ELDERLY REGULAR HEMODIALYSIS PATIENTS HAVE HIGHER MEAN OF CAROTID INTIMA-MEDIA THICKNESS AND SERUM INTERLEUKIN-6 LEVEL THAN NON-ELDERLY
By : Ketut Gede Wiradharma
Email : firstname.lastname@example.org
Faculties : Fakultas Kedokteran
Department : PS. ILMU PENYAKIT DALAM
Increasing elderly population (?60 years old) had an impact on the increased incidence of chronic kidney disease (CKD), as well as increased demand for hemodialysis. The age factor thought to contribute to the occurrence of atherosclerosis and inflammation conditions, including in regular hemodialysis (HD) patients. In general population, there is evidence that the elderly has higher atherosclerosis and inflammation process, but the study in population with regular HD is still limited. Besides age, increased calcium-phosphate product that occurs due to the condition of secondary hyperparathyroidism and length of regular HD is also thought to contribute to atherosclerosis and inflammation. This study was conducted to prove that elderly regular HD patients have atherosclerosis, through examination of carotid intima-media thickness (CIMT), which was higher than non-elderly, elderly regular HD patients had inflammation, through examination of interleukin-6 (IL-6), higher than non-elderly, as well as the directly or indirectly effect (through IL-6 serum) of age, length of regular HD, and calcium-phosphate product towards CIMT. An analytic cross-sectional observational study was conducted at Hemodialysis Instalation, Sanglah General Hospital, from May until June 2016. Regular HD patients over 18 years old were involved in this study, to exclude malignancy, severe anemia, smoking, systemic lupus erythematosus (SLE), acute infection, liver function abnormality, and history of long-term steroid therapy. The studied variables were the means of CIMT using grayscale ultrasound, serum IL-6 level using Quantikine® HS ELISA, calcium-phosphate product using blood calcium and phosphate examination, age and length of regular HD from history taking and medical record. Independent t-test analysis was used to compare mean CIMT and IL-6 between elderly and non-elderly regular HD patients. Path analysis was used to test the effects of age, length of regular hemodialysis, and calcium-phosphate product towards CIMT through IL-6 examination. From 60 samples with regular HD, 30 samples were elderly and 30 samples were non-elderly. In the independent t-test, it was found in the elderly group had a mean of CIMT higher than non-elderly group (0.73±0.1 mm versus 0.58±0.09 mm, p<0.001), elderly group had higher serum IL-6 level than non-elderly group (5.96±3.95 pg/ml versus 4.19±2.36 pg/ml, p=0.04). Of path analysis, showed there was a direct correlation between age and the mean of CIMT (critical ratio of 6.77; p <0.01), whereas for the calcium-phosphate product (p = 0.54) and length of regular HD (p = 0.46 ), there were no significant correlation towards mean of CIMT. From the results of this study, it could be concluded that based on mean of CIMT, elderly regular HD patients has atherosclerosis higher than non-elderly. Based on serum IL-6 examination, elderly regular HD patients have higher inflammation process than non-elderly. It is recommended to do another monitoring of atherosclerosis and inflammation in elderly regular HD patients. It can be also concluded that in regular HD patients, age has a direct correlation towards mean of CIMT. However, indirect correlation of age and the correlation of calcium-phosphate product and length of regular HD towards mean of CIMT showed no significant results. The results of these studies are expected to be used as the basis for further research in order to further prove the role of aging, mineral disturbances, and hemodialysis towards atherosclerosis processes through inflammation.
Keyword : Elderly, regular hemodialysis patients, CIMT, IL-6