Korelasi modification of diet renal disease dan cockdroft-gault terhadap cystatin C :: Studi pada populasi hipertensi dan normotensi

NUGRAHA, Indra Adhi, Prof. Dr. dr. Moch. Sjabani, M.Med.Sc, Sp.PD-KGH

2009 | Tesis | S2 MSPPDS-Ilmu Penyakit Dalam

Hipertensi berperan terhadap meningkatnya insidensi penyakit ginjal kronik. Upaya deteksi dini perburukkan fungsi ginjal berupa pengukuran penanda laju filtrasi glomerulus (LFG). Pengukuran serum kreatinin sebagai penanda LFG endogen mempergunakan formula Cockcroft - Gault (CG) dan Modification of Diet in Renal Disease (MDRD). Cystatin C merupakan penanda endogen lain yang lebih sensitif dibandingkan dengan pengukuran serum kreatinin. Tujuan penelitian untuk mengetahui korelasi penilaian fungsi ginjal antara MDRD dan CG terhadap cystatin C pada hipertensi dan normotensi di populasi. Metode yang digunakan uji potong lintang serta acak stratifikasi dari 12.073 subyek yang berasal dari 39 dusun pada 3 desa di kecamatan Mlati, Kabupaten Sleman. Acak stratifikasi mendapatkan populasi normotensi dan hipertensi, kemudian diambil masing-masing populasi sebanyak 50 subyek penelitian yang berusia 30 – 59 tahun. Perbedaan bermakna tidak didapatkan antara populasi normotensi dan hipertensi pada pengukuran index masa tubuh, ureum, kreatinin serta formula CG. Perbedaan bermakna didapatkan pada pengukuran MDRD dan cystatin C (100.10 ± 18.26 x 91.96 ± 18.27, p = 0.028; 0.71 x 0.99, p = 0.0001). Korelasi yang lebih kuat serta bermakna didapatkan pada penilaian fungsi ginjal dengan MDRD terhadap cystatin C, dibandingkan CG pada populasi normotensi (r = 0.29 x 0.152; p = 0.041 x 0.293). Populasi hipertensi didapatkan korelasi MDRD terhadap cystatin C lebih kuat serta bermakna dibandingkan CG (r = 0.305 x 0.105 ; p = 0,031 x 0,47). Penelitian ini menunjukkan bahwa formula MDRD dapat mendekati hasil perkiraan LFG yang diperoleh oleh pengukuran kadar cystatin C.

Hypertension has a role in increasing the incidence of chronic kidney disease. The effort of early detection in kidney function decline can be measured by glomerular filtration rate (GFR) estimation. Creatinine serum, as an endogenous marker of GFR, can be measured by Cockroft-Gault (CG) and Modification of Diet and Renal Disease (MDRD) equations. Cystatin-C is another marker that is more sensitive than creatinine serum measurement. This study aimed to know the correlation of CG and MDRD to cystatin-C, to estimate kidney function in hypertensive and normotensive population. This cross sectional study used stratified random sampling of 12.073 subjects from 39 sub-villages in 3 villages in Mlati District, Sleman. We stratified the subjects into hypertensive and normotensive groups, then took 50 subjects, 30 – 59 years old, in each group. There is no difference of body mass index (BMI), ureum, creatinine, and CG formula between normotensive and hypertensive subjects. There are significant differences between normotensive and hypertensive subjects in MDRD (100.10 ± 18.26 vs 91.96 ± 18,27, p=0.028, respectively) and cystatin C equations (Median 0,71 vs 0,99, p = 0,0001, respectively). There is a significant and stronger correlation in kidney function assessment by MDRD and cystatin-C equation than in CG and cystatin-C equation in normotensive population (r = 0.29; p = 0,041 vs 0.152; p = 0.293, respectively). In hypertensive population, the correlation between MDRD and cystatin-C equation is significant and stronger than CG and cystatin-C equations (r=0.305; p = 0.031 vs 0.105; p=0.47, respectively). This study showed that MDRD formula could nearly equal to GFR estimation calculated by cystatin-C equation.

Kata Kunci : laju filtrasi glomerulus,Cystatin C5MDRD,Cockcroft,gault,glomerular filtration rate, cystatin C, MDRD, cockcroft – gault.