Tesis

Hubungan Tekanan Darah Sistolik dengan Time to Urinate, Volume Urine dan Laju Filtrasi Glomerulus Pada Pasien yang Menjalani Transplantasi Ginjal: Pengamatan Satu Minggu Pascaoperasi = The Relationship Between Systolic Blood Pressure with Time to Urinate, Urine Volume, and Glomerular Filtration Rate in Patients Undergoing Kidney Transplantation:A One-Week Postoperative Observation.

Latar Belakang: Fungsi ginjal awal pasca transplantasi ginjal merupakan indikator penting keberhasilan transplantasi, yang dinilai antara lain dari time to urinate, volume urin, dan laju filtrasi glomerulus (LFG) dalam satu minggu pascaoperasi. Faktor hemodinamik seperti tekanan darah sistolik intraoperatif dan pascaoperasi diduga memengaruhi perfusi ginjal transplantasi dan pemulihan fungsi graft. Tujuan: Penelitian ini bertujuan untuk mengevaluasi hubungan tekanan darah sistolik (TDS) intraoperatif dan pascaoperasi terhadap parameter fungsi ginjal awal pada pasien transplantasi ginjal. Metode: Penelitian kohort retrospektif ini melibatkan 172 pasien transplantasi ginjal di RS Cipto Mangunkusumo, Jakarta, periode 2022–2024. Tekanan Darah Sistolik (TDS) intraoperatif, TDS pascaoperasi, time to urinate, rerata volume urin minggu pertama, dan estimasi LFG (eLFG) hari ke 7 pascaoperasi dikumpulkan dari rekam medis. Analisis hubungan dilakukan dengan uji statistik bivariat (Mann-Whitney, t-test, dan kurva ROC) serta regresi logistik multivariat untuk mengontrol faktor perancu. Hasil: Tekanan darah sistolik intraoperatif berhubungan signifikan dengan time to urinate. Pasien dengan TDS intraoperatif ≤ 138 mmHg memiliki risiko 3,0 kali lebih tinggi mengalami keterlambatan berkemih ( > 5 menit) dibanding pasien dengan TDS > 138 mmHg (p = 0,023). Tekanan darah sistolik pascaoperasi tidak menunjukkan hubungan bermakna dengan volume urin minggu pertama (p = 0,815). Namun, tekanan darah sistolik pascaoperasi yang tinggi ( ≥ 165 mmHg) berasosiasi signifikan dengan penurunan eLFG satu minggu pasca transplantasi, kurva ROC didapatkan AUC 0,800 (95% IK 0,733 – 0,866) dengan p < 0,000. Simpulan: . Terdapat hubungan antara TDS intraoperatif dengan time to urinate, dan TDS pascaoperasi dengan laju filtrasi glomerulus pada pasien yang menjalani transplantasi ginjal. Namun tidak dijumpai hubungan antara TDS pascaoperasi dengan volume urine dalam 1 minggu pasca operasi transplantasi ginjal.
Kunci: tekanan darah sistolik, transplantasi ginjal, time to urinate, volume urin, laju filtrasi glomerulus


Background: Early kidney allograft function after transplantation is a critical indicator of transplant success. It can be evaluated by metrics such as time to first urine output, urine volume, and glomerular filtration rate (GFR) in the first postoperative week. Hemodynamic factors including intraoperative and postoperative systolic blood pressure (SBP) are thought to influence graft perfusion and functional recovery. Objective: This study aimed to evaluate the relationship between intraoperative and postoperative SBP and early kidney graft function parameters in kidney transplant recipients. Methods: This retrospective cohort study included 172 kidney transplant recipients at Cipto Mangunkusumo Hospital, Jakarta, from 2022 to 2024. Data collected from medical records encompassed intraoperative SBP, postoperative SBP, time to first urination, total urine volume in the first week, and estimated GFR at one-week post-transplant. Relationships were analyzed using bivariate statistical tests (Mann-Whitney, t-test, and ROC curve analysis) and multivariate logistic regression to adjust for potential confounders. Results; This study showed that intraoperative SBP was significantly associated with time to first urination. Patients with intraoperative SBP ≤138 mmHg had a 3.0-fold higher risk of delayed initial urine output ( > 5 minutes) compared to patients with SBP > 138 mmHg (p = 0,023). Postoperative SBP was not significantly related to total urine volume in the first week (p = 0,815). However, higher postoperative SBP ( ≥ 165 mmHg) was significantly associated with a greater likelihood of low eGFR at one week: patients with SBP ≥ 165 had nearly twice the risk of eGFR < 60 mL/min/1.73 m² {ROC with AUC 0.800 (95% CI 0,733 – 0,866); p < 0.001} Conclusions: There is an association between intraoperative systolic blood pressure and time to urinate, as well as between postoperative systolic blood pressure and glomerular filtration rate in patients undergoing kidney transplantation. However, no association was found between postoperative systolic blood pressure and urine volume within one week after kidney transplantation.
Keywords: systolic blood pressure, kidney transplantation, time to urinate, urine output, glomerular filtration rate