[Riyanto* et al.

, 7(4): April, 2020] ISSN: 2349-5197

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COMPARISON OF GAMMA GLUTAMYL TRANSFERASE SERUM LEVELS IN
PATIENTS WITH 5D CHRONIC KIDNEY DISEASES WITH STADIUM 3 AND 4
CHRONIC KIDNEY DISEASE
Bambang Toto Riyanto*1, Burhanuddin Nasution1, Syafrizal Nasution2 & Nindia Sugih Arto1
1
Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan
2
Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan

DOI:
Keywords: CKD 5D, CKD st 3-4, GGT.

Abstract
Background:
Chronic Kidney Disease (CKD) is a global public health problem with increased prevalence and incidence of
kidney failure, poor prognosis and high costs. Therefore the aim of this study is to look at the characteristics of
patients with CKD and the comparison of serum GGT levels in patients with chronic 5D kidney diseasewith
patients with chronic kidney disease St 3 - 4. So they can find out the mortality rate of patients with CKD 5D
with CKD st 3-4.
Method:
This study used a cross sectional data collection method to assess serum GGT levels in patients with 5D chronic
renal failure and stage 3 - 4. chronic kidney disease as many as 49 samples for patients with stage 5D chronic
kidney disease and patients with stage 3 and 4 chronic kidney disease
Results:
In this study the characteristics of CKD patients by sex were obtained by men as many as 55 people (56.1%),
and female sex as many as 43 people (43.9%). From this study, the age of the youngest CKD patient was 26
years and the oldest age was 74 years. In this study also found the cause of CKD was hipertensi as many as 53
patients (54.1%), diabetes militus as many as 43 patients (43.9%), and nephrolithiasis as many as 2 patients
(2.0%). And also obtained the results of a significant difference between the GGT levels of 5D CKD patients
and CKD st 3-4 patients (p = <0.001).
Conclusion:
Characteristics of CKD patients based on sex obtained by men more than women. From this study also obtained
the youngest age of CKD patients is 26 years and the oldest age is 74 years.
There is a significant difference between the GGT levels of patients with CKD 5D and CKD st 3-4.

Introduction
Chronic Kidney Disease (CKD) is a condition in which there is a decrease in kidney function due to chronic and
irreversible damage to the renal parenchyma. Someone is diagnosed with chronic kidney disease if there is an
abnormality and damage to the kidneys for 3 months or more which is characterized by a decrease in kidney
function by 78-85% or the glomerular filtration rate (LFG) of less than 60 ml / min / 1.73m2 with or without
abnormalities in the kidneys. CKD is one of non-communicable disease that needs attention because it is public
health problem with the incidence rate is quite high dan have big effect for morbidity, mortality dan the
economic public because maintenance cost are quite high.9,12

Gamma – Glutamyl Transferase (GGT) is one of enzym on serum, that works in the first line proces degradation
ekstraselular glutathione (GSH).Glutathione is the main antioxidant mammalian cells that play an importan role
in the protecting cell from the oxidant. If stres oxidatif increased, glutathione need also increased; If glutathione
level low, than the damage due to stress oxidative will be increased.16,22

Because of that, the GGT estimated to have an important role in some of kind tissue or the organ. Example, the
kidney, if the kidney damage occurs so the GGT play a role in the process reactive oxygen species (ROS)
especially superoxideanions that nitric oxide will decrease and than the renal blood flow and filtration
glomerulus rate will be low.16,24

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From this concept, so we do the research about content ratio GGT patien CKD 5D with the patien CKD st 3-4.
Our result research contribution with the prognostic streght level for the result in the patien hemodialisa. (Park
et al,2015). GGT play the role relevant on the prediction risk mortality on the end stage renal disease, with the
level GGT leaning to the right with median value 20 UI / L.16,22

Methods
This study is an observational cross sectional study which performed at Haji Adam Malik General Hospital
Medan with permission from Research Ethics Committee of the Faculty of Medicine, Universitas Sumatera
Utara-RSHAM. Subjects were recruited from April to Juny 2019 consecutively. The inclusion criteria were
patients who were clinically confirmed age >18 years old, patient with history CKD level 5D and CKD level 3,
and patient who were willing to take part in this research.

Study Procedure
The population who occupy criteria will be includedin the research, before that we do the inform consent for the
research. The ingredients used in this research is blood serum from mediana vein cubiti. For GGT test, the
serum must keep in the temperature 2-80C, the sample maximum keep in 7 days dan the temperature -20°C
sample stable only 1 years. The GGT test will be do with enzymatic metode colorimetric test.

Statistical analysis
Categorical variables are presented by number or frequency (n) and percentage (%). Numerical variables are
represented by mean and standard deviation for normally distributed data, if data not normally distributed, the
data shown by median. Compare the level GGT we used the T test unpaired when the data normal contribution.
If the data not normality contribution, used Mann Whithney Test. All the data were analyzed using computer
statistic software, the p value <0.05 was said to be statistically significant.

Results
In this research the characteristic patiens from the gender male 55 people (56.1%), and from the female 43
people (43.9%). From this research we get the younger age 26 years old and the oldest 74 years old. From this
research the causes of CKD is Hypertension 53 patients (54.1%), diabetes militus 43 patients (43.9%), and
nefrolitiasis 2 patients (2,0%).

Table 4.1 Characteristics of CKD Patients

Variable N Percentage (%) Median (Min-Max)

Genders

Male 55 56.1

Female 43 43.9

Age 55.00 (26.00 - 74.00)

20 – 29 3 3.1

30 – 39 11 11.2

40 – 49 23 23.5

50 – 59 31 31.6

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60 – 69 25 25.5

Etiology

DM 43 43.9

HT 53 54.1

Nefrolitiasis 2 2.0

From the measurement result obtained average result level ureum from all the patients research is 75.90 mg/dL
with standard deviation 46.00 and the result median mean 77 mg/dL with the lowest level ureum 15 mg/dL and
the highest level ureum 197 mg/dL. The average creatinine from all the patients research is 3.94 mg/dL with
standard deviation 1.28 and the result median mean 3.77 mg/dL with the lowest level creatinine 1.24 mg/dL and
the highest level creatinine7.40 mg/dL.

Table 4.2 Measurement Data Ureum and Creatinine from all the patient PGK
Variabel Mean ± SD Median (Min - Max)

ureum (mg/dL) 75.90 ± 46.00 77.00 (15.00 - 197.00)

Creatinine
(mg/dL) 3.94 ± 1.28 3.77 (1.24 - 7.40)

Measurement data by the tool average GGT from all the patiens research is 301.08 U/L with standard deviation
105.47 and median rate 314.00 U/L with the lowest GGT 130.00 U/L and the highest GGT 449.00 mg/dL.

Table 4.3 Measurement Data GGT from all the patient PGK
Variable Median (Min - Max)

GGT (U/L) 314.00 (130.00 - 449.00)

Using the Mann Whitney test to assess the comparison between the levels of ureum and creatinine in patients
with CKD 5D patients with patients with CKD St. 3-4 obtained p = <0.001.This shows that there is a significant
difference between the levels of ureum and creatinine in patients with CKD 5D and patients with CKD St 3-4.

Table 4.4 Comparison of urea and creatinine levels in 5D CKD patients with CKD St 3-4 patients
Variable Mean ± SD Median(Min-Max) p Value
Ureum (mg/dL) PGK st 3-4 114.63 ± 30.47 102.00 (54.00-197.00)
Ureum (mg/dl) PGK 5D 37.18 ± 30.47 32.00 (15.00-79.00)
0.000
Kreatinin (mg/dl) st 3-4 3.41 ± 0.79 3,42 (2.13-4.91)
Kreatinin (mg/dl) 5D 4.48 ± 1.46 4.60 (1.24-7.40)
*Mann Whitney test

Using the Mann Whitney test to assess the comparison between the GGT levels of CKD 5D patients and CKD
patients st - 3-4 obtained p value = <0.001.This shows that there is a significant difference between the GGT
levels of 5D CKD patients and STK 3-4 patients.

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Table 4.5 Comparison of GGT levels of 5D CKD patients with STK 3-4 patients

Kategori CKD  

Variable PGK stage 3-4 PGK 5D P Value

Median(Min-Max) Media(Min-Max)  

GGT levels Serum (U/L) 211,89(130,00-354,00) 399,00(215,00-449,00) <0.001*

*Mann Whitney test

Figure 4.2 Comparison of GGT levels of 5D CKD patients with CKD st 3-4 patients

Discussion
Oxidative stress (OS), defined as a disturbance in the pro / antioxidant balance, is dangerous for cells due to
excessive generation of reactive oxygen species (ROS) and nitrogen (RNS). When balance is not disturbed, OS
has a role in physiological adaptation and signal transduction. However, excessive amounts of ROS and RNS
cause oxidation of biological molecules such as lipids, proteins, and DNA. Oxidative stress has been reported in
kidney disease, due to antioxidant depletion and increased ROS production. Kidney is a very metabolic organ,
rich in oxidation reactions in the mitochondria, which makes it vulnerable to damage caused by OS, and several
studies have shown that OS can accelerate the development of kidney disease. Also, in patients at an advanced
stage of chronic kidney disease (CKD), increased OS is associated with complications such as hypertension,
atherosclerosis, inflammation, and anemia.7,23

The primary role of cellular glutamyltransferase (GGT) is to metabolize extracellular reduced glutathione
(GSH), allowing precursor amino acids to be assimilated and reused for intracellular GSH synthesis. Recent
experimental studies have shown that cellular GGT can also be involved in the generation of reactive oxygen
species (ROS) in the presence of iron or other transition metals. Although the relationship between cellular GGT
and serum GGT is unknown and serum GGT activity has been commonly used as a marker for excessive
alcohol consumption or liver disease, our epidemiological study series consistently shows that serum GGT in its
normal range may be the initial and sensitive enzymes associated with stress oxidative. Increased serum GGT
within the normal range of laboratory values may be an early and sensitive marker for oxidative stress. Serum

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GGT may be useful in studying oxidative stress-related problems in both epidemiological and clinical
settings.8,24

This study is a cross sectional study that aims to determine the comparison of GGT levels between with CKD
5D patients with patients with CKD st. 3-4. In this study the characteristics of CKD patients by sex were
obtained by men as many as 55 people (56.1%), and female sex as many as 43 people (43.9%). From this study,
the age of the youngest CKD patient was 26 years and the oldest age was 74 years. In this study also found the
cause of CKD was HT as many as 53 patients (54.1%), DM as many as 43 patients (43.9%), and nephrolithiasis
as many as 2 patients (2.0%).

In this study, the characteristics of CKD patients consist of 55 male (56,1%) and 43 female (56,1%). From this
study, the age of the youngest CKD patient was 26 years old and the oldest age was 74 years. This study also
found that CKD patients caused by hypertension, DM, and nephrolithiasis were 53 patients (54.1%), 43 patients
(43.9%), and 2 patients (2.0%) consecutively.

Research by Tanvir Chowdhury Turin et al., In 2012 found that gender differences in CKD development studies
have been reported, with higher development rates for men. The results of Riskesdas 2013 also showed that the
prevalence increased with age, with a sharp increase in the age group of 35-44 years compared to the age group
of 25-34 years and the prevalence in men (0.3%) was higher than women (0.2%). Research by J.F Souza et al.,
2008 found no significant differences were observed between groups regarding gender, namely 50.6% were
women and 49.4% were men. In 2017, the etiological proportion or basic disease of 5 D CKD patients is
hypertension, which ranks first 36% and diabetic nephropathy, known as diabetic kidney disease, is 29%, while
nephrolithiasis ranks sixth from other causes of CKD, which is equal to 4% of Reports from IRR.

In this study the results of a significant difference between the GGT levels of 5D CKD patients and STK 3-4
patients. This is supported by a retrospective study on observations in groups of patients with CKD stage 4-5
pre-dialysis high and abnormal GGT levels are Frequent findings in patients with CKD. 27 In CKD patients who
undergo hemodialysis tend to have higher levels of GGT, this is consistent with research conducted by J.F.
Souza et al., 2008, where patients with CKD undergoing dialysis the mean value of GGT was 3 or 4 times above
the reference limit. Likewise, other studies which state that serum GGT is significantly increased in CKD
patients undergoing hemodialysis.28

Conclusion
Characteristics of CKD patients based on sex obtained by males more than females. From this study also
obtained the youngest age of CKD patients is 26 years and the oldest age is 74 years. There is a significant
difference between GGT levels in patients with CKD 5D and CKD st. 3-4.

Suggestion
Further research needs to be done by calculating other variables that can also play a role in the increase in GGT
in CKD. Longitudinal studies need to be done to see the relationship of GGT levels with mortality rates in CKD
patients.

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