Jurnal
:
Thyroid Dysfunction and Dyslipidemia in Chronic Kidney
Disease patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625624/
Author
: Saroh Khatiwada, Rajendra KC, Sharad Gautam, Madhab
Lamsal, dan Nirmal Baral
Tahun
: 2015
Masalah yang berhubungan dengan penyakit ginjal seperti kegagalan ginjal
kronis merupakan penyakit serius yang terus mengalami peningkatan jumlah
penderita setiap tahunnya. Pada pasien gagal ginjal kronik resiko menjadi
komplikasi juga berpeluang besar, seperti kegagalan ginjal yang disertai
diabetes mellitus tipe II, hipertensi, penyakit kardiovaskuler sebagai
perkembangan dyslipidemia sampai dengan disfungsi tiroid.
Disfungsi tiroid pada penderita gagal ginjal kronik disebabkan banyak jalur.
Seperti diketahui bahwa ginjal dalam kondisi normal berperan sebagai
pengendalian degradasi dan eksresi hormon tiroid. Kegagalan fungsi pada
ginjal menyebabkan gangguan regulasi kontrol hormone tiroid dalam sirkulasi
sehingga menjadikan kontrol hipotalamus terhadap kadar hormon tiroid menjadi
terganggung. Maka dengan demikian diasumsikan bahwa semakin menurunya
laju GFR ginjal maka akan makin besar peluang terjadinya disfungdi tiroid.
Komplikasi lain pada penderita gagal ginjal adalah kondisi dyslipidemia. Kondisi
ini berhubungan dengan gangguan aktivitas enzim lipoprotein lipase dan
hepatic trigliserida lipase. Gangguan aktivitas kedua enzim tersebut
menyebabkan hambatan dalam pengambilan lipoprotein yang kaya trigliserida,
dan Apo-B.
Pada pasien-pasien gagal ginjal kronik di Nepal, kondisi dyslipidemia umum
ditemukan. Seperti telah diketahui juga bahwa hormon-hormon tiroid juga
berperan dalam metabolisme lipid. Sehingga pada penderita gagal ginjal juga
diperlukan skrining awal terhadap tingkatan dyslipidemia beserta kelainan pada
fungsi tiroidnya sebagai predictor terhadap komplikasi dan derajat pada
Biomedik- Maret 2016
Berdasarkan latar belakang tersebut maka telah dilakukan penelitian dengan
studi cross sectional dalam kurun waktu Februari 2012 s.d Maret 2014 yang
dilakukan terhadap pasien gagal ginjal di Laboratorium Biokimia Kairola
Institute Dharan Nepal.
Pada studi ini dilakukan pengukuran laju filtrasi ginjal dengan metode estimasi
eGFR yang didasrkan pada standar acuan MDRD. Dilakukan pula pengukuran
kadar TSH, T3,T4, Kolesterol Total, Trigliserida, HDL, LDL, glukosa, dan ureum
yang bersumber dari sampel darah pasien.
Demografi pasien ditentukan berdasarkan umur, jenis kelamin, beserta riwayat
rekam medis pasien. Data yang diperoleh kemudian dianalisis menggunakan
one way ANOVA dan Kruskall-Wallis.
Berdasarkan hasil penelitian terhadap 360 pasien yang terdiri dari 53.8%
laki-laki dan 46.2% perempuan menunjukan bahwa 45.8% pasien gagal ginjal
mengalami diabetes mellitus, 70.2% mengalami hipertensi, dengan kondisi
dyslipidemia yang ditandai dengan hipertrigliserid dengan stage gagal ginjal
antara stage 3 s,d 5 berdasrkan klasifikasi hasil eGFR.
Dari data pengelompokan diatas kemudian didapatkan bahwa 61.6% penderita
gagal ginjal mengidap Eutiroidisme, 27.2% Subklinik hipotiroidisme, 8.15 %
over hipotiroidisme, dan 3.3% subklinik hipertiroidisme.
Berdasarkan penelitian juga didapatkan bahwa semakin parah kegagalan filtrasi
ginjal yang ditandai dengan penurunan eGFR maka peluang terjadinya
Biomedik- Maret 2016
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