki trombositopenia berat (jumlah trombosit < 50>

Hasil. Didapatkan 12 pada kelompok Hemoperfusi dan 14  subyek pada  kelompok hemodialisis. Pada kelompok hemoperfusi 66,7?alah laki-laki sedangkan pada kelompok 57,1?alah perempuan. Pada kelompok HD+HP terjadi peningkatan hormon paratiroid sebesar 5,08 pg/mL (-261,5-151,5) dibandingkan kelompok HD terjadi peningkatan hormon paratiroid sebesar 6,43 pg/mL (-41,2-278) dengan p 0,607.

Kesimpulan Kombinasi Hemodialisis Hemoperfusi belum dapat dibuktikan lebih efektif menurunkan kadar hormon paratiroid dibandingkan dengan Hemodialisis saja.

Introduction. Multiple studies have shown that Hemodialysis (HD) alone has low clearance rates of medium and large-molecule uremic toxins, one of which is the Parathyroid hormone. Hyperparathyroidism will increase the risk of mineral and bone disease, high risk of peripheral neuropathy, increased valve calcification, pruritus, anemia, and the incidence of heart failure and hypertension. Clinical application of various extracorporeal blood purification technologies shows that the highest clearance rates of medium and large-molecule uremic toxins are obtained from the combination of Hemodialysis (HD) with Hemoperfusion (HP), followed by hemoperfusion and hemodialysis.

Purpose. To determine the effectiveness of HD+HP combination therapy in improving parathyroid hormone levels in routine HD patients.

Methods. A quasi-experimental study with nonequivalent control group design and matching based on age and gender in patients undergoing routine hemodialysis therapy at RSUP Dr Sardjito, Gatot Soebroto Army Hospital (Jakarta), Ciputra Hospital (Jakarta) and meet the inclusion and exclusion criteria. Inclusion criteria are patients aged 18-75 years, who have undergone regular conventional HD therapy for >24 months, receive standard heparin, Qb>200 mL/minute, and use an AV shunt or AV fistula access. the exclusion criteria are in a clinical condition of sepsis, severe thrombocytopenia (platelet count <50>

Results. We got 12 subjects in the hemoperfusion group and 14 subjects in the hemodialysis group. In the hemoperfusion group, 66,7% were men while in the control group, 57,1% were women. In the HD+HP group, the was an increase in parathyroid hormone of 5,08 pg/mL (-261,5 -151,5) compared to the HD group, there was an increase in parathyroid hormone of 6,43 pg/mL (-41,2-278) with p 0,607

Conclusion The combination of Hemodialysis and Hemoperfusion has not been proven to be more effective in reducing parathyroid hormone levels than Hemodialysis alone.

Kata Kunci : Hemodialysis, Hemoperfusion, Parathyroid Hormone, Hyperparathyroidism, End Stage Renal DIsease