Tesis

Hubungan antara Sirosis Hati dan Kadar Virus dengan Penyakit Ginjal Kronik pada Pasien Hepatitis C = Association between liver cirrhosis and viral load with chronic kidney disease in hepatitis C.

Latar Belakang: Hubungan antara hepatitis C dan penyakit ginjal kronik (PGK) sudah semakin jelas. Sirosis hati dan kadar virus pada hepatitis C dikatakan berhubungan dengan PGK, namun hal ini masih menjadi kontroversi. Tujuan: Mengetahui prevalensi PGK serta hubungannya dengan sirosis hati dan kadar virus pada pasien hepatitis C. Metode: Penelitian ini merupakan studi potong-lintang yang dilakukan pada Agustus 2018 sampai Januari 2019 di Poliklinik Hepatologi Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta, Indonesia. Subjek dipilih secara konsekutif pasien dengan antiHCV positif dan ditanyakan kesediannya. Subjek dengan HIV, hepatitis B, riwayat hemodialisis, dan batu ginjal dieksklusi. Data diambil melalui anamnesis, pemeriksaan fisik, elastrografi transien, pemeriksaan darah dan urin. Pasien didiagnosis PGK bila terdapat kelainan laju filtrasi glomerolus atau albuminuria atau hematuria persisten selama tiga bulan. Analisis statistik menggunakan kai kuadrat untuk data kategorik dan menggunakan regresi logistik untuk mengendalikan variabel perancu. Hasil: Dari total 185 subjek yang mengikuti penelitian ini didapatkan prevalensi PGK sebesar 23,2% dengan 95% IK 17,12–29,28% pada subjek dengan hepatitis C. Sirosis hati berhubungan dengan terjadinya PGK pada hepatitis C dengan crude OR 2,786 (1,276– 6,081) dan adjusted OR 2,436 (1,057–5,614) setelah mengendalikan diabetes melitus, usia, dan jenis kelamin. Tidak didapatkan hubungan antara kadar virus dengan PGK (p = 0,632). Simpulan: Terdapat hubungan antara sirosis hati dengan PGK dan tidak terdapat hubungan antara kadar virus dengan PGK pada pasien dengan hepatitis C. Kata Kunci: hepatitis C, penyakit ginjal kronik, sirosis, kadar virus


Background: Association between hepatitis C and chronic kidney disease (CKD) has been more clearly defined. Liver cirrhosis and viral load has been thought to be associated with CKD in hepatitis C, although some studies did not show any consistency. Aim: This study was aimed to know the association between liver cirrhosis and viral load with chronic kidney disease in hepatitis C. Methods: This was a cross-sectional study which was done in August 2018 till January 2019 in Hepatology Clinic Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia. Subject was chosen consecutively to all patients with antiHCV positive and was asked for the informed consent. Subjects with HIV, hepatitis B, history of hemodialysis, or kidney stone were excluded. Data were taken through asking for history, physical examination, transient elastography, blood, and urine examination. Patient was diagnosed with CKD if there was any persistent abnormalities in glomerolus filtration rate, albuminuria, or hematuria in three months. In statistical analysis, chi square was used for categorical data and logistic regression to control confounding variables. Result: From 185 subjects that is included in this study, the prevalence of CKD among hepatitis C was 23.2% (CI 95% 17.12–29.28%.) Liver cirrhosis was associated with CKD in hepatitis C with crude OR 2.786 (1.276–6.081) and adjusted OR 2.436 (1.057–5.614) after controlling diabetes mellitus, age, and sex. There was no association between viral load and CKD (p=0.632). Conclusion: Renal evaluation was need to be done in all patients with hepatitis C, particularly in patient with liver cirrhosis.
Keywords: hepatitis C, chronic kidney disease, cirrhosis, viral load