Reaksi neointimal hyperplasia pada pemasangan kateter tunnelled dan non tunnelled pasien penyakit ginjal kronis di RSUP Prof DR. I.G.N.G Ngoerah Denpasar dengan melihat nilai rasio monosit limfosit, rasio neutrofil limfosit, dan rasio trombosit limfosit

Andri Jaya Atmaja; I Nyoman  Semadi; I Wayan  Niryana

doi:10.15562/ism.v14i2.1749

Reaksi neointimal hyperplasia pada pemasangan kateter tunnelled dan non tunnelled pasien penyakit ginjal kronis di RSUP Prof DR. I.G.N.G Ngoerah Denpasar dengan melihat nilai rasio monosit limfosit, rasio neutrofil limfosit, dan rasio trombosit limfosit

Andri Jaya Atmaja ,

I Nyoman Semadi ,

I Wayan Niryana ,

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DOI: https://doi.org/10.15562/ism.v14i2.1749 |
Published: 2023-06-26

Abstract

Introduction: Vascular access with non-tunneled and tunneled hemodialysis catheters in patients with chronic kidney disease can cause complications such as neointimal hyperplasia. Creating vascular access will cause injury to the endothelium and its underlying layer, which in turn will cause a series of inflammatory reactions. This study was conducted to determine the initial response of neointimal hyperplasia in blood vessels after vascular access in chronic kidney disease by increasing the monocyte lymphocyte ratio, neutrophil lymphocyte ratio, and platelet lymphocyte ratio after insertion of tunneled and non-tunneled catheters.

Methods: The research method is observational analysis with a retrospective cohort design. Sampling was taken using the consecutive sampling method in adult patients with chronic kidney failure who were inserted with tunneled and non-tunneled hemodialysis catheters at Prof. Dr. General Hospital, I.G.N.G. Ngoerah Denpasar. The statistical test uses paired T-test and unpaired T-test with a significance level of 0.05.

Results: A significant difference was found in the value of the neutrophil-lymphocyte ratio in tunneled hemodialysis catheters (mean difference: 0.51; 95% CI: -0.89–(-0.13); p value: 0.01) and non-tunneled (mean difference: 0.04; 95% CI: -0.08–(-0.001); p-value: 0.043). There was no significant difference in the monocyte-lymphocyte ratio after and before insertion of the tunneled hemodialysis catheter (mean difference: 0.04; 95% CI: -0.003–0.81; p value: 0.07) or non-tunneled (median difference: 0.06; p: 0.925). There was a statistically significant difference in the mean platelet-lymphocyte ratio after and before insertion of the tunneled hemodialysis catheter (mean difference: 32.24; 95% CI: -54.11–(-10.38); p-value: 0.005), but no significant difference was found in the placement of non-tunnelled hemodialysis catheters (mean difference: 26.24; 95% CI: -61.47–9.0; p value: 0.14).

Conclusion: There were differences in the inflammatory response after and before the insertion of tunneled and non-tunneled hemodialysis catheters, especially in the value of the neutrophil-lymphocyte ratio.

Pendahuluan: Akses vaskular dengan pemasangan kateter hemodialisa non tunnelled dan tunnelled pada pasien penyakit ginjal kronis dapat menimbulkan komplikasi seperti neointimal hiperplasia. Tindakan pembuatan akses vaskuler akan menyebabkan cedera pada endotel dan lapisan dibawahnya yang selanjutnya akan menyebabkan rangkaian reaksi inflamasi. Penelitian ini dilakukan untuk mengetahui respon awal neointimal hiperplasia pada pembuluh darah yang dilakukan pemasangan akses vaskuler pada penyakit ginjal kronis melalui peningkatan nilai rasio monosit limfosit, rasio neutrofil limfosit, dan rasio trombosit limfosit setelah pemasangan kateter tunnelled dan non tunnelled.

Metode: Metode penelitian berupa analitik observasional dengan rancangan kohort retrospektif. Pengambilan sampel dengan metode consecutive sampling, pada pasien dewasa dengan gagal ginjal kronis yang dilakukan insersi kateter hemodialisis tunnelled dan non-tunnelled di RSUP Prof Dr. I.G.N.G Ngoerah Denpasar. Uji statistic menggunakan Uji T-berpasangan dan Uji T-tidak berpasangan dengan tingkat kemaknaan α=0.05.

Hasil: Ditemukan perbedaan yang signifikan dari nilai rasio neutrofil-limfosit pada pemasangan kateter hemodialisis tunnelled (selisih rerata:0,51; IK95%: -0,89 – (-0,13); nilai p: 0,01) dan non-tunnelled (selisih rerata: 0,04; IK95%: -0,08 – (-0,001); nilai p: 0,043). Tidak terdapat perbedaan yang bermakna dari rasio monosit-limfosit setelah dan sebelum pemasangan kateter hemodialisa tunnelled (selisih rerata: 0,04; IK95%: -0,003 – 0,81 ; nilai p: 0,07) maupun non- tunnelled (selisih median: 0,06; p: 0,925). Adanya perbedaan yang bermakna secara statistik dari rerata rasio trombosit limfosit setelah dan sebelum pemasangan kateter hemodialisa tunnelled (selisih rerata: 32,24; IK95%: -54,11 – (-10,38); nilai p: 0,005), namun tidak ditemukan perbedaan yang bermakna pada pemasangan kateter hemodialisa non-tunnelled (selisih rerata: 26,24; IK95%: -61,47 – 9,0; nilai p: 0,14).

Simpulan: Terdapat perbedaan respon inflamasi setelah dan sebelum pemasangan kateter hemodialsis tunnelled dan non-tunnelled, khususnya pada nilai rasio neutrofil-limfosit.

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