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Kapasitas Difusi Paru Karbon Monoksida (DLCO) pada Pasien Gagal Ginjal Terminal dan Faktor-faktor yang Mempengaruhi = Lung Diffusion Capacity for Carbon Monoxide (DLCO) in End-Stage Renal Disease and The Influencing Factors.

Latar Belakang: Gagal ginjal terminal dapat mempengaruhi seluruh sistem dalam tubuh, termasuk sistem respirasi. Penelitian ini bertujuan mengetahui kapasitas difusi paru terhadap karbon monoksida (D ) pada pasien hemodialisis kronik dan menghubungkannya dengan berbagai faktor demografis dan klinis serta spirometri. LCO Metode: Studi potong lintang ini dilakukan pada pasien hemodialisis kronik berusia ≥18 tahun, stabil dalam 4 minggu terakhir, tidak memiliki riwayat penyakit paru dan jantung sebelumnya. Spirometri dan pemeriksaan D dilakukan dalam kurun waktu 24 jam setelah hemodialisis. Hasil: Terdapat 40 subjek yang sebagian besar adalah laki-laki (67,5%), median usia 51 tahun dan bukan perokok (55%). Rerata indeks massa tubuh (IMT) 22,6 ± 3,9 kg/m 2 , Hb 9,5 ± 1,3 g/dl, median dialysis adequacy 1,62 dan durasi hemodialisis 31,5 bulan. Penyebab terbanyak gagal ginjal terminal adalah hipertensi (62,5%). Sesak napas dialami oleh 20% subjek. Prevalens penurunan D adalah 52,5% dengan derajat ringan-sedang. Sebanyak 47,5% subjek mengalami restriksi dan 5% mengalami obstruksi pada pemeriksaan spirometri. Terdapat hubungan antara riwayat merokok dan penurunan D LCO dengan odds ratio 4,52 (95% IK 1,04 – 19,6) serta antara gangguan restriksi dan penurunan D LCO LCO dengan odds ratio 5,58 (95% IK 1,29 – 23,8). Diperkirakan terdapat gangguan parenkim paru yang menyebabkan restriksi dan menghambat difusi. Kesimpulan: Penurunan kapasitas difusi paru pada pasien hemodialisis kronik cukup sering terjadi meskipun tidak selalu disertai keluhan sesak napas. Faktor risiko penurunan D adalah riwayat merokok dan gangguan restriksi pada spirometri.
Kata Kunci: D LCO LCO , hemodialisis, kapasitas difusi paru


Background: End-stage renal disease affects all systems in human including respiratory system. This study aimed to discover the lung diffusion capacity of carbon monoxide (D ) in chronic hemodialysis patients and to discover its relation to several demographic and clinical factors, as well as spirometry parameters. LCO Method: This was a cross-sectional study among chronic hemodialysis aged ≥18 years old, clinically stable in the last 4 weeks without prior history of lung and cardiac disorder. Spirometry and D examination were performed in the span of 24 hours after hemodialysis. LCO Results: There were 40 subjects analyzed. Majority of them were male (67.5%), median age 51 years old and non-smoker (55%). Mean Body Mass Index (BMI) 22.6 ± 3.9 kg/m 2 , Hb 9.5 ± 1.3 g/dl, median dialysis adequacy 1.62 and hemodialysis duration of 31.5 months. Hypertension was the most common underlying disease. Some 20% of subject had varying degrees of dyspnea. Prevalence of D reduction was 52.5% with mild to moderate degree. Restrictive spirometry pattern was evident in 47.5% and obstructive pattern in 5% of subjects. There was a significant relation between D LCO reduction with smoking history (OR 4.52 [95% CI 1.04 – 19,6]), also with restrictive disorder (OR 5.5 [95% CI 1.29 – 23.8]). We suspected parenchymal disorder as the cause of lung restriction and diffusion inhibition. LCO Conclusion: Reduction of lung diffusion capacity in chronic dialysis patients is common although not accompanied with dyspnea. Risk factors for D reduction are smoking history and restrictive disorder in spirometry.
Keywords: D LCO , hemodialysis, lung diffusion capacity