Tesis

Hubungan Kadar Karnitin Plasma dengan Kelainan Geometri dan Fungsi Ventrikel Kiri pada Anak dengan Gagal Ginjal yang Menjalani Dialisis = Association between plasma carnitine levels and left ventricular geometry and function in children with kidney failure undergoing dialisis.

Latar Belakang: Penyakit kardiovaskular merupakan penyebab utama morbiditas dan mortalitas pada anak dengan gagal ginjal yang menjalani dialisis. Perubahan geometri ventrikel kiri dan kelainan fungsi sistolik dan diastolik sering ditemukan sebagai manifestasinya. Karnitin, derivat asam amino, berperan penting dalam metabolisme asam lemak untuk menghasilkan energi, termasuk pada otot jantung. Pasien gagal ginjal berisiko mengalami kehilangan karnitin dalam proses dialisis. Tujuan: Mengetahui hubungan kadar karnitin plasma dengan kelainan geometri dan fungsi ventrikel kiri pada anak dengan gagal ginjal yang menjalani dialisis. Metode: Penelitian analitik metode potong lintang dilakukan pada anak dengan gagal ginjal yang menjalani dialisis di RS dr. Cipto Mangunkusumo Jakarta pada tahun 2025. Data yang dianalisis meliputi kadar karnitin, parameter ekokardiografi yaitu indeks massa ventrikel kiri (LVMI), fungsi sistolik yaitu fraksi ejeksi (EF), dan fungsi diastolik yaitu E/A dan E/e’ serta karakterisik klinis dan demografi lainnya. Hasil: Sebanyak 59 subjek yang terdiri dari 39 (66,1%) laki-laki dan 20 (33,9%) perempuan dengan median usia 13,58 (RIK 10,58 – 16) tahun. Terdapat 61 subjek menjalani hemodialisis (HD) dan 39% subjek menjalani peritoneal dialisis (PD). Kadar karnitin plasma median pada kelompok HD adalah 104,64 (RIK 94,84-132,28) µmol/L dan PD 1 05,23 (RIK 65,22-118,46) µmol/L. Tidak ditemukan subjek dengan kadar karnitin < 20 µmol/L. Analisis menunjukkan korelasi negatif signifikan antara kadar karnitin dengan LVMI (r = –0,38; p = 0,006). Terdapat kecenderungan hubungan negatif antara kadar karnitin dan E/e’ (r = –0,238; p = 0,092). Tidak ditemukan hubungan bermakna antara kadar karnitin dengan fraksi EF. Setelah dianalisis secara multivariat, hubungan karnitin dan LVMI, EF maupun E/e’ tidak lagi signifikan. Akan tetapi, E/A menjadi signifikan setelah dikontrol oleh variabel kovariat dengan p=0,229, koefisien β - 0,016 dan OR 0,985. Kesimpulan: Tidak ditemukan defisiensi karnitin pada seluruh subjek. Kadar karnitin berhubungan negative dengan LVMI secara signifikan, namun tidak bersifat independen setelah dikontrol oleh variabel klinis lainnya. Terdapat hubungan antara kadar karnitin dengan E/A setelah dikontrol oleh variabel kovariat klinis.
Kata kunci: anak dengan gagal ginjal, karnitin, fungsi ventrikel, LVH, dialisis


Background: Cardiovascular disease is the leading cause of morbidity and mortality in children with kidney failure undergoing dialysis. Changes in left ventricular geometry, as well as systolic and diastolic dysfunction, are frequently observed. Carnitine, an amino acid derivative, plays a vital role in fatty acid metabolism for energy production, including in cardiac muscle. Children with kidney failure are at risk of carnitine loss due to dialysis and impaired renal excretion. Objective: To assess the association between plasma carnitine levels and abnormalities in left ventricular geometry and function in children with kidney failure undergoing dialysis. Methods: This analytical cross-sectional study was conducted at Dr. Cipto Mangunkusumo Hospital, Jakarta, in 2025. Subjects included children with kidney failure receiving hemodialysis (HD) or peritoneal dialysis (PD). Data analyzed included plasma carnitine levels, echocardiographic parameters such as left ventricular mass index (LVMI), systolic function (ejection fraction/ EF) and diastolic function (E/A and E/e’) and clinical and demographic characteristics. Results: A total of 59 subjects were included, consisting of 39 (66.1%) males and 20 (33.9%) females, with a median age of 13.58 years (IQR 10.58–16). Among them, 61% underwent HD and 39% PD. Median plasma carnitine levels were 104.64 µmol/L (IQR 94.84– 132.28) in HD and 105.23 µmol/L (IQR 65.22–118.46) in PD. No subject had plasma carnitine levels < 20 µmol/L. A significant negative correlation was found between carnitine levels and LVMI (r = –0.38; p = 0.006). A nonsignificant trend of negative correlation was observed between carnitine and E/e’ (r = –0.238; p = 0.092). No significant association was found between carnitine and EF. After multivariate adjustment, the associations between carnitine and LVMI, EF, and E/e’ were no longer significant, but E/A was significant with p=0,229, correlation β -0,016 and OR 0,985. Conclusion: No carnitine deficiency was found in children undergoing dialysis. Plasma carnitine levels were negatively associated with LVMI, suggesting a possible protective role, although this association was not independent after adjustment for clinical covariates. Otherwise, plasma carnitine were negatively associated with diastolic function based on E/A after adjustment for clinical covariates.
Keywords: children with kidney failure, carnitine, ventricular function, LVH, dialysis