Hubungan antara Kadar Serum PTH dengan Kalsifikasi Aorta Abdominal pada Pasien Hemodialisis Kronik di RSUP Dr. Mohammad Hoesin Palembang

M Yusuf Arief Akbar, Zulkhair Ali, Taufik Indrajaya, Novadian Suhaimi, SNA Ratnasari Devi, Erial Bahar

Abstract

Pendahuluan. Penyakit kardiovaskular adalah penyebab kematian yang paling sering pada pasien penyakit ginjal kronik (PGK). Hal ini dibuktikan dengan ditemukannya kalsifikasi vaskular pada pasien PGK. Proses kalsifikasi vaskular yang terjadi sering dikaitkan dengan kondisi hiperparatiroid sekunder yang merupakan komplikasi dari pasien PGK. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar parathyroid hormone (PTH) serum dengan kalsifikasi aorta abdominal pada pasien PGK yang menjalani hemodialisis (HD).

Metode. Penelitian observasional analitik uji korelasi dengan desain cross sectional yang dilakukan di ruang perawatan penyakit dalam RSUP dr. Mohammad Hoesin Palembang dari Juli hingga Desember 2019. Populasi penelitian adalah semua pasien PGK yang telah menjalani HD >3 bulan dengan usia >18 tahun. Semua pasien dilakukan pemeriksaan kadar serum PTH dan dilakukan pengukuran derajat kalsifikasi aorta abdomen menggunakan lateral lumbal X-ray yang dihitung menggunakan skor Kauppila.

Hasil. Dari 86 pasien HD yang diteliti, terdapat 65 pasien (75,6%) yang mempunyai kadar serum PTH yang tinggi dan 46 pasien (53,5%) yang mempunyai kalsifikasi pada aorta abdomen. Uji korelasi Spearman mendapatkan kadar serum PTH mempunyai hubungan dengan skor Kauppila (p=0,014, r=0,264). Analisis multivariat regresi linear mendapatkan usia (p<0,001, r=0,510), lama HD (p=0,020, r=0,256), riwayat hipertensi (p=0,031, r=0,239) dan kadar fosfat serum (p=0,011 r=0,281) mempunyai hubungan terhadap skor Kauppila.

Simpulan. Terdapat hubungan yang signifikan antara kadar serum PTH dengan kalsifikasi aorta abdomen pada pasien HD kronik. Faktor usia, lama HD, hipertensi, dan kadar fosfat serum juga berpengaruh terhadap kejadian kalsifikasi aorta abdomen.

Kata Kunci: Hemodialisis, hiperparatiroid sekunder, skor Kauppila


Correlation between Parathyroid Hormone Serum Levels and Abdominal Aortic Calcification in Chronic Hemodialysis Patients at Dr. Mohammad Hoesin Center General Hospital Palembang

Introduction. Cardiovascular disease is the most common cause of death in patients with chronic kidney disease (CKD). This is evidenced by the finding of vascular calcification in CKD patients. The process of vascular calcification that occurs is often associated with secondary hyperparathyroid conditions that are complications of CKD patients. The aim of this study was to asses the relationship between serum PTH levels and the abdominal aorta calcification (AAC) in CKD patients undergoing hemodialysis (HD)

Methods. This observational analytic study with cross-sectional correlation test was conducted in the internal medicine ward of dr. Mohammad Hoesin Palembang from July to December 2019. Subjects were patients who had undergone HD >3 months with age >18 years. All subjects were examined for serum PTH levels and measured the carotid artery wall using doppler ultrasonography and the degree of calcification of the abdominal aorta using a lateral lumbar X-ray which was calculated using the Kauppila score.

Results. There were 86 of HD patients studied, 65 subjects (75.6%) had high serum PTH levels and 46 subjects (53.5%) who had AAC. The Spearman correlation analysis showed that serum PTH levels had a relationship with Kauppila score (p=0.014, r=0.264). Multivariate linear regression analysis obtained age (p<0.001, r=0.510), duration of HD (p=0.020, r=0.256), history of hypertension (p=0.031, r=0.239) and serum phosphate levels (p=0.011, r=0.281) had a relationship to the Kauppila score.

Conclusions. There is a significant relationship between serum PTH levels and AAC in chronic HD patients. The presence of factors including age, duration of HD, hypertension, and serum phosphate levels also affect the incidence of AAC.

Keywords

Hemodialysis, Kauppila score, secondary hyperparathyroidism

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