Tesis

Perbandingan Efektivitas Hemodialisis Dengan Atau Tanpa Suplementasi Natrium Bikarbonat Oral Dalam Mempertahankan Kadar Normal Bikarbonat Darah = Comparison of the Effectiveness of Hemodialysis With or Without Oral Sodium Bicarbonate Supplementation in Maintaining Normal Blood Bicarbonate Levels.

Latar Belakang: Penyakit ginjal stadium akhir (End Stage Renal Disease/ESRD) prevalensinya meningkat secara signifikan di seluruh dunia, termasuk di Indonesia. Pada penyakit ginjal kronik dan ESRD mudah sekali terjadi asidosis metabolik, guna mencegahnya diberikan suplemen NaHCO3 oral atau hemodialisis. Sebagian klinisi tetap memberikan suplementasi NaHCO3 oral pada pasien ESRD yang sudah menjalani hemodialisis rutin, namun sebagian lagi tidak. Penelitian ini bertujuan mengevaluasi apakah masih diperlukan suplementasi NaHCO3 oral pada pasien yang sudah menjalani hemodialisis rutin dua kali seminggu. Metode: Studi observasional analitik dengan desain potong lintang dilakukan di Unit Hemodialisis Rumah Sakit Pusat Pertamina Jakarta pada Desember 2019 hingga Februari 2020. Sampel secara konsekutif dipilih dari pasien dengan hemodialisis rutin 2 kali per minggu minimal 3 bulan dan tidak dalam kondisi hemodinamik yang tidak stabil; 30 orang yang mendapat suplementasi NaHCO3 oral dan 30 orang yang tidak. Sampel darah vena pre dialisis diambil untuk pemeriksaan analisis gas darah guna mengukur kadar HCO3. Hasil: Rerata lama HD per kali tindakan pada kelompok tanpa suplementasi (4 jam 14 menit), dan kelompok dengan suplementasi NaHCO3 (4 jam 26 menit) tidak berbeda signifikan ( p= 0.051 , CI= -0,4006 - 0,0006). Proporsi pasien ESRD dengan hemodialisis rutin tanpa suplementasi NaHCO3 oral yang mencapai kadar HCO3 pre dialisis dalam rentang normal adalah 26,7%, sedangkan yang mendapat suplementasi NaHCO3 oral proporsinya secara signifikan lebih tinggi yaitu 53,3% (p= 0,035, PR= 1,57; IK=1,013 2,438). Kesimpulan: Pada pasien ESRD dengan HD rutin 2 kali per minggu (8 jam/minggu, masih diperlukan suplementasi HCO3 untuk menjaga kadar HCO3 pre dialisis dalam rentang normal.
Kata Kunci: ESRD, asidosis metabolik, hemodialisis, NaHCO3 oral, kadar normal HCO3 pre dialisis.


Background: The prevalence of End Stage Renal Disease (ESRD) has increased significantly worldwide, including in Indonesia. In chronic kidney disease and ESRD metabolic acidosis is very easy to occur, and oral NaHCO3 supplementation or hemodialysis may prevent it. Some clinicians continue to provide oral NaHCO3 supplementation to ESRD patients who are already undergoing hemodialysis regularly, but some do not. This study aims to evaluate whether oral NaHCO3 supplementation is still necessary in patients who have undergone regular hemodialysis. Methods: An analytic observational study with a cross-sectional design was conducted at the Hemodialysis Unit of Pertamina Central Hospital Jakarta from December 2019 to February 2020. Samples were consecutively selected from patients with at least 3 months regular twice weekly hemodyalisis and not in an unstable hemodynamic condition; 30 patients who received oral NaHCO3 supplementation and 30 people who did not. Predialysis venous blood samples were taken for blood gas analysis to measure the HCO3 levels. Results: The mean length of HD per week in the group without supplementation (4 hours 14 minutes), and the group with NaHCO3 supplementation (4 hours 26 minutes) was not significantly different (p= 0.051, CI= -0.4006 - 0.0006). The proportion of ESRD patients with regular hemodyalisis who achieved normal range of pre-dialysis HCO3 without oral NaHCO3 supplementation was 26.7%, while those who received oral NaHCO3 supplementation was significantly higher, namely 53.3% (p= 0.035, PR= 1.57; CI= 1.013 - 2.438). Conclusion: In ESRD patients with routine HD 2 times per week (8 hours/week, HCO3 supplementation is still needed to maintain pre-dialysis HCO3 levels within the normal range.
Key words: ESRD, metabolic acidosis, hemodialysis, oral NaHCO3, normal levels of pre-dialysis HCO3.