Korelasi Hemoglobin A1c dengan Hemoglobin dan Laju Filtrasi Glomerulus Penderita Diabetes dengan dan tanpa Komplikasi Gagal Ginjal Kronik di Bogor
Correlation of Hemoglobin A1c with Hemoglobin and Glomerular Filtration Rate of Diabetics with and without Complications of Chronic Renal Failure in Bogor
Abstract
Diabetes mellitus type 2 (T2DM) is a chronic disease and can cause complications, one of which is decreased kidney function. Anemia is a complication of T2DM, especially if it is accompanied by renal disorders. The aim of this study was to show the relationship between HbA1c and hemoglobin (Hb), hematocrit (HCT), creatinine, and glomerular filtration rate (GFR) in T2DM respondents with and without complications of chronic renal failure (CRF). This study used a subset of the Non-Communicable Diseases cohort data set by the Center for Public Health Efforts in Central Bogor sub-district, Bogor City. The research design was an analytic observational study. Respondents were all T2DM with complete data as much as 303 people. The respondents diagnosed based on the results of previous blood sugar tests. The inclusion criteria were people with T2DM who had complete data (HBA1c, Hb, HCT, and creatinine). Bivariate analysis between the dependent variable (T2DM with or without CRF) and the independent variable (HbA1c, Hb, HCT, creatinine, and LFG) used the Spearman correlation. The results showed a strong positive correlation between HbA1c and Hb (r = 0,66, p<0,05) and HCT (r = 0,67, p<0,05)in T2DM respondents with CRF, but there is no correlation between HbA1c and creatinine and LFG. In T2DM without CRF there is a weak positive correlation between HbA1c and Hb (r = 0,26, p<0,05) and HCT (r = 0,21, p<0,05), a negative correlation between HbA1c and creatinine (r = -0,29, p<0,05), and there is a weak positive correlation between HbA1c and LFG (r = 0,24, p<0,05 ). The conclusion is that controlling blood sugar by examining HbA1c levels shows a strong positive correlation with Hb levels and HCT in T2DM with CRF and a weak negative correlation with LFG in T2DM without CRF. This difference is not in accordance with the existing theory
Abstrak
Diabetes melitus tipe 2 (DMT2) merupakan penyakit kronik dan dapat menimbulkan komplikasi, salah satunya adalah penurunan fungsi ginjal. Anemia merupakan komplikasi DMT2 khususnya jika disertai gangguan renal. Tujuan penelitian ini menunjukkan hubungan hemoglobin A1c (HbA1c) dengan hemoglobin (Hb), hematokrit (HCT), kreatinin, dan laju filtrasi glomerulus (LFG) pada responden DMT2 dengan dan tanpa komplikasi gagal ginjal kronik (GGK). Penelitian ini menggunakan subset data kohor penyakit tidak menular (PTM) yang dilakukan oleh Puslitbang Upaya Kesehatan Masyarakat di Kecamatan Bogor Tengah, Kota Bogor. Desain penelitian adalah studi observasional analitik. Responden adalah semua penderita DMT2 dengan data lengkap sebanyak 303 orang yang didiagnosis berdasarkan hasil pemeriksaan gula darah sebelumnya. Kriteria inklusi adalah penderita DMT2 yang memiliki data lengkap (HbA1c, Hb, HCT, dan kreatinin). Analisis bivariat antara variabel dependen (DMT2 dengan atau tanpa GGK) dengan variabel independen (HbA1c, Hb, HCT, kreatinin dan LFG) mengunakan korelasi Spearman. Hasil penelitian menunjukkan pada responden DMT2 dengan GGK terdapat korelasi positif yang kuat antara HbA1c dengan Hb (r = 0,66, p<0,05) dan HCT (r = 0,67, p<.0,05). Sedangkan HbA1c dengan kreatin dan LFG tidak terdapat korelasi. Pada DMT2 tanpa GGK terdapat korelasi positif lemah antara HbA1c dengan Hb (r = 0,26, p<0,05 ) dan HCT (r = 0,21, p<0,05), terjadi korelasi negatif antara HbA1c dengan kreatinin sebesar (r = -0,29, p<0,05), dan terdapat korelasi positif lemah antara HbA1c dengan LFG ( r = 0,24, p<0,05 ). Simpulan yang dapat diambil adalah pengontrolan gula darah dengan pemeriksaan kadar HbA1c menunjukkan korelasi positif yang kuat dengan kadar Hb dan HCT pada DMT2 dengan GGK dan korelasi negatif lemah dengan LFG pada DMT2 tanpa GGK. Perbedaan tersebut belum sesuai teori yang ada.
References
International Diabetes Federation. IDF diabetes atlas regional factsheet 9th edition 2019. 2019;1– 14.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract [Internet]. 2019;157:107843. Available from: https://doi. org/10.1016/j.diabres.2019.107843
International Diabetes Federation. IDF diabetes atlas ninth edition 2019 [Internet]. International Diabetes Federation; 2019. 1 p. Available from: http://www.idf.org/about-diabetes/facts-figures 4.
Kementerian Kesehatan RI. Hasil utama laporan Riskesdas 2018. Jakarta: Kementerian Kesehatan RI; 2018.
American Diabetes Association. Diabetes care. J Clin Appl Res Educ. 2019;42(supplement 1):S15. 6. Kazi AA, Blonde L. Classification of diabetes mellitus. Vol. 21. Clinics in Laboratory Medicine; 2001. 1–13 p.
Kazi AA, Blonde L. Classification of diabetes mellitus. Vol. 21. Clinics in Laboratory Medicine; 2001. 1–13 p.
Sukohar A, Damara A, Graharti R. Correlation between HbA1c value and glomerular filtration rate (GFR) in type 2 diabetes mellitus. J Kedokt Unila. 2018;2(1):37–41.
Prasetyorini T, Sudiro K, Mujianto B, Martini R. 17. The correlation between the levels of HbA1c with ureum and creatinine in patient with type 2 diabetes mellitus. Asian J Appl Sci. 2019;7(5):696–700.
Ningrum VDA, Ikawati Z, Sadewa AH, Ikhsan 18. MR. Kontrol glikemik dan prevalensi gagal ginjal kronik pada pasien diabetes melitus tipe 2 di Puskesmas wilayah Provinsi DIY tahun 2015.
Pecoits-Filho R, Abensur H, Betônico CCR, MacHado AD, Parente EB, Queiroz M, et al. Interactions between kidney disease and diabetes: dangerous liaisons. Diabetol Metab Syndr. 2016;8(1):1–21.
Sihotang RC, Ramadhani R, Tahapary DL. Efikasi dan keamanan obat anti diabetik oral pada pasien 20. diabetes melitus tipe 2 dengan penyakit ginjal kronik. J Penyakit Dalam Indones. 2018;5(3):150.
Mohanram A, Zhang Z, Shahinfar S, Keane WF, Brenner BM, Toto RD. Anemia and end-stage renal disease in patients with type 2 diabetes and nephropathy. Kidney Int. 2004;66(3):1131–8. 21.
Barbieri J, Fontela PC, Winkelmann ER, Zimmermann CEP, Sandri YP, Mallet EKV, et al. Anemia in patients with type 2 diabetes mellitus. Anemia. 2015;2015:354737. doi: 10.1155/2015/354737. PMID: 26640706; 22. PMCID: PMC4658398. .
Natalia D, Susilawati S, Safyudin S. Hubungan laju filtrasi glomerulus dengan derajat anemia pada penderita penyakit ginjal kronik. Sriwij J Med. 2019;2(3):168–77. 23.
Mihardja L, Delima D, Massie RGA, Karyana M, Nugroho P, Yunir E. Prevalence of kidney dysfunction in diabetes mellitus and associated risk factors among productive age Indonesian. J Diabetes Metab Disord. 2018;17(1):53–61.
Shewaneh DD, Damtie S, Biadgo B, Baynes HW, Melak T, Asmelash D, et al. Diabetic nephropathy gondar 2018. Ethiop J Heal Sci. 2018;28,N(Dm):691–9.
Utomo MRS, Wungouw H, Marunduh S. Kadar Hba1C pada pasien diabetes melitus tipe 2 di Puskesmas Bahu Kecamatan Malalayang Kota Manado. J e-Biomedik. 2015;3(1):3–11.
Rivandi J, Yonata A. Hubungan diabetes melitus dengan kejadian gagal ginjal kronik. J Major [Internet]. 2015;4(9):27–34. Available from: http://juke.kedokteran.unila.ac.id/index.php/ majority/article/view/1404/1246 Jurnal Farmasi Klinik Indonesia. 2017;6(2):78- 90.
Kalantar - Zadeh K. Chronic Kidney Disease (CKD): clinical practice recommendations for primary care physicians and healthcare providers 6.0. Krol. JY& GD, editor. Hypertension, Divisions of Nephrology & Medicine, and General Internal. Los Angeles: University of California; 2014. 145–150 p.
Wijaya IGANR, Mulyantari NK, Yasa, Sutirta IWP. Prevalensi anemia pada diabetes mellitus tipe 2 di rumah sakit Sanglah Denpasar tahun 2014. E-JURNAL Med [Internet]. 2018;7(10):1689–99. Available from: http://ojs.unud.ac.id/index.php/ eum
Hidayat R, Azmi S, Pertiwi D. Hubungan kejadian anemia dengan penyakit ginjal kronik pada pasien yang dirawat di bagian ilmu penyakit dalam RSUP dr M Djamil Padang tahun 2010. J Kesehat Andalas. 2016;5(3):546–50.
Kuo IC, Lin HYH, Niu SW, Lee JJ, Chiu YW, Hung CC, et al. Anemia modifies the prognostic value of glycated hemoglobin in patients with diabetic chronic kidney disease. PLoS One. 2018;13(6):1–13.
Sugondo AT, Nuswantoro D, Notopuro PB. Relationship between HbA1c levels with eGFR and blood pressure in type 2 diabetes mellitus patients at general hospital in Surabaya. 2019;02(02):117–20.
Shipman KE, Jawad M, Sullivan KM, Ford C, Rousseau Gama. Effect of chronic kidney disease on A1C in individuals being screened for diabetes. Prim Care Diabetes 2015 Apr;9(2)142- 6 Available from: https://doi.org/10.1016/j. pcd.2014.05.001.
Sulaiman MK. Diabetic nephropathy: recent advances in pathophysiology and challenges in dietary management. Diabetol Metab Syndr [Internet]. 2019;11(1):1–5. Available from: https://doi.org/10.1186/s13098-019-0403-4
Kang SH, Jung DJ, Choi EW, Cho KH, Park JW, Do JY. HbA1c levels are associated with chronic kidney disease in a non-diabetic adult population: a nationwide survey (KNHANES 2011-2013). PLoS One. 2015;10(12):1–11.
