Evaluasi terapi hipertensi intradialitik menggunakan antihipertensi oral pada pasien gagala ginjal tahap akhir yang menjalani hemodialisis

RAHMATULLAH, Daril, Dra. Widyati, M.Clin., Pharm., Apt

2009 | Tesis | S2 Magister Farmasi Klinik

Latar Belakang : Hipertensi intradialitik merupakan kenaikan tekanan darahyang diakibatkan prosedur hemodialisis atau disebut hemodialysis-induced hypertension. Fenomena paradoks tersebut diantaranya disebabkan aktivasi berbagai vasopresor endogen akibat adanya perubahan status volume maupun factor terdialisisnya obat antihipertensi. Komplikasi ini meningkatkan resiko kardiovaskular hingga 1.96 kali lipat pada kenaikan tekanan darah sistole diatas > 180 mmHg. Obyektif : Penelitian ini bertujuan untuk mengevaluasi perbedaan efektivitas terapi hipertensi intradialitik antara penambahan dosis dengan penambahan agen antihipertensi. Efek samping yang terjadi akibat intervensi juga menjadi bagian penelitian. Metode : Rancangan penelitian ini menggunakan desain eksperimental randomized single blind trial. Pasien direkrut dari bangsal hemodialisis bangsal hemodialisis RSAL Dr. Ramelan Surabaya. Sebanyak 17 pasien yang memenuhi kriteria inklusi serta telah menandatangani inform consent namun dua diantaranya kemudian dieksklusi karena meninggal dunia pada tahap observasi. Populasi pasien yang tersisa kemudian dibagi menjadi dua kelompok intervensi secara acak. Data yang dikompilasi berupa data tekanan darah yang diambil dalam dua tahap, yaitu tahap pra-paska hemodialisis serta tahap pra-paska intervensi. Data yang terkumpul kemudian dianalisis secara statistic menggunakan uji t berpasangan (paired t test) dan uji Mann-Whitney U. Selain tekanan darah, efek samping juga diamati keterjadiannya. Hasil dan kesimpulan : Sebanyak 7 pasien masuk dalam kelompok penambahan dosis (A) dan sebanyak 8 pasien masuk dalam kelompok penambahan agen (B). Rerata penurunan tekanan darah kelompok A adalah sebesar 17.62 + 18.56 mmHg sedangkan kelompok B adalah sebesar 1.13 + 18.17 mmHg. Analisis uji t berpasangan (p<0.05) menunjukkan adanya perbedaan yang bermakna antara sebelum dan sesudah intervensi penambahan dosis namun tidak pada penambahan antihipertensi. Namun, uji Mann-Whitney U (p<0.05) menunjukkan tidak adanya perbedaan yang bermakna antara penurunan tekanan darah pada kelompok intervensi A dibandingkan dengan kelompok B. Efek samping obat berupa episode hipotensi ditemukan pada salah satu pasien yang mendapatkan penambahan dosis. Skala Naranjo menunjukkan bahwa kasus ini termasuk kategori possible dengan nilai skor 4.

Background : Intradialytic hypertension is a kind of hypertension caused by hemodialysis procedure or so called hemodialysis-induced hypertension. There are several possibilities have been proposed to explain the mechanism of intradialytic hypertension. One of those is the activation of endogen vasopressors due to changes in volume status or dialyzed antihypertensive agents. This phenomenon remain unresolved even though intradialytic hypertension has increased the risk of cardiovascular event up to 1.96 times higher by the time systolic blood pressure > 180 mmHg. Objective : This research aims to evaluate the methods use in overcoming intradialytic hypertension which are dose adjustment and antihypertensive addition. The evaluation are focused both on effectiveness and side effect resulted from those interventions. Method : The design of this research is randomized-single-blind experimental design. Patients are recruited from the hemodialysis ward at Navy Hospital Dr. Ramelan, Surabaya. There were 17 patients that passed the inclusion criteria and agreed the inform consent but two died at the observation phase. The rest of the patients were then randomly divided into two intervention groups. The blood pressure was measured as data in two phase, the first was pre-post hemodialysis and the second was pre-post intervention. The pre intervention was measured an hour after the hemodialysis session started and the post intervention was measured an hour before the session ended. Then, the data compilations were analyzed statistically using paired-t test and Mann-Whitney U test. Any side effect occurred in this study was recorded and confirmed by Naranjo scale. Result and Conclusion : There were 7 patients that allocated in dose adjustment group (A) and the rest or 8 patients were allocated in agent addition group (B). The mean of blood pressure lowering at group A was 17.62 + 18.56 mmHg and at group B was 1.13 + 18.17 mmHg. The paired-t test (p<0.05) showed that there is a significant difference between pre and post in dose adjustment intervention group. Yet, the Mann-Whitney test showed the otherwise, there was no significant difference between group A and B. This result concludes that either dose adjustment or agent addition had the same effect on controlling intradialytic hypertension. An adverse event had occurred in one patient at the dose adjustment group that result in hypotension. Using Naranjo scale the event though to be a possible with a score of 4.

Kata Kunci : Hipertensi,Intradialitik,Hemodialisis,hypertension, intradialytic, hemodialysis