Perbandingan Akurasi Berbagai Formula untuk Mengestimasi Laju Filtrasi Glomerulus pada Penderita Karsinoma Nasofaring Stadium Lanjut Sebelum Mendapat Kemoterapi Cisplatin

Abstract

Cisplatin adalah obat sitotoksik dengan efektivitas tinggi dan digunakan secara luas, termasuk pada karsinoma nasofaring (KNF). Salah satu keterbatasan penggunaan cisplatin adalah nefrotoksisitas, terutama pada tubulus ginjal. Formula HARUS 15-30-60 dan HADI merupakan formula baru dalam menilai laju filtrasi glomerulus (LFG) dengan memperhitungkan  fungsi tubulus. Penelitian ini bertujuan mengetahui perbandingan akurasi formula Cockroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), HARUS 15-30-60, dan HADI dengan klirens kreatinin dalam menilai LFG pada penderita KNF stadium lanjut. Dilakukan penelitian analitik komparatif dengan rancangan potong lintang. Data diambil dari rekam medik penderita KNF yang akan mendapat kemoterapi cisplatin di Departemen Ilmu Penyakit Dalam Rumah Sakit Dr. Hasan Sadikin Bandung mulai Agustus 2012 sampai Agustus 2013. Data dianalisis menggunakan ANOVA dan uji concordance correlation coefficient (CCC). Subjek penelitian terdiri atas 70 subjek, 28 perempuan (40%) dan 42 laki-laki (60%), dengan usia rata-rata 42±12,3 tahun. Estimasi LFG berdasarkan MDRD, CG, dan HADI berbeda dengan klirens kreatinin (p<0,05), sedangkan estimasi LFG berdasarkan HARUS 15-30-60 tidak berbeda (p>0,05). Formula HARUS 15-30-60 memiliki CCC 0,401, lebih besar daripada CG (CCC=0,387), HADI (CCC=0,258), dan MDRD (0,136). Simpulan, formula HARUS 15-30-60 lebih akurat dibanding dengan formula CG, HADI, dan MDRD dalam menilai LFG pada penderita KNF stadium lanjut. [MKB. 2015;47(1):42–8]

Kata kunci: Cockroft-Gault, formula HADI dan HARUS 15-30-60, klirens kreatinin, laju filtrasi glomerulus,  modification of diet in renal disease

Accuracy Comparison of Various Formulas for Estimating Glomerular Filtration Rate in Advanced Nasopharyngeal Carcinoma Patients before Cisplatin Administration


Cisplatin is a widely used and highly effective cytotoxic agent, including for nasopharyngeal carcinoma (NPC). One of the side effects of cisplatin is nephrotoxicity, especially in tubulus. HARUS 15-30-60 and HADI are new formulas for estimating glomerular filtration rate (GFR) which also calculate tubular function. The aim of this study was to compare the accuracy of Cockroft–Gault (CG), modification of diet in renal disease (MDRD), HARUS 15-30-60 and HADI formula with creatinine clearance in assessing GFR. This was a cross-sectional study with comparative design in patients with advanced NPC before administration of cisplatin in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Data were collected from August 2012 to August 2013 and analyzed using ANOVA and concordance correlation coefficient test (CCC). There were 70 patients, consisted of 28 (40%) females and 42 (60%) males with the mean age of 42±12.3 years. LFG estimations based on MDRD, CG, and HADI were different from the creatinine clearance  (p<0.05), whereas no difference was found between HARUS 15-30-60 and creatinine clearance (p>0.05). HARUS 15-30-60 with creatinine clearance had CCC 0.401 was greater than CG (CCC=0.387), HADI (CCC=0.258), and MDRD (CCC=0.136). In conclusion, HARUS 15-30-60 formula is more accurate than CG, HADI, and MDRD formula in assessing renal function (GFR) in patients with advanced NPC. [MKB. 2015;47(1):42–8]


Key words: Cockroft-Gault, creatinine clearance, estimated glomerular filtration rate, HADI and HARUS 15-30-60 formula, modification of diet in renal disease

DOI: 10.15395/mkb.v47n1.396