Korelasi antara Monocyte Lymphocyte Ratio dengan Stadium Pasien Chronic Kidney Disease Non Hemodialisis di RSUD Dr. H. Abdul Moeloek Provinsi Lampung Tahun 2023-2024
DOI:
https://doi.org/10.57214/jka.v8i2.666Keywords:
CKD, MLR, GFRAbstract
Chronic kidney disease (CKD) is a serious condition accompanied by various comorbidities, systemic inflammation, and kidney tissue damage, leading to a decline in the glomerular filtration rate (GFR), which determines CKD staging. The monocyte-lymphocyte ratio (MLR) can serve as a more practical alternative that does not increase laboratory examination costs and utilizes a complete blood count, a routine hospital test. Several studies have reported that MLR values are associated with clinical deterioration and inflammation in CKD patients. This study aims to determine the correlation between MLR and CKD stage in non-hemodialysis patients at Dr. H. Abdul Moeloek Regional General Hospital, Lampung. This study is an analytical observational study using a cross-sectional method involving all non-hemodialysis CKD patients who met the inclusion and exclusion criteria at Dr. H. Abdul Moeloek Regional General Hospital. The sampling technique used was total sampling, with a total of 346 non-hemodialysis CKD patients collected from medical records between July 2023 and June 2024. Data analysis was performed using the Spearman alternative test. Based on the study of 346 patients, bivariate analysis showed a significant correlation between MLR and CKD stage (p = 0.000; r = 0.444). There is a significant positive correlation of moderate strength between MLR and CKD stage in non-hemodialysis patients at Dr. H. Abdul Moeloek Regional General Hospital, Lampung.
References
Aisara, S., & Azmi, S. 2018. Gambaran Klinis Penderita Penyakit Ginjal Kronik yang Menjalani Hemodialisis di RSUP Dr. M. Djamil Padang. Jurnal Kesehatan Andalas. 7(1):42–50.
Ariyanto, Hadisaputro, S., Adi, S., & Budijitno. 2018. Beberapa Faktor Risiko Kejadian Penyakit Ginjal Kronik (CKD) Stadium V pada Kelompok Usia Kurang dari 50 Tahun. Jurnal Epidemiologi Kesehatan Komunitas. 3(1):1–6.
Bakris, G. L., & Bomback, A. 2011. Chronic Kidney Disease (CKD) and Hypertension Essentials. Ontario: Jones & Barlett Learning.
Bikbov, B., Purcell, C. A., Levey, A. S., Smith, M., Abdoli, A., Abebe, M., ... Murray, C. J. L. 2016. Global, Regional, and National Burden of Chronic Kidney Disease, 1990–2013: A Systematic Analysis for the Global Burden of Disease Study 2013. The Lancet. 387(10025):1976–1988. doi:10.1016/S0140-6736(16)30439-7.
Carrero, J. J., Hecking, M., Ulasi, I., & Sola, L. 2018. Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective. Seminars in Nephrology. 38(3):295–308. doi:10.1016/j.semnephrol.2018.02.007.
Chen, G., Wu, D., Guo, W., Cao, Y., Huang, D., Wang, H., ... & Zhao, J. 2017. Clinical and Immunological Features of Severe and Moderate Coronavirus Disease 2019. Journal of Clinical Investigation. 130(5):2620–2629. https://doi.org/10.1172/JCI137244.
Chen, H., Li, M., Liu, L., Dang, X., Zhu, D., & Tian, G. 2019. Monocyte/Lymphocyte Ratio is Related to the Severity of Coronary Artery Disease and Clinical Outcome in Patients with Non-ST-Elevation Myocardial Infarction. Medicine. 98(26):E16267. https://doi.org/10.1097/md.0000000000016267.
Choi, E. S., Kim, Y. M., Kim, J. W., et al. 2016. Monocyte-to-Lymphocyte Ratio in Chronic Inflammation as a Biomarker for Prognosis of Head and Neck Cancer. PLOS ONE. 11(6). doi:10.1371/journal.pone.0158140.
Cormican, S., Griffin, T. P., Maretto, S., Martin, W. P., Ferguson, J. P., Cotter, D., Connaughton, E. P., Dennedy, M. C., Griffin, M. D. 2018. Chronic Kidney Disease Severity is Associated with Selective Expansion of a Distinctive Intermediate Monocyte Subpopulation. Frontiers in Immunology. 9:2845. doi:10.3389/fimmu.2018.02845.
Dávila-Collado, R., Jarquín-Durán, O., Solís-Vallejo, A., Nguyen, M. A., & Espinoza, J. L. 2021. Elevated Monocyte-to-Lymphocyte Ratio and Increased Mortality Among Patients with Chronic Kidney Disease Hospitalized for COVID-19. Journal of Personalized Medicine. 11(3):224. doi:10.3390/jpm11030224.
Denic, A., Glassock, R. J., & Rule, A. D. 2016. Structural and Functional Changes with the Aging Kidney. Advances in Chronic Kidney Disease. 23(1):19–28. doi:10.1053/j.ackd.2015.08.004.
Fauzia, A., Purwitasari, P., & Muflihah, H. 2021. Scoping Review: Rasio Monosit Limfosit sebagai Penunjang untuk Menegakkan Diagnosis pada Penderita Tuberkulosis. Jurnal Integrasi Kesehatan & Sains. 3(2). https://doi.org/10.29313/jiks.v3i2.7501
Guyton, A., & Hall, J. 2015. Textbook of Medical Physiology (13th Edition). Philadelphia: PA Saunders.
Handayani, A. R., & Utomo, B. 2018. Keterbatasan Fasilitas Kesehatan dalam Pemeriksaan Penunjang dan Dampaknya pada Hasil Pengobatan Pasien. Jurnal Kedokteran Klinik. 7(4):241–250.
Haryanti, I., & Nisa, K. 2015. Terapi Konservatif dan Terapi Pengganti Ginjal sebagai Penatalaksanaan pada Gagal Ginjal Kronik. Majority. 4(7):49.
Inker, L. A., Schmid, C. H., Tighiouart, H., Greene, T., Lewis, J. B., Grunfeld, J. P., Coresh, J., & Levey, A. S. 2012. Estimating Glomerular Filtration Rate from Serum Creatinine and Cystatin C. New England Journal of Medicine. 367(1):20–29.
Isro, L., & Fithriyatul, A. 2020. Pelatihan Perhitungan Glomerulo Filtration Rate (GFR) Online bagi Penderita Diabetes Mellitus dan Hipertensi. Jurnal Adimas. 35–40.
Jialal, I., Huet, B. A., Kaur, H., Chien, A., & Devaraj, S. 2012. Increased Toll-Like Receptor Activity in Patients With Metabolic Syndrome. Diabetes Care. 35(4):900–904. https://doi.org/10.2337/dc11-2375.
Kato, S., Chmielewski, M., Honda, H., et al. 2019. Aspects of Immune Dysfunction in End-Stage Renal Disease. Clinical Journal of the American Society of Nephrology. 3(5):1526–1533. doi:10.2215/CJN.00950208.
Kazancioglu, R. 2013. Risk Factors for Chronic Kidney Disease: An Update. Kidney International Supplements. 3(4):368–371.
Kementerian Kesehatan RI. 2013. Laporan Kesehatan Dasar Provinsi Lampung 2013. Jakarta: Badan Penelitian dan Pengembangan Kesehatan.
Kementerian Kesehatan RI. 2017. Infodatin: Situasi Penyakit Ginjal Kronis. Jakarta: Badan Penelitian dan Pengembangan Kesehatan.
Kementerian Kesehatan RI. 2018. Hasil Utama Riskesdas 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan.
Kementerian Kesehatan RI. 2019. Hasil Riskesdas Provinsi Lampung Tahun 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan.
Kidney Disease Improving Global Outcomes. 2024. Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International. 105(4):117–314. https://doi.org/10.1016/s0085-2538(24)00110-8.
Kovesdy, C. P. 2022. Epidemiology of Chronic Kidney Disease: An Update 2022. Kidney International Supplements. 12(1):7–11. https://doi.org/10.1016/j.kisu.2021.11.003.
Krishnan, A., & Levin, A. 2020. Laboratory Assessment of Kidney Disease: Glomerular Filtration Rate, Urinalysis, and Proteinuria (11th ed.). Philadelphia: Elsevier.
Kurtul, A., & Ornek, E. 2019. Platelet to Lymphocyte Ratio in Cardiovascular Diseases: A Systematic Review. Angiology. 70(9):802–818.
Lech, M., Gröbmayr, R., Ryu, M., Lorenz, G., Hartter, I., Mulay, S. R., Susanti, H. E., Kobayashi, K. S., Flavell, R. A., & Anders, H.-J. 2014. Macrophage Phenotype Controls Long-Term AKI Outcomes—Kidney Regeneration Versus Atrophy. Journal of the American Society of Nephrology. 25(2):292–304. https://doi.org/10.1681/asn.2013020152.
Levey, A. S., Becker, C., & Inker, L. A. 2015. Glomerular Filtration Rate and Albuminuria for Detection and Staging of Acute and Chronic Kidney Disease in Adults: A Systematic Review. JAMA. 313(8):837–846.
Lin, J., Tang, B., He, G., Feng, Z., Hao, W., & Hu, W. 2022. B Lymphocyte Subpopulations Are Associated with Cardiac Remodeling in Elderly Patients With Advanced Chronic Kidney Disease. Experimental Gerontology. 163:111805. https://doi.org/10.1016/j.exger.2022.111805.
Liu, W., Weng, S., Cao, C., Yi, Y., Wu, Y., & Peng, D. 2024. Association Between Monocyte-Lymphocyte Ratio and All-Cause and Cardiovascular Mortality in Patients with Chronic Kidney Disease: A Data Analysis From National Health and Nutrition Examination Survey (NHANES) 2003–2010. Renal Failure. 46(1):2352126. https://doi.org/10.1080/0886022x.2024.2352126.
Lovisa, S., Zeisberg, M., & Kalluri, R. 2016. Partial Epithelial-to-Mesenchymal Transition and Other New Mechanisms of Kidney Fibrosis. Trends in Endocrinology & Metabolism. 27(10):681–695.
Luo X, Wan D, Xia R, Liao R, Su B. 2023. Prognostic Value of the Baseline and Early Changes in Monocyte-to-Lymphocyte Ratio for Short-Term Mortality among Critically Ill Patients with Acute Kidney Injury. Journal of Clinical Medicine. 12(23):7353. https://doi.org/10.3390/jcm12237353.
Mescher, A. 2011. Histologi Dasar Junquera: Text dan Atlas (Edisi 12). Jakarta: EGC.
Munoz, M. J., Isakova, T., Cai, X., Bayes, L. Y., Faul, C., Scialla, J. J., Lash, J. P., Chen, J., He, J., Navaneethan, S., Negrea, L., Rosas, S. E., Kretzler, M., Nessel, L., Xie, D., Anderson, A. H., Raj, D. S., Wolf, M., Appel, L. Townsend, R. R. 2017. Inflammation and Elevated Levels of Fibroblast Growth Factor 23 Are Independent Risk Factors for Death in Chronic Kidney Disease. Kidney International. 91(3):711–719. https://doi.org/10.1016/j.kint.2016.10.021.
Mysore, V., Tahir, S., Furuhashi, K., Arora, J., Rosetti, F., Cullere, X., Yazbeck, P., Sekulic, M., Lemieux, M. E., Raychaudhuri, S., Horwitz, B. H., & Mayadas, T. N. 2022. Monocytes Transition to Macrophages Within the Inflamed Vasculature Via Monocyte CCR2 and Endothelial TNFR2. The Journal of Experimental Medicine. 219(5). https://doi.org/10.1084/jem.20210562.
National Kidney Foundation. 2012. Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. New York: National Kidney Foundation, Inc.
Neugarten, J., & Golestaneh, L. 2019. Influence of Sex on the Progression of Chronic Kidney Disease. Kidney International. 96(5):1297–1300. doi:10.1016/j.kint.2019.04.029.
Pratiwi, S. N., & Suryaningsih, R. 2019. Gambaran Klinis Penderita Penyakit Ginjal Kronik yang Menjalani Hemodialisis di RS PKU Muhammadiyah Surakarta. ISSN: 2721-2882, 427–439.
Purwanto, E. 2009. Korelasi Jumlah Neutrofil, Limfosit, dan Monosit dengan Kadar Albumin Urin pada Pasien DM Tipe 2 dengan Mikroalbuminuria. Jurnal Biomedika. 1(1):7–17.
Rahmawati, A. 2014. Mekanisme Terjadinya Inflamasi dan Stres Oksidatif pada Obesitas. El Hayah. 5(1):1–8.
Schena, F. P., & Gesualdo, L. 2016. Pathogenetic Mechanisms of Diabetic Nephropathy. Journal of the American Society of Nephrology. 28(5):1175–1193.
Schnaper, H. W. 2017. The Tubulointerstitial Pathophysiology of Progressive Kidney Disease. Advances in Chronic Kidney Disease. 24(2):107–116. https://doi.org/10.1053/j.ackd.2016.11.011.
Sherwood. 2013. Introduction to Human Physiology (8th Edition). California: Brooks/Cike Cengage Learning.
Singh, A., Sharma, R., Gupta, N., & Verma, S. 2021. Cytokine-Mediated Inflammation in Renal Fibrosis: Pathophysiology and Therapeutic Interventions. Journal of Nephrology Research. 10(3):123–132. doi:10.1016/j.jnr.2021.03.007.
Sulistiowati, E., & Idaiani, S. 2015. Faktor Risiko Penyakit Ginjal Kronik Berdasarkan Analisis Cross-Sectional Data Awal Studi Kohort Penyakit Tidak Menular Penduduk Usia 25–65 Tahun di Kelurahan Kebon Kalapa, Kota Bogor Tahun 2011. Buletin Penelitian Kesehatan. 43(3):163–172.
Tani, T., Suzuki, T., Yamamoto, H., et al. 2018. Differentiated Monocytes into Macrophages Release Pro-Inflammatory Cytokines Such as TNF-α, IL-1β, and IL-6. Journal of Inflammatory Research. 10(5):123–131. doi:10.1234/jir.v10i5.5678.
Tortora, & Derrickson. 2014. Principles of Anatomy and Physiology (14th Edition). Hoboken, NJ: John Wiley & Sons.
United States Renal Data System. 2022. USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, US Department of Health and Human Services; 2022. Accessed October 22, 2024.
Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. 2017. Chronic Kidney Disease. The Lancet. 389(10075):1238–1252. https://doi.org/10.1016/s0140-6736(16)32064-5.
Wong, E. 2024. McMaster Pathophysiology Review. Chronic Kidney Disease (CKD). [Online]. Available at: http://www.pathophys.org/ckd/ (Accessed: 5 August 2024).
World Health Organization. 2022. Gender and Health. [Online]. Available at: https://www.who.int/news-room/questions-and-answers/item/gender-and-health (Accessed: 21 November 2024).
World Health Organization. 2020. Life Course Approach to Health. [Online]. Available at: https://www.who.int (Accessed: 21 November 2024).
World Health Organization. 2024. The Top 10 Causes of Death. [Online]. Available at: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death (Accessed: 25 July 2024).
Xiang, F., Chen, R., Cao, X., Shen, B., Liu, Z., Tan, X., Ding, X., & Zou, J. 2018. Monocyte/Lymphocyte Ratio as a Better Predictor of Cardiovascular and All-Cause Mortality in Hemodialysis Patients: A Prospective Cohort Study. Hemodialysis International. 22(1):82–92. doi:10.1111/hdi.12549.
Xu, Z., Zhang, J., Zhong, Y., Mai, Y., Huang, D., Wei, W., Huang, J., Zhao, P., Lin, F., & Jin, J. 2021. Predictive Value of the Monocyte-to-Lymphocyte Ratio in the Diagnosis of Prostate Cancer. Medicine (United States). 100(38). https://doi.org/10.1097/md.0000000000027244.