Tesis

PROFIL KADAR ASAM FOLAT DAN VITAMIN B12 PADA PASIEN HEMODIALISIS KRONIK DAN HUBUNGANNYA DENGAN hsCRP DAN HOMOSISTEIN SEBAGAI FAKTOR RISIKO PENYAKIT KARDIOVASKULAR = SERUM FOLIC ACID AND VITAMIN B12 PROFILES IN CHRONIC HEMODIALYSIS PATIENTS AND THEIR RELATIONSHIP WITH hsCRP AND HOMOCYSTEINE AS CARDIOVASCULAR DISEASE RISK FACTORS.

Latar Belakang. Pasien dengan penyakit ginjal kronik memiliki risiko mortalitas akibat penyakit kardiovaskular lebih tinggi dibandingkan dengan populasi normal. Hiperhomosisteinemia telah diketahui sebagai salah satu faktor risiko penyakit kardiovaskular. Asam folat dan vitamin B12 rutin diberikan untuk menurunkan homosistein darah. Belum ada penelitian mengenai profil asam folat dan vitamin B12 pada kelompok PGK yang menjalani hemodialisis dua kali seminggu. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar asam folat dan vitamin B12 dengan hsCRP dan homosistein sebagai faktor risiko penyakit kardiovaskular pada pasien penyakit ginjal kronik yang menjalani hemodialisis. Metode. Penelitian dilakukan pada 80 pasien PGK yang menjalani hemodialisis dua kali seminggu di unit hemodialisis RSUP Nasional dr. Cipto Mangunkusumo pada bulan AgustusOktober 2019. Dilakukan pengambilan darah predialisis untuk pengukuran kadar asam folat, vitamin B12, homosistein, dan hsCRP. Pasien dengan kondisi yang mempengaruhi pemeriksaan tersebut dieksklusi dari penelitian. Hasil. Terdapat variasi kadar asam folat, vitamin B12, homosistein, dan hsCRP pada subjek penelitian. Median kadar asam folat darah 18,04 ng/mL dengan RIK 36,89 ng/mL. Kadar vitamin B12 memiliki median 1.753 pg/mL dengan RIK 76.782,5 pg/mL. Median kadar homosistein adalah 20,85 μmol/L dengan RIK 11,45 μmol/L. Kadar hsCRP didapatkan median 4,7 mg/L dengan RIK 12,63 mg/L. Terdapat korelasi lemah yang bermakna antara kadar vitamin B12 dengan homosistein (p=0,027; r=-0,325), namun tidak terdapat hubungan bermakna antara kadar asam folat dengan hsCRP, asam folat dengan homosistein, maupun vitamin B12 dengan hsCRP. Analisis subgrup pada pasien dengan kadar hsCRP > 3 mg/L menunjukkan adanya hubungan bermakna antara asam folat dan vitamin B12 dengan homosistein. Analisis subgrup pada pasien yang mendapatkan asam folat 35-105 mg/minggu juga menunjukkan adanya hubungan terbalik antara kadar asam folat dan homosistein darah. Kesimpulan. Sebagian besar pasien PGK yang menjalani hemodialisis dua kali seminggu memiliki kadar asam folat dan vitamin B12 normal hingga tinggi. Terdapat hubungan bermakna antara kadar vitamin B12 dengan homosistein, namun tidak terdapat hubungan bermakna antara kadar asam folat dengan hsCRP, asam folat dengan homosistein, maupun vitamin B12 dengan hsCRP. Analisis subgrup menunjukkan hubungan bermakna pada kelompok risiko tinggi dan kelompok yang mendapatkan suplementasi asam folat.
Kata kunci: Asam folat, vitamin B12, homosistein, hsCRP, penyakit ginjal kronik, kardiovaskular


Background. Patients with chronic kidney disease face increased mortality from cardiovascular disease compared with normal population. Hyperhomocysteinemia is known to be a cardiovascular risk factor. Folic acid and vitamin B12 is routinely prescribed to reduce serum homocysteine. There was no study to determine serum folic acid and vitamin B12 profiles in twice weekly hemodialysis patients. Methods. This study involved 80 twice daily hemodialysis patients in dr. Cipto Mangunkusumo National Hospital’s Hemodialysis Unit from August-October 2019. Predialysis blood samples were taken to measure serum folic acid, vitamin B12, homocysteine and hsCRP levels. Patients with medical conditions affecting the assays were excluded. Results. There were variations in serum folic acid, vitamin B12, homocysteine, and hsCRP levels. Median serum folic acid level was 18,04 ng/mL (IQR 36,89 ng/mL). The median of serum vitamin B12 level was 1.753 pg/mL (IQR 76.782,5 pg/mL). Median serum homocysteine was 20,85 μmol/L (IQR of 11,45 μmol/L). Serum hsCRP had median value of 4,7 mg/L (IQR 12,63 mg/L). We found mild correlation between serum vitamin B12 level and serum homocysteine level (p=0,027; r=-0,325), but no correlation between folic acid and hsCRP, folic acid and homocysteine nor vitamin B12 with hsCRP. Subgroup analysis in patients with hsCRP>3 mg/L found significant correlation between folic acid and homocysteine and also between vitamin B12 and homocysteine. Subgroup analysis in patients with weekly folic acid intake 35-105 mg/week showed significant correlation between folic acid and homocysteine. Conclusion. Most chronic kidney disease patients who underwent twice weekly hemodialysis had normal to elevated serum folic acid and vitamin B12. There was significant correlation between serum vitamin B12 with homocysteine, but no correlation in other variables. However, in specific group of subjects with high cardiovascular risk, there was significant correlation between folic acid and homocysteine and also between vitamin B12 and homocysteine. Subgroup analysis in patients taking folic acid supplementation also showed significant correlation between folic acid and homocysteine.
Keywords: Folic acid, vitamin B12, homocysteine, hsCRP, chronic kidney disease, cardiovascular