Articles

Found 4 Documents
Search

Effect of Calcineurin Inhibitor on Blood Glucose Level in Non-Diabetic Kidney Transplant Patients Aditiawardana, A; Liani, Fauzia N; Irwanadi, Chandra; Mardiana, Nunuk; Pranawa, P
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2018): September - December 2018
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (494.625 KB) | DOI: 10.32867/inakidney.v1i1.7

Abstract

Background Calcineurin inhibitor (CNI) is a class of immunosuppressant agent used in kidney transplant management, known to pose risk for new-onset diabe­tes after transplant (NODAT). Tacrolimus and cyclo­sporine cause NODAT through multiple mechanisms, such as decreasing insulin secretion, increasing in­sulin resistance, and a direct effect on the pancreatic beta cell. Method This is a retrospective study on pa­tients receiving immunosuppressant agents for kidney transplant patients in Surabaya. The immunosuppres­sant agents studied were CNI (tacrolimus and cyclo­sporine) in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroid. The blood glucose measured were fasting blood glucose (FBD) and 2-hour postprandial blood glucose (2PPBG). Ob­jective Aim of this study is to determine the effect of calcineurin inhibitor (CNI) on glucose regulation in the nondiabetic renal transplant patient. Result Fifty-six subjects were included in the study, divided into two groups. One group of 28 patients (50%) received tac­rolimus-MMF-MP and the other group received cyc­losporine-MMF-MP. A significant increase in fasting blood glucose (pre-intervention level 86 ± 6 mg/dl vs post-intervention level 109 ± 34 mg/dl with p = 0.01) and 2-hour postprandial blood glucose (pre-interven­tion level 117 ± 20 mg/dl vs post-intervention level 150 ± 43 mg/dl with p < 0.001) was found in the tacro­limus group. A significant increase was also found in the cyclosporine group, both in fasting blood glucose (pre-intervention value 85 ± 7 mg/dl vs post-interven­tion value 97 ± 22 mg/dl with p = 0.002) and 2-hour postprandial blood glucose (pre-intervention value 119 ± 18 mg/dl vs post-intervention value 148 ± 55 mg/dl with p = 0.001). Tacrolimus was found to have a relative risk of NODAT up to 1.2 fold compared to cy­closporine. Conclusion Tacrolimus poses 1.29 relative risk of NODAT compared to cyclosporine. However, both drugs significantly increase fasting blood glucose and 2-hour postprandial blood glucose in non-diabetic patients receiving kidney transplantation.
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)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (443.476 KB)

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.
Comparison of High-sensitivity C-reactive Protein Level between Chronic Kidney Disease Stages Thaha, Mochammad; Imroati, Tri Asih; wardana, aditia; Widodo, S; Pranawa, S; irwanadi, chandra
Biomolecular and Health Science Journal Vol 1, No 1 (2018): Biomolecular and Health Science Journal
Publisher : Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1125.644 KB) | DOI: 10.20473/bhsj.v1i1.8226

Abstract

ABSTRACTAim : This research is to evaluate the hs-CRP level comparison between CKD stages in Dr. Soetomo General Hospital Surabaya.Methods: An analytic observational cross-sectional study, evaluating the differences of hs-CRP level between CKD stages in 72 patients (mean age 55.49±7.62 years, the ratio between male:female was 1:1.48, mean BMI 24.18±3.64 kg/m2, 36.11% diabetics, 43.05% on ACEI/ARB, 29.16% on statin), recruited from Nephrology Outpatient Clinic, Dr Soetomo General Hospital, Surabaya, from January to May 2014. The stages were stratified  according to the MDRD formula.Results: The mean hs-CRP of  CKD stage 3 was 2.29±2.86, stage 4 was 2.48 ± 2.19, and non-dialysis stage 5 was 2.09 ± 2.54. The analysis using Kruskal-Wallis test showed no significant differences among patients with  CKD stage 3, stage 4, and non-dialysis stage 5 (median 1.25 vs 1.80 vs 1.05 mg/L; p=0.430). No significant differences of the serum hs-CRP level were detected between diabetics and non diabetics in stage 3, 4, and non-dialysis stage 5  (p=0.673 vs 0.666 vs 0.138); between patients with and without ACEI/ARB treatment (p=0.610 vs 0.649 vs 0.671); and between patients with and without statin treatment (p=0.852 vs 0.341 vs 0.309).Conclusion: The elevation of serum hs-CRP level can not indicate the decline of kidney function, but it still needs further investigations.
Association of Serum Magnesium Levels with Matrix metalloproteinase-9 (MMP-9) Urine in Patients with Diabetic Kidney Disease Stage 1 and 2 Rafsanjani, M. Hashemi; Wibisono, Sony; Irwanadi, Chandra
Biomolecular and Health Science Journal Vol 2, No 2 (2019): Biomolecular and Health Science Journal
Publisher : Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (258.402 KB) | DOI: 10.20473/bhsj.v2i2.15045

Abstract

Introduction: The progressiveness of stage 1 and 2 kidney disease is indicated by an increase in matrix metalloproteinase-9 (MMP-9). Development of diabetic kidney disease (DKD) is characterized by a thuckening of the glomerular basement membrane followed ultimately by progression to glomerular sclerosis and fibrosis. One of the factors that contribute is magnesium levels. This study aimed to determine the association between serum magnesium levels and MMP-9 urine in patients with stage 1 and 2 DKD.Methods: This was a cross sectional study from stage 1 and 2 DKD patients. Patients were examined for serum magnesium levels and urine MMP-9. Urine MMP-9 examination was taken from the middle portion urine collection and examined using Sandwich-ELISA method then normalized with urine creatinine. The correlation between magnesium and MMP-9 urine was analyzed by the Spearman rank test.Results: This study involved 56 subjects. The mean serum magnesium level was 1.8 ± 0.26 mg/dL. The mean MMP-9 was 120 ng/g creatinin. The mean value of FBG (fasting blood glucose) in patients in the study was 153.29±50.22 mg/dL. The mean value of PPG (post prandial glucose) was 233.61±71.3 mg/dL. The mean HbA1c value was 7.6±1.13%. The mean creatinin serum value was 1.1±0.43 mg/dL. There was a significant negative relationship with a moderate correlation between serum magnesium levels and urine MMP-9 (p = 0.000, r -0.512).Conclusion: There was a significant negative relationship between serum magnesium levels and urine MMP-9 in stage 1 and 2 DKD patients.