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 | 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.