,

! i,lr,.-1,.

PEMAKAIAN ASAM FOLAT

KRONIK
PADA GAGAL GINJAL
A'
Suhardi D
SLlb Bagian Ginjal - HiPertensi
Dalam
SIvF/l ab llrru Penyakrl '
Gadjdh f'lada
Falultdc P pdokteran Universitas
logjakarta

lnti sori
PemokoionosomfololpqdokosusgogolginiolselorongsedongromoidlleliliPodoposien <plro'no
obnor mol linqgioon berloniul 'neninqkol
ooootoiniol rngon dilemufon r'odornolnoJ'itoiri'
progrpsrviro goqot qrniol
X"iJ"" t""i"ql"'*" 85% penderilo gogqlginiol lerminol memiliki Penelili lennifer
(20021 meloporion bohwo
Snovely

k"d;il;;;,;i"; ;";insko'o,'o'p'q'iJp*:"^::::l*:,"1ru;$iii::1t"ff*;f 'T;

er"''"r"'T:t:-":::'ill:"-q:")::HT,i:,:"Jlil'ffiil;J;;;lij",n"o'o'iir"'n"'io
'"oone
lffi lxi: f ixru?. ;::ru#::ffi ffi ;;.oi ioioi iunsoor'ouo'|ind;k o'nbrosi donoon
viro
min 86 don Bl2 pulo
lleinem o berhosil molo oiholoplo'mompl
Apobilo pengondolon I'ipelhomos 'ri pemol olon
r'ool elel:o'np'ng
gogol
on odonyo
elodlo n cot dio vos'utotdl'il'l ditem'l
menoendol;kon I
p"tortoion osom folot podo kosus
*utiilbLi n ir'
oso; folol dosis linggi toupun ao''' '"ii

giniol kronik songot dioniurkon

osam folot
Koto kunci: gogoiginlo I kronik- hiperhomasisleinemio -
Pendohuluon lndependen dori
merupolon soloh solu foklor
hiperhomosrstarnemio
Ieloh disepokoli bohwo rnoir'cooo posien gogol giniol lerminol
yong
no-o:nso'iliJ'
ortero slleros,s {Boushey er ot toos' lBoslom
p"nggonf i 5";" berodo oolom leodoon hiper homosisle'nemio
["'op' mengolomi
dilolukon l'emodiohsis pulo Do;;i"rnt;;;"""" gogolginlor lerminolyonq
drkelohur Davelop-
a crrllelon. lossl Teloh {conspnsus
oleikeioo'onpenvoliitoi'a;ovoskulor
hemodioIsrs lerspbul 5o"t disebooton menurunlon
oor'tt eeroos;r"io;pl-nlrili" i"r'o'p"r'l't
lerbukli bohwo

denoor
monr conlp'pnce toqat pooo la posien gogol grnlol lerrninol
keodoon hrperhomositteinem
jllii!
o do"gon oi"ifo'oi
pr o/'
i"i i * rro'nbosi<menu'unrcrowiord 20011
","0 "ccess
Podomokolohiniokondilqporkonbeberopopenelllionpodoposiengogolgin]olierminoldenqordopolditurunkor
t"oJoon nip"tf'otosisreinemro
hemodiolisis vong dilokuron r"'op'o'ornioioi[!it
dopoi dilurunkon pulo
.l] it'JJ'i"iti,ilo;;vokitkordiovoskulor
20(
PenemuonlmlohTohLrnon LlmLrPenvokrDolom
 Pombohqson
l, gogolmqno mekonism€
teriodinyq hiperhomosisteinemlq podo gqgol giniql ,ermlnql?
Podo posien goqor qinior
konik sering,m-engoromi hiperhomosisreinemio. Kodor
berkisor onroro 20_80 homosisrein lmotlL dionggop
umot,/t {Dierkes el a. rccar. r"oor.;.;riJ;i" oo.ioiilrriso. normol Aoobito kodor
homosistein *,.. njo rrrn# oijnggqp onrorq s_is
moderote. sedonq meningkot
opobito kodornv., meningkot onroro rr-too pm-oitioiJnig";;
opobito kodor homosistein ,nlerm"a.re don
> 100 umot/r dionggop,""ingkoif"ri'ii""#riXt
"r,
,noof
pooo ,"',,o
nonoin'lio,.on,r,'
*""0'"""n"";1ilTfi#?1"'jfl?Yifi?J:l'r"j#tli'terhom-o-sisteiiemio o"'nuo'ngon
longsung densqn
ruo,nrn orgoon inii."rijion'inl"j#i keodoon gog.olginlolnfo
rio"r.ar".i,i"" r,."'.,i;;;#::,f,T'.*iiJt:il"3"B:fl: g'?flJ1rutr',".:fr*[;:i
terjodrnyo hiperhomosisteinemio odoroh siruosiuremik sendiriyong dipoiri"-n,,i'ooorono"r"r pooo melobolisme homosistein {Bostom &
Culle,on, 19991.
Podq posien gogol gjnjol kronik cukup, sering
vong,tidok mendqpol suplemen vilomin yong
mengolomi defisiensi
osom lotor rnrtnko; hemoOiofigs ienalriilenylio'o"lon
hilong termosukvitomin B Boqi ll"nyor, ui,ornin yong
Oender o-gogol giniql
terminol yong bonyok dilokukon pembotoson
mokon
don ridok mendopqr supremen viromin yong
Keodoon defisiensiosom cukup, moio oion tlioji a-e'niiensrosomtotor
fotot inimendorong rer.i"ji"1," ilip"rh"rn"lri",iJillo"6lrt",

Poro peneliti yong lergobunq dolom

,Clevelond Clinic foundotion, teloi rn"nyirnpuf "rot. ,ocrt
podo penderiro gooor qinior f.on Uotro
rerminor mempunvoi rooo. rro,nosisiein
v'on'g
i;iqlai aoro, ao,ot.
Keodoon ini dopot diproleksi
dori keiodion penyokit kor;iovo;;;;r'il;n;""Lr"
supJemen osom fotot. "- .. memberikon
vitomin 86 don vitomin brz rn"oi".on "r,i.'iii;i"
2. potogenesishipefiomosisteinemiodonorleriosklerpsis
Bogoimono
mekonisme keodoon hioerhomosisleinemio orlerio
skterosis dopqt menim6ulkon terjodinyo
berum dikerohui secoro ieros boro peneriri seruiu
oJ;; r'r-J"iiiiil"lillinemiobersifor
sitotoksik podo endolel pembuluh
doroh Meningkqtnyo t"a", f,"r;r,r[i"'",i.,to produksi
oxide podo set set dindjnq pembutuh
doroh diteion ."hinggo p"rUrfriO",Ji","rr"but niki,
don keodoon inj mempermudoh terioOin},o - ku.ong
'teksibet plogii;vio;_6in;. ffi;'
Teoriroin
menyorokon bohwo mcningkotnyo kodor tromosistein
dkqn menyebqbkon dorohiiiperhomosiseinemiot
kerusokon dindino nimbrirr,
odhesi plotetet (Reeder eto/. 20001 -sementoro o_ot vo"g ;"io;i,iirl oi"unXi,iru o"nrnro"r,
p"nOopor
i"n"iiriioi,in-r'o'"r""n,i"orrfon
hiperhomosisieinemio
dopor memocu oedumbuho; set_s;t oi; 'ltr."r,
Oot,*o

menimbutkon ;;;ur.t orrerio skterosis eiot.l99zt.

iilL p.o".tt n"v"
lGubq reoritoin menffioil"o|"'ilii'i"#on'o.,r,"in",nto
mengoktilkon koskode
kooqutosidon denqon g;ro,nUor, oOonvo t"rJrJi"o" O'"iif,n
moko okon teriodiorlerio
sklerosis lcub;e, ol, 19971. o",nOrf"r, aor.t
pengobctqn
3. hherhomosisleinemio pcdo penyokil kordiwoskulor
f:i'Jil;,T:::'ij"":i*::i:jlllhomosist"in
dengon risiko -t - -'
'''""'t"rvuP
croup'dioniurkonururrlulKon
bohwooonwo
podo
penderilo
tinggi, kodor ::l:1':1dvjsory
di l0 pmol/L
1999)19991. Ado 2 ketomnnr. .,",r^ r,^^^, ,l.l1lo^hokon .selolu -bqwoh
urnor/L lMolrnow
lMolinow elet ol,

mereko
'iikior
? kelompok risiko d

voskulqrvoskutqr don
tinqqivono-^^^

vongvurrq menqenlomenoeriro penyoiiipenyokil

belumbetum diketohuir,ikpr6h'ii;L;^. ;.,JT:i1"*':Lryiru:.ll) 'c^u
yong
menderitoo penyokii oenvokii voskulorvoskrrlnr rRoraar ,oootonYo
isil t""o {2) mereko memiiiki riwoyot keluorlo
lBerger, l99Bl.
Obotyong dipokoiunluk yong meningkol
menurunkon kodorhomosislein lersebulodoloh osom
totol, viromin,86
don viromin Bt2 t'erger.rcsot. asom foroiad;ui,;;;
proses
remetirisosi. ;?;;;i:;""tuk memocu
sedonqkon vi'omin
sislolhionin 86 dituiukon nu;ruk ;";;;;i;;ff;;;; dori
b-sinlose {lihol gombor lompironl "nzimorik

PerlemLron
llmioh Iohunof tlmlr penyokilDotom 2oo2
t3
l-

Podo penderjto dengon osom foiot

hiperhomosisleinemio telopi lidok qdo derisiensi vitomjn, pember0l
1,2 mg soio selomo
6 minaqu dopot menurunion hipernomosi.i"i""rio +o Soy" fsoW
t99B). obot gobungon yong mompvu
dipokqiodoloh 2.5 mg osomfotot. z5 mg Bo J*i,ig'Biiyongaionggp
menurunkon hiperhomosislejnemio yong
seloniutnyo morn-pu m"nc"gJ;ki;oOlon penyott

4. PengEunoon osom toldt podo penderitq gogol giniol terminol

Bqnyok penelili yonq mencobo
menurunkon hiperhomosjsleinemio podo gogol ginioltermin0 honyo dengon,memokoi osom fotor Telopi
ontoro osom foloi, vilqmin
soio^Di
peneliti
doto..pungoln;to;
yonq loin menemukon
p;;J,[iu'i)irJi orrot gooungo, 86 don vitomin Bt2 dirosokon Jopot menurunion-niJJrn'ororu,"in.r,
menggunokon
tqndo,tondo r efrokter Oleh seLoL ,,, L"O",5io p"n"fiti.*.lo osom folql dosis besor unluk menurunkon
hjperhomosrsLrneriL.pooo penderiro gogol giniol terminol
Beberopo penelit,on Uniled Slotes
Vonq dilot,ukon dtConodo NewZeolond don
2000. sunder
ptossrnonn
p/
tBoslorr ei0I
2000.
ol Trernbtoy eroi. 2000t mJ;il;;"-k;#;;i.n rrenurunton
hiperhomosis'ernemropodo or"oir,'
pendenro gogot binr"r o""g;n ,;;kij ioiii oori. tinggiloo
,,,Fopurru#li:::,rl]11fl.,:":,i,Sl:"i:9:l 9"091
men,
opo, n-orgo ;,;"r ;;k;;;o"
Oende to hemodlolisis yong
pere,jri yo.s
oonwo Dooo penatttron drkerlokon 5e(oro /ondom?ed
double blnd monymoulr on
bohwo hdol odo OoOonyo .enqjun;kln orim''rotl'cfos,.
mg dibonding -- " Oeso, S-zO
dengon dosis 1mg untuk menurunton niperfio"mo.ift"l";; j;
Ringkqson/Kesimpulon
Teloh merupokon soloh sotu foklor dori keiodion
disepokoti bohwo hiperhomosisleinemjq
penyol.il podo
l.ordiovostuJor
keodoon hiperhomosisterfemro
penderiro
gogot ginlot ringon iomloi!;gof g;t"f ,lrii""r OiO"p",k*
Denoon menuruntonieodoon hipieiior-o.ili"inurnio ainoropt*
dopor ma"uJ unl on lo;odion penyofu ilordiovo<l urol
Penggunoon osont folol secoro sendiri
oloupun secoro bersomo dengon vtlomin 86 don Bl2
diloporkon mompu
diperlukon
menurunkon keodoon hrperlomosisteinemio peig;;n"o";n
;r1rrl iofot .ongoi
didolom usoho pengendotion hipe,nornoss"inu.io poOo g,ni"t
sompoi gogol ginictl berol JJ"j",i" i"gof ,irg,

Kepustokoon
Berger, P fl99B). Homocysteine ond
coronory orlery diseose. Amerco n Coltege of Cardiotogy. l3l2l,

Boslom, A & Cullelon, B. {1999). Hyperhomocysleinemio Jounal of

in chronic renol fqiJure: Djseose ot the monlh
the Americon Society of Nephrolaqy, 10, B9j,89g
u"ttRT:
j;.^tn"Il:13."t:91%l lo.,.v,,,2, zonob[ A., chrisrophe, K. spiesel. p, rocques, p,
?^ry:,|:*:i !:,lyo. I (2000). conlroled comporison of L s "[Llr"lro"[v".il.oii,r"i"";;fi:]ri; ocid for the treotment of hyperhomocysteinemio in
r,".oaioiyiil'po-ir:;;;'r-;i;;i;;7"i;iill,
2829 2832
Boushey, C., Beresford, S..
Omenn, c. & Molulsky. A. (1995). A quonrilotjve ossessmenl of plosmo
homocysleine os risk
o foctor for vosculor diseose proboble benefils of increosing folic qcid JAMA.
27409.1049 1057
Consensus Development Conference ponel. , onsorsrs,
11994) MorL .Jily ond mortolily of renol diolysis: An N H
pnr
onle erro \totpn A4nols ol /n tet nol Medrne 12llll L;.7;
Crowford, F, Rosenthol, A, Speors, Oo',enrsby
C & Tqbori. H {2001j Normolizofion olhomocysteine in djolysis
dite,'odep'.t,on plot1loliot1.
wlh oDoor^rl r^duclion ot o.Lpss f","afr"." Dot)sts E hot1,. 301& 512 521

PerlemLron penvok
lm oh Tohunon I m! I Dotom 200,
 (1999).
Dierkes, J., Domrose, U., Ambrosch, A., Bosselmonn, H., Neumonn, K. & tuley, C. Response of
hyperhomocysleinemio lo folic ocid supplemenlolion in polienls with end sloge renol diseose.
Clinicol Nephrology, 51(21, 108-ll5.
Gubo,5., Fink, L. & tonsecq, V {19971. Hyperhomocysteinemio. An emerging ond imporlont risk
foclor for lhromboembolic ond co[diovosculot diseose. Americon Jounol of Clinical Palhology,
t06161,709-722.

goslom,
Molinow R., A. & Krouss, R. {1999}. Homocysteine, diet, ond cordiovosculor diseoseiA slole-
menl for heqlth core professionols from lhe nutrition committee, Americqn Heorl Associolion.
(l
arculolion. 9 9 ). 17 8-182.
Monns, 8., Hyndmon, E., Burgess, E., Porsons, H., Schoeffer,1., Snyder, F. & Scott-Douglqs, N. 12001).
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Kidney lnternotionol, 59, ll03ll09.
(20001.
Reeder, s., Hoffmon, R.. Mogdic, K. & Rodgers, J. Homocysteiner The lotesl risk foctor for
heorl diseose. D,;?lersions ol Ctilicol Core, l9lll,22-28.
qdery
Robinson, K., Moyer, E. & Jocobsen, D. {19941. Homocysleine ond coronory diseqse. C/eve,ond
Clinic Journol of Medicine. 6116l. 438-450-
(2002).
Snovely, J. Hyperhomocysleinemio inend sloge renoldiseose: lstreolmenl necessory?. Neph-
tology Nursing Journol, 29121. 155-161.

SundeFPlossmqnn, G., Fodinger, M., Buchmoyer, H., Popogionnopoulos, M., Woicik, J., Klelzmoyr, J.,
Enzenberger, 8., Jqnolo, O., Winkelmqyer, W., Poul, G., Auinger, M., Bornos, U. & Horl, W 120001.
Effecl ol high dose folic ocid lheropy on hyperhomocysteinemiq in hemodiolysis pqiienis: Re-
sulls ofthe Vienno mullicenler study. Journol oflhe Ame can Sociely of Nephrclog\ 1l(61,1106-
lll6.
qrtherosclerolic
ToyloFchinn, M. (2000). Homocysleine ond heort diseose. Clinicion Review
lo{bl, 45.57.
Trembloy, R., Bonnordeoux, A., Geodoh, D., Busque, l-., l-ebrun, M., Quimel, D. & LeBlonc, M. {2000).
Hyperhomocysteinemio in hemodiolysis potients: Effecls of l2monlh supplemenlotion wiih
hydrosoluble viiomins. Kdney lnlernalional, 58. 851-858.

Perlemuon llmioh lohunon lmu Penyokll Dolom 2002 15