Rakhman, M. Farid and Dr. dr. Atma Gunawan, SpPD, K-GH and dr. B.P. Putra Suryana, Sp.PD, K-R. (2023) Perbandingan Kadar Kalsium Serum, Kadar Fosfat Serum Dan Kepadatan Tulang Pada Pasien Pgk Dengan Capd Dan Hemodialisa Di Rs Saiful Anwar Serta Korelasi Kadar Kalsium Serum Dan Kadar Fosfat Serum Dengan Kepadatan Tulang Pada Pasien Pgk Dengan Capd Dan Hemodialisa Di Rs Saiful Anwar. Magister thesis, Universitas Brawijaya.
Abstract
Pendahuluan: Fosfor dan kalsium diketahui berperan penting dalam gangguan mineral dan tulang pada PGK. Penurunan eksresi fosfat pada PGK mengakibatkan peningkatan FGF-23 yang selanjutnya menyebabkan penurunan kadar 1,25(OH)2- vit D3, sehingga mengganggu homeostasis kalsium dan mengakibatkan hiperparathitoid sekunder yang menyebabkan peningkatan pergantian tulang. Pedoman KDIGO tahun 2017 menganjurkan pemeriksaan densitas tulang untuk memprediksikan resiko fraktur pada pasien PGK. Tujuan: Mengetahui korelasi kadar kalsium serum dan kadar fosfat serum terhadap kepadatan tulang belakang, panggul dan 1/3 distal radius pada pasien PGK, serta mengetahui perbandingan kadar kalsium serum, kadar fosfat serum, kepadatan tulang belakang, panggul dan 1/3 distal radius antara pasien PGK dengan hemodialisa dan CAPD di rs saiful anwar Metode: Desain penelitian observasional dengan metode cross sectional pada pasien PGK yang menggunakan hemodialisa dan CAPD, yang dianalisis dengan uji statistik komparasi dan korelasi. Pasien kemudian di periksa kadar kalsium serum, kadar fosfat serum serta kepadatan tulang belakang, tulang panggul dan 1/3 distal tulang radius, yang diukur menggunakan menggunakan alat DXA (dualenergy X-ray absorptiometry). Analisis data dengan untuk menilai korelasi menggunakan Pearson (kadar kalsium serum) dan Sperman (kadar fosfat serum), sedangkan untuk menilai perbedaan kadar kalsium serum, kadar fosfat serum, kepadatan tulang belakang, panggul dan 1/3 distal radius menggunakan uji T Tidak berpasangan. Hasil: Nilai rata-rata kadar kalsium serum dari pasien PGK kelompok hemodialisa adalah 9.0 (s.d. 0.9) sedangkan kelompok CAPD adalah 8.2 (s.d. 1.2) (p <0.001). Nilai rata-rata kadar fosfat serum dari pasien PGK kelompok hemodialisa adalah 3.9 (s.d. 1.4) sedangkan kelompok CAPD adalah 4.5 (s.d. 1.4) (p 0.002). Nilai ratarata kepadatan tulang belakang pasien PGK kelompok hemodialisa adalah 0.906 gram/cm2 (s.d. 0.193) sedangkan kelompok CAPD adalah 0.832 gram/cm2 (s.d. 0.163) (p 0.003). Nilai rata-rata kepadatan neck hip kanan pasien PGK kelompok hemodialisa adalah 0.765 gram/cm2 (s.d. 0.164) sedangkan kelompok CAPD adalah 0.719 gram/cm2 (s.d. 0.157) (p 0.041). Nilai rata-rata kepadatan total hip kanan pasien PGK kelompok hemodialisa adalah 0.860 gram/cm2 (s.d. 0.164) sedangkan kelompok CAPD adalah 0.798 gram/cm2 (s.d. 0.163) (p 0.008). Nilai rata-rata kepadatan neck hip kiri pasien PGK kelompok hemodialisa adalah 0.739 gram/cm2 (s.d. 0.156) sedangkan kelompok CAPD adalah 0.704 gram/cm2 (s.d. 0.156) (p 0.108). Nilai rata-rata kepadatan total hip kiri pasien PGK kelompok viii hemodialisa adalah 0.825 gram/cm2 (s.d. 0.174) sedangkan kelompok CAPD adalah 0.787 gram/cm2 (s.d. 0.169) (p 0.115). Nilai rata-rata kepadatan rata-rata neck hip bilateral pasien PGK kelompok hemodialisa adalah 0.752 gram/cm2 (s.d. 0.117) sedangkan kelompok CAPD adalah 0.712 gram/cm2 (s.d. 0.153) (p 0.034). Nilai rata-rata kepadatan rata-rata total hip bilateral pasien PGK kelompok hemodialisa adalah 0.842 gram/cm2 (s.d.0.126) sedangkan pasien kelompok CAPD adalah 0.793 gram/cm2 (s.d. 0.164) (p 0.016). Nilai rata-rata kepadatan 1/3 distal tulang radius pasien PGK kelompok hemodialisa adalah 0.717 gram/cm2 (s.d. 0.151) sedangkan kelompok CAPD adalah 0.710 gram/cm2 (s.d. 0.139) (p 0.737). Terdapat hubungan signifikan antara kadar kalsium terhadap tulang belakang (p 0.001, Pearson Correlation 0,237) maupun tulang panggul area total hip kanan (p 0.024, Pearson Correlation 0,157), neck hip kiri (p 0.016, Pearson Correlation 0,167), total hip kiri (p 0.003, Pearson Correlation 0,208), rata-rata neck hip (p 0.022, Pearson Correlation 0,159) dan rata-rata total hip (p 0.003, Pearson Correlation 0,208). Namun tidak terdapat hubungan signifikan antara kadar kalsium terhadap neck hip kanan (p 0.086) dan 1/3 distal tulang radius (0.571). Tidak terdapat hubungan signifikan antara kadar fosfat terhadap tulang belakang (p 0.956), tulang panggul (neck hip kanan: p 0.796, total hip kanan: p 0.393, neck hip kiri: p 0.827, total hip kiri: p 0.215, rata-rata neck hip: p 0.866, rata-rata total hip: p 0.238) dan 1/3 distal tulang radius (0.689). Kesimpulan: Kadar kalsium serum berkorelasi terhadap kepadatan tulang, sedangkan kadar fosfat serum tidak berkorelasi terhadap kepadatan tulang. Kadar kalsium pada kelompok hemodialisa lebih tinggi dibanding CAPD, sedangkan kadar fosfat pada kelompok hemodialisa lebih rendah dibanding CAPD. Kepadatan tulang belakang, neck femur dan total femur bilateral lebih tinggi pada kelompok hemodialisa dibanding CAPD. Sedangkan pada 1/3 distal radius, tidak terdapat perbedaan antara pasien hemodialisa dan CAPD.
English Abstract
Background: Phosphorus and calcium are known to play an important role in mineral and bone disorders in CKD. The decrease in phosphate excretion in CKD results in increased of FGF-23 that induce decrease of 1,25(OH)2-vit D3 levels, thus disrupting calcium homeostasis and causing secondary hyperparathioids which causes increased bone turnover. The 2017 KDIGO guidelines propose bone density examination to predict fracture risk in patients with chronic kidney disease. Aims: To determine the correlation between serum calcium levels and serum phosphate levels on the density of the spine, hip and 1/3 distal radius in CKD patients, and to determine the comparison of serum calcium levels, serum phosphate levels, density of spine, hip and 1/3 distal radius among CKD patients with hemodialysis and CAPD at Saiful Anwar Hospital. Methods: Observational study design with cross sectional method in CKD patients that use hemodialysis and CAPD. The patient was then examined for serum calcium levels, serum phosphate levels and the bone density of the spine, hip and 1/3 distal of the radius bone, which were measured using a DXA (dual-energy Xray absorptiometry). Data analysis was used to assess correlation using Pearson (serum calcium level) and Sperman (serum phosphate level), while to assess differences in serum calcium level, serum phosphate level, density of spine, hip and 1/3 distal radius using unpaired T test.. Results: The mean serum calcium level of CKD patients in the hemodialysis group was 9.0 (s.d. 0.9) while the CAPD group was 8.2 (s.d. 1.2) (p <0.001). The mean serum phosphate level of CKD patients in the hemodialysis group was 3.9 (s.d. 1.4) while the CAPD group was 4.5 (s.d. 1.4) (p 0.002). The mean of spine bone mineral density in CKD patients in the hemodialysis group was 0.906 gram/cm2 (s.d. 0.193) while in the CAPD group it was 0.832 gram/cm2 (s.d. 0.163) (p 0.003). The mean of neck hip dextra bone mineral density in CKD patients in the hemodialysis group was 0.765 gram/cm2 (s.d. 0.164) while the CAPD group was 0.719 gram/cm2 (s.d. 0.157) (p 0.041). The mean total hip dextra bone mineral density in CKD patients in the hemodialysis group was 0.860 gram/cm2 (s.d. 0.164) while the CAPD group was 0.798 gram/cm2 (s.d. 0.163) (p 0.008). The mean of neck hip sinistra bone mineral density in CKD patients in the hemodialysis group was 0.739 gram/cm2 (s.d. 0.156) while the CAPD group was 0.704 gram/cm2 (s.d. 0.156) (p 0.108). The mean of total hip sinistra bone mineral density in CKD patients in the hemodialysis group was 0.825 gram/cm2 (s.d. 0.174) x while the CAPD group was 0.787 gram/cm2 (s.d. 0.169) (p 0.115). The mean of bilateral neck hip bone mineral density in patients with CKD in the hemodialysis group was 0.752 gram/cm2 (s.d. 0.117) while the CAPD group was 0.712 gram/cm2 (s.d. 0.153) (p 0.034). The mean of bilateral total hip bone mineral density in CKD patients in the hemodialysis group was 0.842 gram/cm2 (s.d.0.126) while the patients in the CAPD group was 0.793 gram/cm2 (s.d. 0.164) (p 0.016). The mean of the 1/3 distal radius bone mineral density of CKD patients in the hemodialysis group was 0.717 gram/cm2 (s.d. 0.151) while the CAPD group was 0.710 gram/cm2 (s.d. 0.139) (p 0.737). There was a significant relationship between calcium levels on the spine (p 0.001, Pearson Correlation 0.237), total hip dextra (p 0.024, Pearson Correlation 0.157), neck hip sinistra (p 0.016, Pearson Correlation 0.167), total hip sinistra (p 0.003, Pearson Correlation 0.208), mean of neck hip billateral (p 0.022, Pearson Correlation 0.159) and mean of total hip billateral (p 0.003, Pearson Correlation 0.208) bone mineral density. However, there was no significant relationship between calcium levels on the right neck hip (p 0.086) and 1/3 of the distal radius (0.571) bone mineral density. There was no significant relationship between phosphate levels on the spine (p 0.956), pelvis (right neck hip: p 0.796, total right hip: p 0.393, neck hip dextra: p 0.827, total left hip: p 0.215, average neck hip: p 0.866, mean total hip: p 0.238) and distal 1/3 of the radius (0.689) bone mineral density. Conclusion: Serum calcium levels correlate with bone density, while serum phosphate levels do not correlate with bone density. Calcium levels in the hemodialysis group were higher than CAPD, while phosphate levels in the hemodialysis group were lower than CAPD. The bone density of the spine, neck femur bilateral and total femur bilateral higher in the hemodialysis group than in the CAPD group. Whereas in 1/3 of the distal radius, there was no difference between hemodialysis and CAPD patients.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0423060070 |
| Uncontrolled Keywords: | Kalsium, fosfor, kepadatan tulang belakang, kepadatan tulang neck hip, kepadatan tulang total hip, kepadatan tulang 1/3 distal radius, CAPD, Hemodialisa |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases |
| Divisions: | Profesi Kedokteran > Spesialis Ilmu Penyakit Dalam, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 05 Dec 2023 06:24 |
| Last Modified: | 05 Dec 2023 06:24 |
| URI: | http://repository.ub.ac.id/id/eprint/204791 |
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