Oleh Admin Kalbe Medical pada November 15, 2017 07:30

Jangan Abaikan Fungsi Ginjal Sisa, Meskipun Hanya Sedikit

Meskipun hanya dalam jumlah yang sedikit, fungsi ginjal sisa pada pasien dengan hemodialisis dapat terus menyumbang bersihan solut (zat terlarut) yang akan berdampak pada kondisi klinis pasien. Pernyataan ini merupakan hasil salah satu presentasi poster dalam pertemuan American Society of Nephrology's Kidney Week 2017.

Dalam penelitian dengan nama studi HEMO (Hemodialysis Study) yang dilakukan oleh Johns Hopkins School of Medicine in Baltimore diukur 8 jenis solut non-urea dari 1280 pasien HD selama 3-6 minggu setelah diacak. Penelitian ini mengeksklusi pasien dengan fungsi ginjal sisa di atas 1,5 mL/menit/1,73 m2, karena biasanya fungsi ginjal sisa yang sering diabaikan adalah di bawah nilai tersebut. Fungsi ginjal sisa telah diketahui memiliki dampak yang bermanfaat melalui peningkatan bersihan toksin uremik, akan tetapi sampai seberapa besar fungsi ginjal sisa yang masih dapat diperhitungkan memiliki manfaat pada kondisi klinis pasien belum diketahui.

Pada awal penelitian, sejumlah 34% pasien memiliki fungsi ginjal sisa yang secara klinis mungkin diabaikan (rerata 0,7 mL/menit/1,73m2), sedangkan 66% pasien sudah tidak memiliki fungsi ginjal sisa lain. Kelompok pasien yang memiliki fungsi ginjal sisa memiliki usia yang lebih tua, memiliki onset yang lebih sering dari dialisis dan memiliki persyaratan ultrafiltrasi yang lebih rendah daripada pasien tanpa fungsi ginjal sisa.

Pasca-evalusi terlihat bahwa dibandingkan dengan pasien yang tidak memiliki fungsi ginjal sisa, pasien dengan fungsi ginjal sisa secara signifikan menurunkan kadar 7 dari 8 solut non-urea, yaitu nonindoxyl sulfate (-11%), hippurate (-24%), phenylacetylglutamine (-14%), trimethylamine-N -oxide (-7%), metilguanidine (-14%), dimethylarginine asimetrik (-4%), dan dimethylarginine simetrik (-7%). Sedangkan penurunan kadar p-cresol sulfate tidak terlihat. Jumlah fungsi ginjal sisa yang sangat kecil sekalipun ternyata sebenarnya jauh lebih baik dalam menurunkan kadar toksin dibandingkan prosedur hemodialisis standar, jadi meskipun hanya ada sedikit fungsi ginjal sisa, meskipun hanya 250 mL urin yang diproduksi dalam sehari, secara klinis tidak dapat diabaikan karena memiliki peran yang sangat penting dalam regulasi metabolik.

Dari hasil peneltian ini mungkin perlu pertimbangan baru dalam manajemen pasien dialisis, misalnya pasien HD yang masih memiliki nilai bersihan urea tertentu dan mampu memproduksi urin 500 mL/hari tidak memerlukan HD yang sama seperti pasien yang telah menjalani HD selama 5 tahun dan tidak lagi memproduksi urin. Strategi lain adalah dengan tetap memberikan diuretik pada pasien HD. (DHS)

Image : Ilustrasi
Referensi:
1.Charnow JA. ‘Clinically negligible' residual kidney function still beneficial [Internet]. [cited 2017 November 10th]. Available from: http://www.renalandurologynews.com/kidney-week-2017/hemodialysis-clinically-negligible-residual-kidney-function-still-beneficial/article/703955/
2.Toth-Manikowski SM, Sirich TL, Hostetter TH, et al. HEMO Study results suggest that “clinically negligible” residual kidney function (RKF) is a significant contributor to uremic solute clearance. Data presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31 to Nov. 5). Poster FR-PO894.

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