Akhil Deepak Vatvani

20 Quality of Life of Hypertensive and Non-Hypertensive End Stage Renal Disease Patients Undergoing Hemodialysis

Background: With the increasing prevalence of hypertension, there has been a growing interest in understanding the health-related quality of life (HRQOL) of patients with hypertension. Although hypertension is often perceived as asymptomatic, its relation with Quality of life (QoL) is still controversial. Objective: The aim of this study is to assess the QoL of End Stage Renal Disease (ESRD) who are on maintenance dialysis with or without hypertension. Methods: This is a multicenter cross sectional study that took place in 4 hemodialysis clinics in Jakarta from October to December 2016. QoLwas measured using WHOQOL-BREF containing 4 domains related to physical health, psychological, social relationships and environmental. Hypertension is defined as systolic BP ≥ 140mmHg or diastolic BP ≥ 90mmHg or previously taking antihypertensive medications. Analysis was carried out using T-test or Mann-Whitney, depending on the distribution of the data. Results: A total of 138 patients were collected, out of which 86(62.3%) were male. The mean age of the patients were 53.0(±12.5) years. The etiology of ESRD was mostly due to hypertension (56.5%) and diabetes (29.7%). The median duration of dialysis was 33(1–216) months. There were 106(76.8%) patients suffering from hypertension. The mean scores for physical health domain in the hypertensive and non-hypertensive patients were 54.8(±16.9) and 61.5(±15.4) respectively (p: 0.049). There was no significant difference between between the 2 groups for the other domains of QoL. Conclusion: Patients with hypertension have significantly lower physical health related QoL. Extra attention must be given to these group of patients in order to improve the QoL.

19 Prevalence and Characteristics of Patients with Intradialytic Hypertension in Indonesia

Background: Intradialytic hypertension (IDH) is common and it increases the incidence of cardiovascular morbidity and mortality, however this is often ignored. The pathophysiological mechanisms are still unclear. Little is known about the demographic, clinical and laboratory characteristics. Objective: The aim of this study is to identify the prevalence of IDH and compare the clinical characteristics of patients with and without IDH. Methods: This is a multicenter cross sectional study that took place in 3 hemodialysis clinics. We compared characteristics such as age, BMI, duration of hemodialysis, hemoglobin, hematocrit, ureum, creatinine, sodium, potassium, calcium, uric acid, ferritin, erythrocyte, iron, total cholesterol, MAP and dry body weight in patients with IDH and control group without IDH. IDH was defined as >10 mmHg increase in systolic BP in atleast four of six prior consecutive hemodialysis sessions. Analysis was done using T-test or Mann-Whitney, depending on the distribution of data. Results: Out of 114 patients, 86(62.3%) were male. IDH was present in 47(34.1%) patients. The mean age in IDH and control group were 53.4(±13.2) and 52.8(±12.4) years respectively (p: 0.800). The mean BMI of IDH and control group were 21.8(±3.7) and 24.0(±4.4) kg/m2 respectively (p: 0.031). The meanMAP during dialysis of IDH and control group were 108(±13.1) and 98.6(±23.2) mmHg respectively (p: 0.011). The median creatinine levels of IDH and control group were 8.1(3.02–22.20) mg/dl and 10.8(2.89–22.0) mg/dl respectively (p: 0.008). Other variables did not have any significant difference between the 2 groups. Conclusion: The prevalence of IDH ishigher than previously reported. Patients with IDH have lower BMI, higher MAP and lower creatinine levels than in controls.

1 Prevalence and Population at Risk for Peripheral Arterial Disease in Hypertensive Patients Undergoing Hemodialysis

Background: Hypertensive patients with Chronic Kidney Disease are associated with cardiovascular disease. Peripheral Arterial Disease (PAD) is one of relatively underrated. The aim of this study is to identify the prevalence of PAD in hypertensive patients undergoing routine hemodialysis and its association with classic cardiovascular risk factors. Method: This is a multicenter cross sectional study that took place in 4 hemodialysis clinics in Jakarta from October to December 2016. We evaluated patients that have undergone hemodialysis for ≥6 months. PAD was diagnosed by Ankle Brachial Index (ABI). Patient was categorized as having PAD if ABI<0.9. Hypertension is defined as systolic BP ≥140mmHg or diastolic BP ≥90mmHg or taking antihypertensive medications. Analysis was done using Chi-square. Result: A total of 99 samples were collected, out of which 60 (60.6%) were male. The mean age of the patients were 52.7 (±12.6) years. There were 45 (45.5%) patients with PAD. PAD was significantly higher in patients aged >50 years (OR: 2.72, p: 0.025), male gender (OR: 2.75, p: 0.018), and in patients which had a history of smoking (OR:2.89, p:0.011). BMI, DM and alcohol history did not show any significant association with PAD. Conclusion: Almost half of the population in this study have abnormal ABI, which categorized them to have PAD. Age >50 years, male gender and positive smoking history are the factors that are associated with risk for PAD. DM as one of major risk factor of cardiovascular disease do not associate with PAD in this population, which assume that in hypertensive hemodialysis patients DM would not add any significant contribution in the presence of PAD.

18 Clinical Characteristics and Antihypertensive Agents Used at Hemodialysis Clinics in Jakarta

Background: Chronic kidney disease (CKD) has emerged as a public health challenge in developing countries like Indonesia. Hypertension as one of the most common etiology of CKD could also be a complication of CKD itself. Hypertension is seen in majority of patients undergoing hemodialysis and should be controlled properly in order to prevent major cardiovascular outcome and reduce mortality rate. Objective: To investigate the clinical characteristics and the types of antihypertensive agents used at hemodialysis clinics in Jakarta. Methods: This is a descriptive study that took place in 4 local hemodialysis clinics from October to December 2016. Clinical, laboratory data and antihypertensive medications used were recorded. Results: A total of 138 patients were included in our study, out of which 86(62.3%) were male. The mean age of the patients were 49.3(±12.4) years. The most common etiology of CKD was hypertension (56.5%) and diabetes (29.7%). The mean duration of HD was 38.6(1–216) months. There were 23(16.6%) patients with BMI >25 kg/m2. Median hemoglobin values were 8.3(1–11.8) mg/dl. The median creatinine levels were 9.71(2.8–31.4) mg/dl. The median sodium levels were 138(101–147) mEq/L.41(29.7%) patients had potassium greater than 5.0mEq/L. Median systolic BP pre and post HD was both 140mmHg. 106(76.8%) had hypertension, 46(33.3%) had diabetes mellitus, 24(17.3%) had hyperlipidemia. The median number of antihypertensive drugs were 2(1–4).43% received CCB, 32.5% received ACEI or ARB, 6.97% received beta blockers, 8.1% received alpha blockers and 9.3% received diuretics. Conclusion: Most of our patients use CCB, ACEI or ARB to control their blood pressure. By knowing the characteristics of the patients, we can treat the underlying causes better and prevent further complications from happening.

P3-260Factors Asssociated with Hypopituitarism Reversibility After Neurosurgical Treatment of Pituitary Adenomas in Indonesia

Case 1: A 76-year-old woman who had no smoking history presented with left eyelid ptosis and grade 4 creatine phosphokinase elevation after the 2nd cycle of nivolumab monotherapy. She was diagnosed with lung adenocarcinoma which had EGFR mutation. Dyspnea and muscle weakness developed rapidly with an acute exacerbation. We diagnosed her with myasthenia gravis based on the symptoms and the detection of anti-acetylcholine receptor antibody. She was received plasmapheresis and intravenous immune globulin followed by low dose prednisolone. Her symptoms gradually improved.