Penatalaksanaan Anemia pada Penyakit Ginjal Kronik

Abstract

Abstract: Anemia in chronic kidney disease (CKD) causes a decrease of quality of life, and increases of cardiovascular disease, cognitive impairment and death. Management of anemia in CKD with iron and erythropoiesis stimulating agents (ESA) could improve the patient's quality of life. This study aimed to determine the management of anemia in CKD focused on management of iron and ESA. This was a literature review study. Literature searching was performed by using three databases, namely ProQuest, Pubmed, and ClinicalKey. After an adjustment based on inclusion and exclusion criteria, 10 journals were obtained. The results showed that intravenous (IV) iron was a faster and superior option for iron correction than oral iron in CKD patients with anemia. Correction of anemia using ESA therapy could significantly increase hemoglobin level. If transferrin saturation (TS) was <20% and serum ferritin (SF) <100 ng/ml in CKD-ND and CKD-PD, as well as TS <20% and SF <200 ng/ml CKD-HD, erythropoiesis stimulating agents (ESA) had to be administered to increase hemoglobin levels. In conclusion, in management of anemia, iron status and iron therapy have to be evaluated first, therefore, erythropoiesis stimulating agents (ESA) administration could increase the hemoglobin level of patients with chronic kidney disease.

Keywords: iron management; erythropoiesis stimulating agents; anemia; chronic kidney disease

Abstrak: Anemia pada penyakit ginjal kronik (PGK) menyebabkan penurunan kualitas hidup, peningkatan penyakit kardiovaskular, gangguan kognitif, dan kematian. Penatalaksanaan anemia pada PGK dengan pemberian besi dan erythropoiesis stimulating agents (ESA) dapat meningkat-kan kualitas hidup pasien. Penelitian ini bertujuan untuk mengetahui penatalaksanaan anemia pada PGK dengan fokus pemberian besi dan ESA. Jenis penelitian ialah literature review dan pencarian data menggunakan tiga database yaitu ProQuest, Pubmed, dan ClinicalKey. Setelah dilakukan penyesuaian berdasarkan kriteria inklusi dan eksklusi didapatkan 10 artikel yang dilakukan review. Hasil penelitian menunjukkan bahwa pemberian besi intravena (IV) menjadi pilihan koreksi besi yang lebih cepat dan unggul dibandingkan besi oral terhadap penderita PGK dengan anemia Koreksi anemia dengan terapi ESA dapat meningkatkan kadar hemoglobin secara bebrmakna. Jika saturasi transferin (ST) <20% dan feritin serum (FS) <100 ng/ml pada PGK-ND dan PGK-PD, dan ST <20% dan FS <200 ng/ml PGK-HD, dapat dilanjutkan dengan pemberian ESA untuk mening-katkan kadar hemoglobin. Simpulan penelitian ini ialah dalam penatalaksanaan anemia pada penyakit ginjal kronik perlu dilakukan evaluasi status besi dan pemberian besi terlebih dahulu agar pemberian erythropoiesis stimulating agents (ESA) dapat meningkatkan kadar hemoglobin.

Kata kunci: penatalaksanaan besi; erythropoiesis stimulating agent; anemia; penyakit ginjal kronik