Indonesian Journal of Kidney and Hypertension

Sepsis and Acute Kidney Injury (AKI): Which is More Important, Sepsis Biomarkers or AKI Biomarkers?

2026-04-24T15:25:11+07:00

Characteristic of Patients Undergoing Initiation of Emergency Haemodialysis at Ngoerah Hospital Denpasar in 2023

2026-04-24T15:25:11+07:00

Background: Initiation of emergency hemodialysis is associated with higher morbidity and mortality compared to planned hemodialysis. Identifying the characteristics of patients undergoing emergency hemodialysis is essential to improve clinical outcomes. This study aimed to describe the clinical characteristics of patients who initiated emergency hemodialysis at Ngoerah Hospital, Denpasar, in 2023.

Methods: This cross-sectional descriptive study used secondary data obtained from the patient registry. Total sampling was applied to include all patients who underwent initiation of emergency hemodialysis at Ngoerah Hospital, between January 1 and March 31, 2023. Data were analyzed descriptively.

Results: A total of 70 patients were included. The mean age was 54.54 ± 14.6 years, and 52.3% were male. The most common etiology of CKD) was obstructive nephropathy (32.8%), followed by diabetic kidney disease (21.4%). Major comorbidities included heart disease (35.7%), malignancy (25.8%), and diabetes mellitus (21.4%). The most frequent indications for emergency hemodialysis were metabolic acidosis (71.8%). Temporary jugular vein central venous dialysis catheters were the most commonly used vascular access (67.6%). Only 21.1% of patients had received pre-dialytic monitoring. The median estimated glomerular filtration rate (eGFR) was 5.69 mL/min/1.73 m², median serum creatinine was 8.47 mg/dL, and median serum potassium level was 5.6 mEq/L.

Conclusion: Patients initiating emergency hemodialysis at Ngoerah Hospital demonstrated diverse clinical characteristics. The high prevalence of metabolic acidosis along with low rates of pre-dialytic monitoring, highlights the need for improved early detection and management of CKD to reduce emergency hemodialysis initiation.

Keywords: emergency hemodialysis, patient characteristics, chronic kidney disease, Ngoerah Hospital Denpasar

The Relationship of Social Support and Spirituality to Resilience in Chronic Kidney Disease Patients Undergoing Regular Hemodialysis at Adam Malik Hospital Medan in 2025

2026-04-24T15:25:11+07:00

BACKGROUND End Stage Renal Disease (ESRD) patients undergoing hemodialysis are faced with demanding long-term therapy that often has a psychological impact. Resilience, the ability to adapt and recover from difficult situations, is an important protective factor for patients to manage medication adherence. External factors such as social support and internal factors such as spirituality were identified as aspects associated with individual resilience.

METHODS This research is an analytic study with a cross-sectional design. Data were obtained through distributing questionnaires at Adam Malik Hospital Medan in 2025. Data were processed using Statistical Package for the Social Science (SPSS) software.

RESULTS Based on the results of the analysis of 50 research samples, it was found that respondents had a high (66%) and moderate (34%) distribution of resilience. Social support and spirituality have a significantly positive relationship with individual resilience levels.

CONCLUSIONS The majority of PGTA patients undergoing HD at Adam Malik Hospital have high levels of resilience. Social support and spirituality play an important role in increasing individual resilience. Therefore, good social support and spirituality are necessary in order to support treatment compliance, adaptation, and quality of life for HD patients.

Diagnostic Value of Proenkephalin A 119 – 159 Serum in Early Detection of Sepsis Associated Acute Kidney Injury

2026-04-24T15:25:12+07:00

Background: Sepsis asscociated acute kidney injury (SA-AKI) is common condition that found in sepsis. Due to the lack of creatinine serum, this condition possibly makes therapy delayed. Proenkephalin A 119-159 (PENK) is a breakdown product of the prohormone proenkephalin A which freely filtered at the glomerulus. In other hand, this prohormone and its receptor predominantly expressed in proximal Tubular Epythelial Cells (pTEC) of kidney. Elevated serum PENK levels are an indicator of AKI. However, previous studies have shown varies results.

Objectives: This study aims to determine early detection biomarkers for the presence of AKI in sepsis.

Methods: This diagnostic test was conducted at Dr. M. Djamil General Hospital Padang in sepsis patients. The diagnosis of AKI was established based on the 2012 KDIGO criteria.

Results: The study involved 98 sepsis patients, 58.16% (n=57) of them experienced AKI. Serum creatinine levels at admission and within 48 hours of hospitalization were 1.0 (IQR 0.8–1.5) mg/dl and 1.6 (IQR 0.9–2.1) mg/dl, respectively. A serum PENK level ≥82.6 pmol/L at admission had sensitivity of 98.6%, specificity of 95.1%, positive predictive value of 96.1%, negative predictive value of 97.5%, and accuracy of 96.9% in early detection of AKI in sepsis.

Conclusion: Serum PENK level has excellent diagnostic value in early detection of AKI in sepsis.

Seroprevalence of CMV and HSV in Kidney Transplant Donor Candidates and Recipients at Ngoerah Hospital, Denpasar

2026-04-24T15:25:12+07:00

Background: Despite significant advancements in solid organ transplantation over recent decades, infections remain a leading cause of morbidity and mortality among transplant recipients. Herpesviruses, particularly Cytomegalovirus (CMV) and Herpes Simplex Virus (HSV), are the most common viral pathogens affecting this patient population. This study aims to evaluate the seroprevalence of CMV and HSV infections among kidney transplant donor and recipient candidates at RS. Ngoerah Denpasar.

Methods: This descriptive study involved 66 adult subjects, comprising 33 kidney transplant donor candidates and 33 recipient candidates, all aged over 18 years. The study participants were evaluated for CMV and HSV seroprevalence using serological tests, including IgG and IgM antibodies, to determine the presence of latent or active infections. The study population included patients with chronic kidney disease (CKD) stage V who were candidates for kidney transplantation.

Results: Among the 33 donor candidates, 39.4% were found to have both CMV and HSV infections, with 45.5% testing positive for IgG anti-CMV, indicating a latent CMV infection. In the recipient candidate group, 27.3% were infected with both CMV and HSV, with 42.4% showing seropositivity for IgG anti-CMV. Additionally, a small proportion of donor and recipient candidates were found to have reactivated HSV infections, as indicated by the presence of IgM antibodies. The study highlights the significant prevalence of CMV and HSV infections among kidney transplant donor and recipient candidates.

Conclusion: These findings underscore the importance of thorough serological screening prior to transplantation to identify latent infections that may influence post-transplant outcomes.

New Guideline for Chronic Kidney Disease 2024, What Primary Care Can Do About It?: A Narrative Review

2026-04-24T15:25:12+07:00

Chronic Kidney Disease (CKD) presents an urgent global public health crisis, affecting over 850 million people worldwide, with low-income nations like Indonesia facing a high burden of undiagnosed cases due to limited awareness and a deficient primary care system. This paper serves as a vital, practical response to the novelty of the KDIGO 2024 Clinical Practice Guideline update, which incorporates a decade of new evidence, including the ethical imperative to eliminate the race coefficient from eGFR equations and the introduction of consensus-based "Practice Points." Key findings from this review highlight that CKD diagnosis is not solely reliant on Glomerular Filtration Rate (GFR), but also on persistent markers of kidney damage such as albuminuria and urine sediment abnormalities. The 2024 updates strongly recommend the race-free CKD-EPI 2021 equation for routine screening, the use of estimated GFR based on creatinine and cystatin C (eGFRcr-cys) for superior accuracy, and the strong recommendation for Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i) in Type 2 Diabetes patients with CKD. Additionally, the guidelines introduce actionable risk prediction thresholds for nephrology referral, alongside practical advice like "sick day rules" for primary care. This review addresses the critical research gap concerning the primary care sector's capacity and capability by synthesizing the KDIGO 2024 updates. It concludes that primary care, as the frontline in health services, must rapidly adopt these standards to enhance early screening, improve patient risk stratification, and facilitate timely, informed referrals to advanced care, thereby mitigating disease progression and improving patient outcomes globally.

Ruptured Renal Artery Aneurysm in a Young Man with Uncontrolled Hypertension

2026-04-24T15:25:12+07:00

Renal artery aneurysm (RAA) is a rare renovascular condition that may represent both a consequence of long-standing hypertension and an underrecognized cause of secondary hypertension, particularly in young patients. A 23-year-old man with a four-year history of poorly controlled hypertension (peak blood pressure 170/100 mmHg) presented with acute left flank pain. On admission, blood pressure was 154/110 mmHg with severe anemia (hemoglobin 6.3 g/dL), preserved renal function (creatinine 1.18 mg/dL), and mild proteinuria (1+) without hematuria. Contrast-enhanced CT angiography demonstrated a 2.54-cm saccular RAA (Rundback type I) arising from the left renal artery, accompanied by a large perirenal hematoma measuring 8.3 × 6.7 × 14.2 cm, consistent with rupture. The patient had been taking intermittent captopril 12.5 mg once daily prior to admission. Selective endovascular coil embolization using a 3.3-mm VortX coil via right femoral access was successfully performed, achieving complete aneurysm exclusion with preserved renal perfusion. This case highlights the bidirectional relationship between hypertension and RAA. Chronic hypertension likely contributed to aneurysm formation, while intrarenal hemodynamic disturbances may have activated the renin-angiotensin-aldosterone system (RAAS), leading to secondary hypertension. The marked improvement in blood pressure following intervention supports a reversible renovascular mechanism. RAA should be considered in young patients with uncontrolled or resistant hypertension. Early vascular imaging and timely endovascular management are essential to prevent life-threatening complications and address reversible renovascular hypertension.