Factors Associated with Sarcopenia in Maintenance Hemodialysis Patients: A Cross-Sectional Study.

BACKGROUND: Sarcopenia is associated with worse outcomes in maintenance hemodialysis (MHD) patients. Differences in criteria and methods used to diagnose sarcopenia, results in a wide range of prevalence. Factors associated with sarcopenia in MHD have not been well-studied. This study aimed to investigate the prevalence and factors associated with sarcopenia in the MHD population. METHODS: Observational cross-sectional study was done with 96 MHD patients aged ≥18 years old, with dialysis vintage ≥120 days at Cipto Mangunkusumo Hospital March-May 2022. Descriptive, bivariate, and logistic regression analysis were done to find sarcopenia's prevalence and association with Simplify Creatinine Index (SCI), type 2 diabetes (DM), Interleukin-6 (IL-6), nutritional status, physical activity, and phosphate serum level. Asian Working Group for Sarcopenia (AWGS) 2019 criteria used to diagnose sarcopenia, Hand Grip Strength (HGS) to identify muscle strength, Bioimpedance Spectroscopy (BIS) to calculate muscle mass, and 6-meter walk test to evaluate physical performance. RESULTS: The prevalence of sarcopenia was 54.2%. Factors with a significant association in bivariate analysis were phosphate serum level (p=0.008), SCI (p=0.005) and low physical activity (International Physical Activity Questionnaire) (p-0.006). Logistic regression analysis found higher phosphate serum level and high physical activity protective of sarcopenia (OR 0.677;CI95% 0.493-0.93 and OR 0.313;CI95% 0.130-0.755 respectively). CONCLUSION: The prevalence of sarcopenia in the MHD population was 54.2%. Phosphate serum level, SCI, and physical activity were significantly correlated with sarcopenia. Both high phosphate level and high physical activity were protective against sarcopenia.

Cohort Prospective Study to Evaluate Immunogenicity of Epodion® (Biosimilar Epoetin-a) in Anemia Associated with Chronic Kidney Disease (CKD) Patients.

BACKGROUND: Anemia due to chronic kidney disease (CKD) is often associated with decreased erythropoietin (EPO) levels in the blood. Treatments available are improving blood iron levels and administration of exogenous EPO (rhEPO). This study aims to assess the safety and immunogenicity of Epodion, a biosimilar rhEPO product, in haemodialysis patients with CKD-associated anaemia in three Indonesian hospitals. METHODS: This prospective, open label, single arm, and multicenter study enrolled patients with anemia associated with CKD under hemodialysis treatment. Patient eligibility was assessed within the 4-week screening period. Blood samples for determination of erythropoietin antibody (Anti-Drug Antibody) were taken at week-0, 24, and 52 using a validated and highly sensitive bridging ELISA method. Evaluation of Neutralizing Antibody (NAb) was carried out to confirm the impact of the antibody to pharmacological activity (e.g., antibody-mediated PRCA) when the ADA detection of patients was positive after screening and confirmatory assay. RESULTS: Results from all tested patients show that Epodion could maintain hemoglobin and hematocrit levels. ADA detection using ELISA assay yielded negative results for all plasma samples of week-24 and week-52, so the evaluation of NAb was not carried out. No adverse events were considered relevant to tested product. CONCLUSION: This study proves no immunogenic effect of Epodion on stimulating immune system's antibodies in Indonesian patients with CKD-associated anemia.

Association of BsmI Polymorphisms in the Vitamin D Receptor Gene Among Indonesian Population with Diabetic Kidney Disease.

BACKGROUND: Diabetic kidney disease (DKD), as a common cause of end-stage renal disease (ESRD), is a chronic complication of diabetes mellitus (DM). It has been established that vitamin D deficiency is one of DKD risk factors, which may be related to vitamin D receptor (VDR) polymorphisms. This study aimed to analyze the association between VDR polymorphisms and DKD in Indonesian population, also risk factors that influence it. METHODS: a cross-sectional study was conducted in Type 2 DM patients  who visited internal medicine outpatient clinic at Dr. Cipto Mangunkusumo Hospital, Jakarta, from November 2014 until March 2015.  Data collection includes characteristics of subjects and laboratory examination, including BsmI polymorphisms in the vitamin D receptor gene. Patients with acute and severe disease were excluded from the study. Bivariate and multivariate analyses were done. RESULTS: of 93 DM subjects, 42 (45.2%) subjects were without DKD and 51 (54.8%) subjects had DKD. Most of the subjects had the Bb genotype (89.2%), with no subject having the BB genotype. The proportions of the B and b alleles were 44.6% and 55.4%, respectively. There is no association between BsmI polymorphisms in the vitamin D receptor gene and DKD (OR = 1.243; CI 95% 0.334-4.621; p value = 0.751). CONCLUSION: the profile of BsmI polymorphisms in the vitamin D receptor gene in the Indonesian population were genotypes Bb (89.2%) and bb (10.8%). There was no association between BsmI polymorphisms in the vitamin D receptor gene and DKD. Duration of DM more than five years influenced the association between those variables.

Comparison of Quality of Life between Patients Undergoing Chronic Hemodialysis with Reusable Dialyzer and Single-Use Dialyzer: A Retrospective Cohort Study.

BACKGROUND: in Indonesia, majority of hemodialysis centers use reusable dialyzer for cost efficiency reason. Currently, there is no available data regarding the quality of life of the end stage-renal disease patient'who use reusable dialyzer measured by a standardized questionnaire, as it was stated that at molecular level, reusable dialyzer could worsen leukocyte activity and could affect patients' complaints and symptoms. METHODS: this was a retrospective cohort study which involved 39 subjects. All subjects underwent hemodialysis at Cipto Mangunkusumo Hospital. The study was conducted in March - September 2017. All subjects had experienced two kinds of dialyzers, the reusable dialyzers (before 2015) and the single-use dialyzers (after 2015). Of all patients, 19 patients did not know the change of dialyzers. Subjects were interviewed with Kidney Disease Quality of Life-Short Form 36 questionnaire. RESULTS: in kidney disease component dimension, there was a significant mean difference between reusable group (68.74; SD 13.22) and single-use group (74.87; SD 13.54) (Wilcoxon test, p=0.01). The Physical Component Summary dimension, in reusable group was 63.65; SD 27.07 and in single-use group was 69.38; SD 23.07 (Wilcoxon test, p=0.217). The Mental Component Summary dimension, in reusable group was 71.78; SD 21.54 and in single-use group was75.27; SD 22.30 (Wilcoxon test, p=0.127). Bivariate analysis and further analysis showed significant association between income less than 5 million rupiah and low quality of life (p=0.048). CONCLUSION: the reusable dialyzer membrane lowers the ESRD patients' quality of life influenced by another factor such as low income.