Tesis

Hubungan Frailty dengan Variabilitas Tekanan Darah Intradialitik pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis Reguler = The Association between Frailty Status and Blood Pressure Variability in Chronic Kidney Disease Patients Undergoing Hemodialysis.

Latar Belakang: Tingginya angka mortalitas pada pasien PGK-HD diperberat oleh tingginya kematian dengan penyebab kardiovaskular dan variabilitas tekanan darah (VTD). Tujuan: Tujuan penelitian ini adalah untuk mengetahui hubungan antara status frailty dengan VTD intradialitik. Metode: Penelitian ini menggunakan desain potong lintang pada pasien PGK-HD yang menjalani HD di RSUPN dr. Cipto Mangunkusumo selama periode AgustusSeptember 2022. Data sekunder berupa hasil pengukuran tekanan darah selama delapan kali sesi HD dan hasil laboratorium selama tiga bulan terakhir didapat dari rekam medis. VTD dihitung menggunakan metode ARV dan status frailty dinilai berdasarkan FI 40 Item. Hubungan antara status frailty dengan VTD intradialitik dianalisis dengan uji Chi-Square yang dilanjutkan dengan analisis regresi logistik untuk menyingkirkan pengaruh variabel perancu yaitu usia, status gizi, komorbid, obat anti-hipertensi, lama (vintage) HD, dan interdialytic weight gain. Perbedaan rerata VTD intradialitik antara status frailty dinilai dengan uji Kruskal-Wallis. Hasil: Sebanyak 88 subjek penelitian didapatkan 28,4% (IK (95%)18,98-37,82) frail, 55,7% (IK (95%) 45,32-66,08) pre-frail, dan 15,9% (IK (95%)8,26-23,54) robust. Rerata VTD intradialitik sebesar 10,11 (8,60 –13,35). Terdapat peningkatan prevalensi yaitu semakin tinggi status frailty maka semakin tinggi rerata VTD intradialitik berdasarkan hasil uji Kruskal-Wallis yang memiliki kemaknaan secara statstik. Hasil dari analisis multivariat terdapat peningkatan prevalensi VTD pada pasien dengan pre-frail adjusted PR 1,606 (IK (95%) 0,681 -3,787); frail: adjusted PR 1,886 (IK (95%) 0,783-4,545). Namun, peningkatan tersebut tidak bermakna secara statistik. Kesimpulan: Tidak terdapat hubungan antara status frailty dengan VTD intradialitik secara statistik. Namun, secara klinis didapatkan hubungan doserespond, semakin frail semakin besar Prevalence Ratio terjadinya variabilitas tekanan darah intradialitik.
Kata kunci: penyakit ginjal kronik; hemodialisis; frailty; variabilitas tekanan darah intradialitik.



Background: The high mortality rate in CKD-HD patients is aggravated by the high cardiovascular-induced death and blood pressure variability (BPV). Objective: The aim of this study was to find out the association between frailty status and intradialytic BPV. Method: This study used a cross-sectional design in CKD-HD patients who underwent HD at Cipto Mangunkusumo National General Hospital from August to September 2022. The secondary data were the results of blood pressure measurements in eight HD sessions and those of laboratory testing for the last three months derived from the medical records. BPV was calculated by using the ARV method and frailty status was assessed based on FI 40 Item. The association between frailty status and intradialytic BPV was analyzed with Chi-Square test which was proceeded with logistic regression analysis to exclude the influence of the confounding variables, namely age, nutritional status, comorbidities, antihypertensive agents, duration of HD and interdialytic weight gain. The mean difference of intradialytic BPV among frailty statuses was valued by KruskalWallis test. Results: Out of eighty-eight study subjects, were obtained the following data: 28.4% (CI (95%)18.98-37.82) frail, 55,7% (CI (95%) 45.32-66.08) pre-frail, and 15.9% (CI (95%) 8.26-23.54) robust. Mean intradialytic BPV was as much as 10.11 (8,.0 –13.35). It was found that the trend increased along with the rising frailty status and the mean difference of intradialytic BPV based on the results of KruskalWallis testing had statistical significance. The result of the multivariate analysis reveals an increase in BPV prevalence in patients with pre-frail: adjusted PR 1.606 (CI (95%) 0.681-3.787); frail: adjusted PR 1 .886 (CI (95%) 0.783-4.545). Nevertheless, it has no statistically significance. Conclusion: There is no association between frailty status and intradialytic BPV statistically; however, clinically, the dose-respond relationship was found, the higher the frailty status was, the higher the Prevalence Ratio was in the occurrence of BPV.
Keywords: Chronic kidney failure; hemodialysis; frailty; intradialytic blood pressure variability.