Tesis

Hubungan Heart Rate Variability dengan Frailty pada Pasien yang Menjalani Hemodialisis Kronik = The association between heart rate variability and frailty in chronic kidney disease patients undergoing chronic hemodialysis.

Latar Belakang: Penyakit ginjal kronis (PGK) merupakan suatu kondisi progresif dan salah satu kontributor mortalitas dan morbiditas di seluruh dunia. Gangguan sistem saraf otonom (SSO) adalah salah satu mekanisme kemunculan komorbiditas pada PGK seperti frailty. Frailty adalah sindrom penurunan kapasitas fungsional multisistem dalam menghadapi stressor, dan adanya kondisi ini menjadi faktor yang memperburuk prognosis pasien tersebut. Pengukuran Heart Rate Variability (HRV) menggambarkan fungsi SSO dan merupakan pemeriksaan potensial yang dapat menjadi penanda frailty pada PGK secara efektif dan objektif. Tujuan: Mengetahui hubungan antara pemeriksaan HRV dengan frailty pada pasien PGK yang menjalani hemodialisis kronik. Metode: Penelitian ini merupakan penelitian analitik potong lintang dengan merekrut pasien PGK yang menjalani hemodialisis kronik di RSUPN dr.Cipto Mangunkusumo pada bulan November - Desember 2024. Pengukuran HRV dilakukan 5 menit pre-HD dengan sadapan dada Polar-H10. Frailty dinilai lewat pengisian kuesioner Frailty Index 40 Item. Karakteristik pasien dan faktor perancu didapatkan dari hasil pemeriksaan serum, hasil kuesioner depresi, cemas, dan gangguan tidur, dan rekam medis. Hasil penelitian dianalisis secara statistik secara bivariat dan multivariat. Hasil: Dari 114 subjek PGK yang diteliti, didapatkan bahwa 28.1% mengalami frail, dengan rerata SDNN 20,51ms ± 11,52, RMSSD 19,23 ms ± 11,96, dan LF/HF ratio 2,27 ± 1,69. Setelah pengkategorian dan analisis bivariat terhadap status frailty, didapatkan bahwa SDNN < 23 ms, RMSSD < 17 ms, riwayat hipertensi dan indeks massa tubuh merupakan variabel dengan tren signifikan. Setelah penyesuaian dengan analisis multivariat, didapatkan bahwa hanya SDNN < 23 ms yang memiliki hubungan signifikan dengan status frail. Simpulan: Pada pasien dengan kondisi PGK yang menjalani hemodialiasis kronik, pengukuran SDNN sebagai parameter HRV memiliki kaitan erat dan independen dengan keberadaan kondisi frail.
Kata kunci: penyakit ginjal kronis, heart rate variability, frailty, hemodialisis, hipertensi, indeks massa tubuh, sistem saraf otonom


Background: Chronic kidney disease (CKD) is a progressive condition and a contributor to mortality and morbidity worldwide. Mechanistically, CKD is underlined by various physiological disorders that interact with each other, one is the autonomic nervous system (CNS) disorders that can be the underlying mechanism for several CKD comorbidities such as frailty. Frailty is a syndrome of decreased multisystem functional capacity and reduced ability to cope with stressors. The presence of frailty in CKD patients, especially in advanced CKD patients undergoing hemodialysis (HD), is a factor that worsens the prognosis of these patients. Heart Rate Variability (HRV) measurement, which illustrates SSO function, is a potential examination that can effectively and objectively show the frailty in CKD patients. Objective: To identify the relationship between HRV assessment and frailty in CKD patients undergoing routine HD. Methods: This study was a cross-sectional, observational study that recruited CKD patients undergoing HD at Cipto Mangunkusumo National Referral Hospital from September to October 2024. HRV measurements were taken 5 minutes pre-HD with Polar-H10 chest leads. Frailty was assessed by completing the 40-item Frailty Index questionnaire. Patient characteristics and confounding factors were obtained from blood serum examination results, results of depression, anxiety, and sleep disorder questionnaires, and medical records. Bivariate and multivariate analysis were performed on the results. Results: Of the 114 CKD subjects studied, 28.1% were found to be frail, with a mean SDNN of 20.51 ± 11.52, RMSSD of 19.23 ± 11.96, and LF/HF ratio of 2.27 ± 1.69. After categorization and bivariate analysis of frailty status, it was found that SDNN < 23 ms, RMSSD < 17 ms, history of hypertension, and body mass index were variables with significant trends statistically. After adjustment by multivariate analysis, it was found that only SDNN < 23 ms had a significant and independent association with frailty status. Conclusion: In patients with CKD undergoing routine hemodialysis, HRV measurements, especially SDNN parameters assessing sympathetic innervation function, are strongly associated with frailty, regardless of the presence of other confounding factors.
Keywords: chronic kidney disease, heart rate variability, frailty, hemodialysis, hypertension, body mass index, autonomic nervous system.