Tesis

Korelasi Kadar Beta-2 Mikroglobulin Serum Dengan Ketebalan Tunika Intima-Media Arteri Karotis Pada Pasien Hemodialisis High Flux dan Continuous Ambulatory Peritoneal Dialysis Non Diabetik = Correlation Between Serum Beta-2 Microglobulin Level and Carotid Artery Intima-media Thickness Among Non-Diabetic High Flux Hemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients.

Latar Belakang: Penyakit vaskular aterosklerotik merupakan penyebab penting morbiditas dan mortalitas pasien penyakit ginjal kronik (PGK), terutama penyakit ginjal tahap akhir (PGTA) yang menjalani dialisis. Perbedaan potensial antara tindakan hemodilisis (HD ) dengan Continuous Ambulatory Peritoneal Dialysis (CAPD) dapat memberi efek berbeda terhadap faktor risiko penyakit kardiovaskular (PKV) dan dalam mempengaruhi timbulnya PKV. Salah satu faktor yang mendorong timbulnya PKV pada pasien PGTA ialah retensi produk toksin uremik, di antaranya Beta-2 mikroglobulin (2M) yang dihubungkan secara independen dan bermakna dengan PKV pada pasien aterosklerosis asimtomatik. Ketebalan tunika intima-media karotis (KIMK) merupakan petanda aterosklerosis pada pasien PGK. Tujuan: Mengetahui perbedaan kadar 2M serum dan KIMK antara pasien HD dibandingkan pasien CAPD, dan korelasi antara kadar 2M serum dengan KIMK. Metode: Penelitian dilakukan secara potong lintang. Subjek adalah pasien PGTA yang rutin menjalani HD atau CAPD dan memenuhi kriteria penelitian, dilakukan pengumpulan data berupa karakteristik subjek, pemeriksaan fisik, pemeriksaan kadar 2M serum dan pemeriksaan KIMK dengan ultrasonografi. Dilakukan perbandingan rerata kadar 2M serum, rerata KIMK kanan, rerata KIMK kiri antara kelompok pasien HD dan CAPD dengan uji t tidak berpasangan dan uji Mann Whitney, serta uji korelasi Pearson antara kadar 2M serum dengan KIMK. Hasil: Dari 62 subjek penelitian yang terdiri 36 pasien HD dan 26 pasien CAPD, didapatkan kadar 2M serum pasien HD lebih tinggi tetapi tidak bermakna (p 0,167; IK95% 2,041-11,508), KIMK kanan lebih tebal bermakna pada pasien CAPD (p 0,006), KIMK kiri lebih tebal tetapi tidak bermakna (p 0,770), dan tidak didapatkan korelasi antara kadar 2M serum dengan KIMK kanan maupun kiri (r 0,085 p 0,514 ; r 0,082 p 0,529) Kesimpulan: Kadar 2M serum tidak berbeda bermakna antara pasien HD dengan CAPD, KIMK kanan lebih tebal bermakna pada pasien CAPD, KIMK kiri tidak berbeda antara pasien HD dengan CAPD, tidak didapatkan korelasi antara kadar 2M serum dengan KIMK.
Kata Kunci: Kadar 2M serum, Beta-2 mikroglobulin, KIMK


Background: Atherosclerotic vascular disease is a main cause of morbidity and mortality in chronic kidney disease patients, especially end stage renal disease undergoing dialysis. Potensial difference between hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) treatment could have a different effect on cardiovascular risk factors and may differentially influence the risk of developing CVD. One of the risk factors can induce CVD is uremic toxin retention. Beta-2 microglobulin (2M) is a middle molecule uremic toxin independently and significantly related to CVD in patients with asymptomatic carotid atherosclerosis. Carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis in chronic kidney disease patients. Objectives: To know the difference of serum 2M level and CIMT in HD patients group compared to CAPD patients group, and to determine correlations between serum 2M level with CIMT. Methods: We conducted a cross sectional study. Subjects were ESRD patients undergoing HD or CAPD which fulfilled study criteria were included in study. Data collection included subjects characteristics, physical examination, laboratory examination of serum 2M level, and measurement of CIMT by Doppler ultrasound. We used non pair student t test and Mann Whitney test to compare the mean of serum 2M level and the mean of left and right CIMT between HD group and CAPD group, and Pearson correlation test to serum 2M level and CIMT. Results: Of 62 subjects, consisted of 36 HD patients and 26 CAPD patients, we found non significant higher serum 2M level in HD patients (p 0,167; 95%CI 2,041-11,508), significant thicker right CIMT in CAPD patients (p 0,006), non significant thicker left CIMT in HD patients (p 0,770), and there was no correlation between serum 2M level with right or left CIMT (r 0,085 p 0,514; r 0,082 p 0,529) Conclusions: Serum 2M level was not significant different between HD and CAPD patients, right CIMT was thicker in CAPD patients, left CIMT was not different between HD and CAPD patients, and no correlation between serum 2M level and CIMT.
Keywords: ESRD, HD, CAPD, Beta-2 microglobulin, CIMT