Aditiawardana Aditiawardana, Aditiawardana
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Paricalcitol For CKD-MBD Associated With Secondary Hyperparathyroidism: A Case Series Focus On TRAP5b, b-ALP, and DKK-1 Suprapti, Budi; Hartono, Frenky; Iqbal, Muhammad; Zuhri, Muhammad Isnaini; Aditiawardana, Aditiawardana
Indonesian Journal of Pharmacy Vol 30 No 1, 2019
Publisher : Faculty of Pharmacy Universitas Gadjah Mada, Yogyakarta, Skip Utara, 55281, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (884.22 KB) | DOI: 10.14499/indonesianjpharm30iss1pp66

Abstract

Chronic kidney disease (CKD) lead to secondary hyperparathyroidism (sHPT) that caused by phosphate retention and hypocalcemia. This condition known as mineral and bone disorder (CKD-MBD). The increase in parathyroid hormone would increase bone turnover that result in an increased risk of bone fractures, and vascular calcification. These will increase the levels of tartrate-resistant acid phosphatase 5b (TRAP5b), and bone-specific alkaline phosphatase (b-ALP), which is a marker of bone turnover, and also dickkopf-related protein 1 (DKK-1), which is an inhibitor of the Wnt pathway. Secondary hyperparathyroidism in CKD also caused by calcitriol deficiency. Paricalcitol is a synthetic calcitrol analogue used to reduce parathyroid hormone (iPTH) with minimal calcemic and phosphatemic activity. Vitamin D receptor activation by paricalcitol will decrease TRAP5b, b-ALP, and DKK-1. In this study we reported 9 cases of CKD-MBD with Hemodialysis (HD) and associated with sHPT. Four of nine cases received 5μg paricalcitol every HD (twice a week) while the others five is not. Level of iPTH, phosphate, calcium, TRAP5b, b-ALP, and DKK-1 were measured before initiation of study and after three months treatment. According to this study, the paricalcol administration suppresses the increase in iPTH level, bone turnover and vascular calcification showed by decreasing or supresses the increase b-ALP, TRAP5b, DKK-1  leves without increasing calcium and phosphate levels.
Risk Factors for New-Onset Diabetes After Transpant in Kidney Transplant Recipients Pramudya, Dana; Aditiawardana, Aditiawardana; Tjempakasari, Artaria; Irwanadi, Chandra; Mardiana, Nunuk; Pranawa, Pranawa; Widodo, Widodo
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2019): January - April 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

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Abstract

Background New-onset diabetes after transplant (NODAT) is one of the metabolic complications of kidney transplant surgery. The incident of NODAT varies highly, from 5% up to 53%. Some factors increase the risk for NODAT, such as age, gender, immunosuppressant drugs, among others. The progressivity of NODAT leads to increased cardiovascular risks, making the identification of risk factors crucial. Method Medical records of 56 patients who have undergone kidney transplant throughout 1998 - 2015 were evaluated. Data obtained from the records include age, gender, history of hypertension, dyslipidemia, the use of calcineurin inhibitors (CNI), and familial history of diabetes. Bivariate analysis with crosstabs (for nominal data) was used to analyze the data, with a threshold of p < 0.25 and followed up with multivariate analysis using logistic regression. Result The mean age of subjects was 53.85±12.92 years, with 80.4% of the subjects were male. Pre-transplant hypertension was 46.4%. The CNI used were tacrolimus in 46.4% and cyclosporine in 53.6% of patients. Around 25% of patients have a familial history of diabetes and the mean triglyceride level was 165.83±77.5 mg/dl. NODAT occurred in 18 patients and the majority of occurrence happened in the first year post-transplant. Bivariate analysis shows no significant risk factors, however clinically significant risk factors were gender (male), the CNI drug used (tacrolimus), and familial history of diabetes. Further multivariate analysis showed OR for gender (male) with OR 6.532 (0.735- 58.051), age with OR 5.249 (0.658-41.853)}, and the use of tacrolimus with OR 3.217 (0.895-11.571). Conclusion In this study, the clinically significant risk factors for NODAT were male gender, age, and the use of tacrolimus. However, these risk factors did not show statistical significance. Further study with bigger sample size is needed.
HAEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS: INCIDENCE, RISK FACTOR, AND ANTIBIOGRAM Siahaan, Budi Darma; Widodo, Widodo; Aditiawardana, Aditiawardana
Indonesian Journal of Kidney and Hypertension Vol 3 No 1 (2020): January - April 2020
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v3i1.26

Abstract

Background The incidence of central-line associated bloodstream infection (CLABSI) is one of the complications of using a temporary HD catheter is one of the causes of HD patient morbidity and mortality. Identifying CLABSI risk factors and causative micro-organisms are important for setting prevention policies. There were no data regarding CLABSI in hemodialysis in Indonesia Objective: This study identified the epidemiology and risk factor of HD CLABSIs and to aid in the choice of empiric antibiotics therapy given to patients with HD CLABSI   Method: This study was an analytical observational study with a cross-sectional design conducted at the Inpatient Installation of Dr. Soetomo General Hospital in August 2018 - January 2019. The study population was patients with installed non-tunneled double lumen hemodialysis catheters more than two calendar days established. The inclusion criteria in this study were the patient 18-60 years old and any clinical presentation of fever, chills, and or hypotension. HD patients who presented with other sources of infection were excluded from the study. Data analysis was performed using SPSS v.23.   Results: In this study, 42 subjects were included in the composition of male: female 24: 18, with an average age of 49.62 years.  The incidence of CLABSI is  11,3 /1000 catheter days. The results of blood cultures by gram-negative bacteria were 51.86%, and gram-positive bacteria were 48.14%. The most bacterial causes of CLABSI were Staphylococcus aureus by 25.9%. The most gram-positive bacteria causing CLABSI Staphylococcus aureus was 53.84%. The most gram-negative bacteria that caused CLABSI was Enterobacter cloacae at 53.84%. Antibiotics that have the highest sensitivity to gram-positive bacteria are Fosfomycin, Teicoplanin, and Chloramphenicol. Antibiotics that have the highest sensitivity to gram-negative bacteria are Cefoperazone Sulbactam, Imipenem, and Meropenem. There was a statistically significant relationship between DM and CLABSI events (OR = 3.896; p 0.037). There was a statistically significant relationship between hypoalbuminemia and the incidence of CLABSI (OR = 4,524; p 0,023).   Conclusion: This study found S. aureus was the most common cause of CLABSI. Our study was unusual as a high prevalence of gram-negative bacteremia was found in HD patients. Diabetes mellitus and hypoalbuminemia increase the risk of CLABSI in hemodialysis patients.
ASSOCIATION BETWEEN THE BIOFILM OF DOUBLE-LUMEN CATHETER AND BLOOD CULTURE IN HEMODIALYSIS PATIENTS WITH SUSPECTED CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION Sangadji, Dicky Pendi Alaudin; Aditiawardana, Aditiawardana; Tjempakasari, Artaria; Alimsardjono, Lindawati
Indonesian Journal of Kidney and Hypertension Vol 3 No 1 (2020): January - April 2020
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v3i1.38

Abstract

Abstract Background One complication of double lumen catheter (DLC) for hemodialysis (HD) is central line associated bloodstream infection (CLABSI). Blood culture examination is still the gold standard for diagnosis. CLABSI is also often associated with biofilm formation. Biofilms can cause recurrent bacteremia and antibiotic resistance thereby increasing mortality and morbidity. Until now in Dr. Soetomo General Hospital, there have been no objective data or research on the relationship between biofilms and blood cultures in patients with systemic infections associated with catheters. Objective: This study aims to analyze the relationship between the biofilms of double lumen catheter and blood cultures in hemodialysis patients with suspected CLABSI. Method: This was an analytic observational study with cross sectional design to determine the relationship of biofilms and blood culture in HD patients with suspected CLABSI at Dr. Soetomo General Hospital in August 2019 - November 2019. Inclusion criteria: patients aged >18 years with routine HD and suspected CLABSI, also were willing to participate in the study with informed consent. Exclusion criteria: other sources of infection. Biofilm examination on DLC using the test tube method was measured with a nephelometer. Biofilm results is positive if ? 0.36 MF and negative if > 0.36 MF. Blood was cultured with a 3D BacT/ALERT tool in the Clinical Microbiology Installation Laboratory of Dr. Soetomo General Hospital. Results: Of the 33 subjects, 45.5% were men and 54.5% were women, with an average age of 49.06 ± 1.5 years. The most common cause of CKD is hypertension (54.5%). The median length of HD was 3 months, ranging from 1-8 months. DLC were mostly inserted at subclavia dextra (87.9%) and installed with a mean duration of 77.94 ± 5.22 days. The majority (66.7%) had normal nutritional status. The mean albumin level was 3.28 ± 0.07 g/dL. There was biofilm growth in 16 subjects (48.5%). The evaluation of blood culture revealed 15 positive results (45.5%). The analysis between biofilm density and CLABSI found significant differences between the two groups (p=0.024). From chi-square test, the association of biofilms with blood culture in HD patients with suspected CLABSI obtained a p value of 0.001. Conclusion: Patients with suspected CLABSI and positive bacteria growth in blood cultures had biofilm in DLC. In addition, the density of biofilms in DLC is higher CLABSI cases. Keywords: chronic kidney disease, CKD, Double lumen catheter, Biofilm, Blood culture, Infection, CLABSI