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"Kepatuhan manajemen terapi hemodialisis berpengaruh terhadap kejadian komplikasi yang mungkin dapat muncul, kualitas hidup dan angka mortalitas pada pasien. Salah satu faktor yang berpengaruh terhadap tingkat kepatuhan tersebut adalah persepsi penyakit. Tujuan penelitian ini adalah untuk mengetahui hubungan antara persepsi penyakit dengan kepatuhan manajemen terapi hemodialisis pada pasien penyakit ginjal kronik. Desain penelitian yang digunakan adalah analitik korelatif dengan jumlah sampel 103 responden yang dipilih berdasarkan teknik purposive sampling pada pasien hemodialisis. Data dikumpulkan melalui Brief Illness Perception Questionnaire B-IPQ untuk persepsi penyakit dan modifikasi End-Stage Renal Disease Adherence Questionnaire ESRD-AQ untuk kepatuhan manajemen terapi hemodialisis. Data tersebut diolah dengan menggunakan SPSS versi 23. Hasil penelitian ini menunjukkan ada hubungan antara persepsi penyakit dengan kepatuhan manajemen terapi hemodialisis r= -0.244; p value= 0.007 . Akan tetapi, jika ditinjau per-dimensi maka hanya kontrol personal r= 0.329; p value= 0.000 dan respon emosi r= -0.292; p value= 0.001 yang berhubungan dengan kepatuhan manajemen terapi hemodialisis. Dengan sebab itu, tenaga kesehatan perlu memperhatikan persepsi penyakit pada pasien untuk meningkatkan kepatuhan manajemen terapi hemodialisis pada pasien.

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The adherence of hemodialysis therapy management influenced occurence rate of complication that might be appear, quality of life, and mortality rate in patient. One of the factors that affect adherence of hemodialysis therapy management is illness perception. This research aimed to identify the relation between illness perception and adherence of hemodialysis therapy management in patient with chronic kidney disease. Correlation analytic with purposive sampling technique was used for this research with 103 patients in hemodialysis as a sample. Data were collected by Brief Illness Perception Questionnaire B IPQ for illness perception and End Stage Renal Disease Adherence Questionnaire ESRD AQ for adherence of management hemodialysis therapy. Data were analyzed by SPSS ver. 23. Result shows that illness perception affect adherence to therapy management r 0.244 p value 0.007 . Yet, only control personal r 0.329 p value 0.000 and emotional response r 0.292 p value 0.001 that influence adherence to therapy management. Therefore, it is recommend to assess patient view of their illness to increase adherence rate to hemodialysis."

"Pasien gagal ginjal kornik (GGK) membutuhkan penatalaksaan berupa pengaturan diet, masukan kalori suplemen dan vitamin, obat-obatan, pembatasan asupan cairan dan terapi pengganti ginjal. Hemodialisis merupakan salah satu terapi pengganti ginjal. Komplikasi pada hemodialisis seringkali terjadi karena masalah kepatuhan diet. Penerimaan penyakit dan dukungan sosial dapat berhubungan dengan kepatuhan diet. Tujuan penelitian ini yaitu mengetahui hubungan penerimaan penyakit dan dukungan sosial dengan kepatuhan diet pada pasien GGK yang menjalani hemodialisis. Penelitian ini menggunakan desain cross sectional dengan consecutive sampling pada 106 responden. Pengumpulan data dengan kuesioner acceptance of illness, kusioner dukungan sosial dan kuesioner kepatuhan diet. Analisis yang digunakan yaitu uji Chi-Square dan regresi logistik berganda. Hasil penelitian didapatkan responden yang patuh terhadap kepatuhan diet sebanyak 78.3%, dukungan sosial tinggi sebanyak 61.3% dan penerimaan penyakit tinggi 40.6%. Hasil analisis didapatkan adanya hubungan yang signifikan antara penerimaan penyakit dengan kepatuhan diet (p=0.005), terdapat hubungan yang signifikan antara dukungan sosial dengan kepatuhan diet (p=0.026). Selanjutnya pada analisis multivariat variabel yang paling dominan mempengaruhi kepatuhan diet adalah lama menjalani hemodialisis (p=0.032) setelah dikontrol variabel jenis kelamin, tingkat pendidikan pekerjaan, lama menjalani hemodialisis, sosial ekonomi, penerimaan penyakit, dan dukungan sosial serta mampu memprediksi sebesar 8% terhadap kepatuhan diet. Rekomendasi penelitian ini adalah perawat perlu mengidentifikasi serta melakukan upaya meningkatkan penerimaan penyakit dan dukungan sosial pada pasien untuk meningkatkan kepatuhan diet.

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Patients with chronic kidney disease (CKD) require management in the form of diet regulation, calorie intake, supplements and vitamins, medication, limiting fluid intake and kidney replacement therapy. Hemodialysis is a type of kidney replacement therapy. Complications in hemodialysis often occur due to dietary compliance problems. Disease acceptance and social support may be associated with dietary compliance. This research aims to determine the relationship between acceptance of illness and social support with dietary compliance in CKD patients undergoing hemodialysis. This study used a cross-sectional design with consecutive sampling of 106 respondents. Data were collected using an acceptance of illness questionnaire, social support questionnaire and diet compliance questionnaire. The analysis used is the Chi-Square test and logistic regression. The research results showed that 78.3% of respondents were compliant with diet, 61.3% had high social support and 40.6% had high disease acceptance. The results of the analysis showed that there was a significant relationship between acceptance of illness and diet compliance (p=0.005), and there was a significant relationship between social support and diet compliance (p=0.026). Furthermore, in the multivariate analysis, the variable that most dominantly influenced diet compliance was the length of time undergoing hemodialysis (p=0.032) after controlling for the variables gender, occupational education level, length of time undergoing hemodialysis, socio-economics, disease acceptance, and social support and was able to predict 8% of dietary compliance. This research recommends that nurses need to identify and make efforts to increase disease acceptance and social support for patients to increase dietary compliance."

"Kepatuhan manajemen terapi hemodialisis terdiri dari empat aspek yaitu program hemodialisis, medikasi, pembatasan cairan, dan diet. Salah satu faktor penting dalam kepatuhan manajemen terapi hemodialisis adalah kualitas antara petugas kesehatan dengan pasien. Perawat merupakan petugas kesehatan yang sering bertatap muka dengan pasien sehingga memiliki peranan dalam meningkatkan kepatuhan. Tujuan penelitian adalah mengidentifikasi hubungan antara sikap caring perawat dan karakteristik responden. Jumlah responden penelitian ini sebanyak 97 orang pasien hemodialisis dengan desain penelitian cross sectional, yang didapat dengan purposive sampling. Hasil penelitian menggunakan uji Chi-Square menunjukkan bahwa tidak terdapat hubungan antara sikap caring perawat dengan kepatuhan manajemen terapi hemodialisis pada pasien gagal ginjal terminal dengan P value 0,418 >0,05 , namun ditemukan adanya hubungan pada variabel karakteristik responden yaitu dukungan keluarga dengan nilai P value 0,033.

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The adherence of hemodialysis therapy management consists of four aspects, they are hemodialysis program, medication, fluid restriction, and diet. One of important factor in adherence to hemodialysis therapy management is the quality between health care providers and patients. Nurses are health workers who often face to face with patients so that they have a role in improving compliance. The purpose of this study was to identify the association between caring nurse behavior and respondent characteristics. The number of respondents of this study were 97 hemodialysis patients with cross sectional study design, obtained with purposive sampling. The result of Chi Square test shows that there was no correlation between caring nurse attitude with hemodialysis therapy management adherence in end stage renal disease patients with p value 0,418 0,05, and found correlation to characteristic variable of respondent, that was family support with p value 0,033."

"ABSTRAKPenyakit ginjal kronik PGK merupakan penyakit kronik progresif yang mengakibatkan penurunan fungsi ginjal dan bersifat irreversible. Pasien PGK stadium akhir membutuhkan terapi pengganti ginjal untuk memertahankan tubuh dari toksisitas uremia. Prosedur dialisis bersifat katabolik, sehingga pasien yang menjalani hemodialisis HD mengalami peningkatan kebutuhan energi dan protein yang penting untuk mencegah terjadinya protein-energy wasting PEW . Empat orang pasien dalam serial kasus ini mengalami PGK stadium akhir dan telah menjalani hemodialisis dengan rentang waktu yang berbeda, 2 orang dalam rawat inap dan dua orang lainnya rawat jalan. Pasien didiagnosis dengan PGK stadium 5 dengan HD, hipertensi, diabetes melitus, dan ensefalopati uremikum. Walaupun saat pemeriksaan status gizi pasien normoweight dan satu orang mengalami malnutrisi ringan, seluruh pasien memiliki riwayat asupan protein 10 dalam 6 bulan, sehingga dibutuhkan terapi medik gizi yang mencakup penentuan kebutuhan makro dan mikronutrien, nutrien spesifik, sesuai dengan toleransi dan kondisi klinis pasien. Hasil pemantauan menunjukkan pasien mengalami perbaikan klinis, toleransi asupan dan kapasitas fungsional serta kualitas hidup pasien dapat dipertahankan. Terapi medik gizi berperan penting pada semua pasien PGK yang menjalani HD dengan mencegah PEW, memperbaiki kondisi klinis, serta meningkatkan kapasitas fungsional pasien.Kata kunci: terapi medik gizi, penyakit ginjal kronik, hemodialisis, hipertensi.

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ABSTRACT

Chronic kidney disease is a irreversible progressive chronic process that causes worsening renal function. Patients with end stage renal disease needs renal replacement therapy to protect themselves from uremia toxicity. Patients who have to undergo dialysis are in high catabolism state and has an increased energy and protein expenditure. Adequate energy and protein for these patients are needed to prevent protein energy wasting PEW . Four cases from this serial case has ESRD and has been on hemodialysis with different time frames. Two outpatient and two inward patients who have CKD stage V with hypertension, diabetes mellitus, and uremic encephalopathy. Although only one patient I categorized as mildly malnourished, 3 of four patients experienced weigth loss 10 in 6 months. Thus, medical nutritional therapy is needed to determine energy and protein requirements in these patients. Evaluation and monitoring form these cases shows that all patients have better clinical outcome, better nutrition intake, and functional capacity were preserved. Medical nutrition therapy has an important role in all CKD patients with dialysis to prevent PEW, to improve their clinical outcome and to increasetheir functional capacity. Key words medical nutrition therapy, chronic kidney disease, hemodialysis, hipertension."

"Pasien gagal ginjal terminal memiliki kualitas hidup cenderung rendah. Diperlukan kepatuhan terhadap rekomendasi diet serta mampu meredakan emosi negatif sebagai tanda penerimaan terhadap penyakit pada pasien gagal ginjal terminal. Penelitian ini bertujuan untuk mengetahui hubungan kepatuhan diet dan penerimaan penyakit dengan kualitas hidup pasien gagal ginjal terminal yang menjalani hemodialisis. Penelitian ini menggunakan pendekatan potong lintang, melibatkan 114 pasien gagal ginjal terminal yang dipilih dengan teknik non-random consecutive sampling. Data kepatuhan diet diperoleh menggunakan Renal Adherence Behaviour Questionnaire, data penerimaan penyakit diperoleh menggunakan kuesioner Acceptance of Illness dan WHOQoL-BREF untuk mendapatkan data kualitas hidup. Analisa data menggunakan Pearson Correlation menunjukkan terdapat hubungan berpola positif dengan kekuatan sedang antara kepatuhan diet dengan kualitas hidup p value.

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Patients with end stage renal disease have a low quality of life. Required adherence to dietary recommendation and able to alleviate negative emotions as a sign acceptance of illness in patients with end stage renal disease. This study aims to determine the relationship between dietary adherence and acceptance of illness with quality of life of end stage renal failure patients undergoing hemodialysis. This study used cross sectional approach involving 114 ESRD patients selected using non random consecutive sampling technique. Dietary compliance data were obtained using Renal Adherence Behavior Questionnaire RABQ , acceptance of disease was obtained using the Acceptance of Illness Questionnaire AoI , and the WHO Quality of Life BREF to get quality of life data. The data were analyzed using Pearson correlation and showed significant moderate association between diet adherence and quality of life p value."

"[ABSTRAKPasien penyakit ginjal kronik derajat 5 mengalami suatu keadaan di mana ginjal sama sekali tidak dapat mempertahankan homeostasis metabolisme tubuh sehingga membutuhkan terapi pengganti ginjal. Terapi pengganti ginjal yang paling sering dipilih oleh pasien PGK derajat 5 adalah hemodialisis. Perubahan metabolik pada PGK derajat 5 dengan hemodialisis dapat disebabkan oleh gangguan fungsi ginjal dan proses hemodialisis. Perubahan metabolik tersebut antara lain gangguan keseimbangan cairan, dan asam basa serta gangguanmetabolisme protein, karbohidrat, dan lemak. Dibutuhkan terapi terintegrasi pada pasien PGK yang terdiri atas terapi farmakologi, terapi pengganti ginjal, terapi nutrisi dan dukungan psikologis. Peran nutrisi dalam menurunkan komplikasi dan meningkatkan kualitas hidup sangat penting dalam tatalaksana pasien PGK. Pemberian nutrisi pada pasien PGK dengan hemodialisis bertujuan untuk mengatasi gejala akibat gangguan ginjal dan mencegah komplikasi akibat progresivitas kerusakan ginjal. Pemberian nutrisi yang tepat dapat dilakukan dengan memahami patofisiologi yang terjadi pada pasien PGK dan proseshemodialisis yang dipilih sebagai terapi pengganti ginjal. Berdasarkan hal tersebut, dilaporkan empat serial kasus pada pasien PGK derajat 5 dengan hemodialisis rutin. Diberikan terapi nutrisi sesuai panduan yaitu energi 30-35 kkal per kg berat badan, protein 1,2 g per kg berat badan, lemak 25-30% energi total, dan karbohidrat 60-65% energi total. Diketahui bahwa penyebab asupan tidak terpenuhi adalah keadaan klinis yaitu sesak, penurunan kesadaran, dan gangguan saluran cerna yaitu mual dan muntah.

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ABSTRACTStage 5 of chronic kidney disease represents total inability of kidneys to maintain body homeostasis normally. At this stage, it is necessary to use methods that substitute kidney function such as hemodialysis, peritoneal dialysis, or kidney transplantation. The most used method is hemodialysis. Metabolic changes in stage 5 of chronic kidney disease can be caused by kidney disease itself and also hemodialysis treatment. Metabolic complications of chronic kidney disease and hemodialysis include changes in acid-base balance and metabolism of proteins,carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complication and to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are to overcome the symtoms and to prevent the complication that caused by kidney disease. Nutrition therapy can be done properly by understand the pathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney disease with hemodialysis are reported here. The nutrition which is given consist of energy 30-35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid 25-30 % total energy, and carbohydrate 60-65 % total energy. There is inadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit. Stage 5 of chronic kidney disease represents total inability of kidneys to maintain body homeostasis normally. At this stage, it is necessary to use methods thatsubstitute kidney function such as hemodialysis, peritoneal dialysis, or kidney transplantation. The most used method is hemodialysis. Metabolic changes in stage 5 of chronic kidney disease can be caused by kidney disease itself and also hemodialysis treatment. Metabolic complications of chronic kidney disease and hemodialysis include changes in acid-base balance and metabolism of proteins, carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complication and to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are to overcome the symtoms and to prevent the complication that caused by kidney disease. Nutrition therapy can be done properly by understand the pathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney disease with hemodialysis are reported here. The nutrition which is given consist of energy 30-35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid 25-30 % total energy, and carbohydrate 60-65 % total energy. There is inadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit., Stage 5 of chronic kidney disease represents total inability of kidneys to maintainbody homeostasis normally. At this stage, it is necessary to use methods thatsubstitute kidney function such as hemodialysis, peritoneal dialysis, or kidneytransplantation. The most used method is hemodialysis. Metabolic changes instage 5 of chronic kidney disease can be caused by kidney disease itself and alsohemodialysis treatment. Metabolic complications of chronic kidney disease andhemodialysis include changes in acid-base balance and metabolism of proteins,carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complicationand to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are toovercome the symtoms and to prevent the complication that caused by kidneydisease. Nutrition therapy can be done properly by understand thepathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney diseasewith hemodialysis are reported here. The nutrition which is given consist ofenergy 30–35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid25–30 % total energy, and carbohydrate 60–65 % total energy. There isinadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit.]"

"Latar Belakang: Variabilitas hemoglobin (var-Hb) merupakan suatu fenomena fluktuasi kadar Hb dalam satuan waktu tertentu yang dialami oleh pasien penyakit ginjal kronikyang menjalani hemodialisis rutin (PGK-HD).Var-Hb telah diketahui sebagai prediktor independen luaran klinis buruk. Namun,faktor-faktor yang mempengaruhinya belum banyak diketahui. Tujuan: Mengetahui besaran proporsi var-Hb pada pasien PGK-HD di Indonesia dan faktor-faktor yang mempengaruhinya. Metode: Penelitian ini merupakan studi kohort prospektif yang melibatkan pasien GGK-HD berusia ≥18 tahun di Unit Hemodialisis RSCM. Faktor-faktor yang dinilai saat awal ialah kadar Hb, reticulocyte-hemoglobin equivalent(RET-He), albumin, fosfatase alkali, dan C-reactive protein (CRP)serum, serta adekuasi dialisis (Kt/V). Adanya perdarahan saluran cerna(termasuk darah samar feses), dosis erythropoietin-stimulating agent(ESA)dan zat besi, serta kejadian transfusi darah akan dicatat. Kadar Hb kemudian diperiksa setiap 4 minggu hingga 24 minggu pengamatan. Var-Hb dinilai dengan standar deviasi residual dan nilai ≥1,0dianggap sebagai var-Hb tinggi. Uji hipotesis dilakukan dengan uji bivariat sesuai jenis data, dilanjutkan dengan analisis multivariat menggunakan uji regresi logistikmultipel. Hasil: Sejumlah 127 subyek (rerata[SD]usia 49,06[15,1], perempuan 52%, rerata[SD]kadar Hb 9,75[1,00]g/dL) diikutsertakan dalam analisis. Proporsi subyek dengan var-Hb tinggi ialah 47,24%. Berdasarkan analisis bivariat dan multivariat, faktor yang mempengaruhi var-Hb adalah kadar RET-He(p=0,004), dosis ESA (p=0,032), dan kejadian transfusi darah (adjustedOR6,967, IK95% 2,74-17,71;p<0,001). Kesimpulan: Proporsi pasien PGK-HD di Indonesia yang memiliki var-Hb tinggi ialah 47,24%(IK95% 38,3-56,3%). Faktor-faktor yang mempengaruhi var-Hb ialah kadar RET-He,dosis ESA, dan kejadian transfusi darah.

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Background: Hemoglobinvariability(Hb-var) is a phenomenon of Hb fluctuation during a course of time that is frequently observed in chronic kidney disease on hemodialysis (CKD-HD)patients. Hb-varis now recognized asapredictor of poor clinical outcomes. However, factors that influence the Hb-var are not well understood.Objectives.This study was aimedto measure the proportion of Hb-var in CKD-HD patients in Indonesia and identify factors associated. Methods: This was a prospective cohort study involving CKD-HD patients aged ≥18 years old in Hemodialysis Unit in RSCM. Factors identified at baseline were serum levels of Hb,reticulocyte-hemoglobin equivalent (RET-He), albumin,alkalinephosphatase, C-reactive protein (CRP), and dialysis adequacy (Kt/V). Hb level was measured every 4 weeks until 24weeks of follow up. Any evidence of gastrointestinal bleeding (including occult blood feces), erythropoietin-stimulating agent (ESA) dosage, and blood transfusion werealsonoted. Hb-var was calculatedas the residual standardofdeviation, and value ≥1.0 was considered as high.Hypothesis testing was performed by bivariate analysis, thencontinued with multivariateanalysis using multiple regression logistic test. Results: As 127 subjects (mean[SD]of age 49.06[15.1], female 52%, mean[SD]of Hb 9.75[1.00]g/dL) were included in the analysis. The proportion of subjects with high Hb-var were 47.24%. According to bivariate and multivariate analysis, factors that determined Hb-var were RET-Helevels (p=0.004), ESA dosage (p=0.032), and blood transfusion (adjustedOR 6.967, 95%CI2.74-17.71,p<0.001). Conclusion: Theproportion of CKD-HD patients in Indonesia with high Hb-var was47.24% (95%CI 38.3-56.3%). Factors that determined Hb-var wereRET-Helevels, ESA dosage, and blood transfusion."

"Protein energy wasting (PEW) merupakan sindrom gangguan nutrisi yang sering terjadipada pasien penyakit ginjal kronik (PGK) dengan hemodialisis rutin sekitar 28-80%.Proses hemodialisis dapat meyebabkan hilangnya nutrien seperti asama amino,meningkatkan proses inflamasi yang kemudian dapat meningkatkan katabolisme protein,dan dapat menghambat utilisasi asam amino dalam sintesis protein. Jika tidak ditangani,PEW dapat meningkatkan morbiditas dan mortalitas pasien PGK. Tujuan utamapenelitian adalah untuk mengetahui profil asam amino pasien PGK dengan hemodialisisrutin. Desain penelitian adalah potong lintang dengan 60 subjek pasien PGK usia >18tahun dengan hemodialisis rutin di RS. Umum Pusat Nasional Dr. Cipto Mangukusumo.Sampel berupa dried blood spot (DBS) dan pemeriksaan asam amino menggunakanmetode Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS). Asam aminoyang diperiksa adalah asam amino nonesensial (alanin, arginin, asam aspartat, asamglutamat, asparagin, glisin, glutamin, prolin, serin, tirosin), esensial (histidin, fenilalanin,isoleusin, leusin, lisin, metionin, treonin, triptofan, valin), dan khusus (ornitin, sitrulin).Hasil penelitian didapatkan hampir semua kadar asam amino pada subjek lebih rendahterutama alanin, tirosin, histidin, dan valin; sebaliknya asam aspartat dan serin ditemukanlebih tinggi kadarnya dibandingkan nilai rujukan Mayo dan data internal dewasa sehat.Didapatkan adanya hubungan bermakna antara jenis kelamin dengan fenilalanin,isoleusin, leusin; hipoalbuminemia (albumin <4 g/dL) dengan glisin; hipoalbuminemia(<3,5 g/dL) dengan arginin, asam aspartat, asparagin, histidin, lisin, metionin, danornitin. Didapatkan korelasi yang bermakna antara usia dengan BCAA (isoleusin, leusin,valin), dan metionin; dan hemoglobin dengan isoleusin. Penelitian ini merupakanpenilitian pertama tentang profil asam amino pada pasien PGK dengan hemodialisis diIndonesia dan penelitian pertama kali yang menggunakan sampel DBS pada orangdewasa. Dengan diketahuinya profil asam amino pada PGK dapat dimanfaatkan sebagaidasar pemberian jenis suplementasi asam amino yang sesuai dengan populasi pasien PGKdengan hemodialisis di Indonesia.

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Protein energy wasting (PEW) is a nutritional disorder syndrome that often occurs in

patients with chronic kidney disease (CKD) on routine hemodialysis around 28-80%. The

process of hemodialysis can cause the loss of nutrients such as amino acids, increase the

inflammatory process which can increase protein catabolism, and be able to inhibit the

utilization of amino acids in protein synthesis. If untreated, PEW can increase the

morbidity and mortality of CKD patients. The main objective of the study was to

determine the amino acid profile of CKD patients on routine hemodialysis. The study

design was cross sectional with 60 subjects of CKD patients aged >18 years on routine

hemodialysis at Dr. Cipto Mangunkusumo National Public Hospital. Samples in the form

of dried blood spot (DBS) and amino acid examination using the Liquid Chromatography

Tandem Mass Spectrometry (LC-MS/MS) method. Amino acids examined were

nonessential amino acids (alanine, arginine, aspartic acid, glutamic acid, asparagine,

glycine, glutamine, proline, serine, tyrosine), essential (histidine, phenylalanine,

isoleucine, leucine, lysine, methionine, glycine, glutamine, proline, serine, tyrosine),

special (ornithine, citrulline). The results showed that almost all amino acid levels in the

subjects were lower especially alanine, tyrosine, histidine, and valine; in contrast, aspartic

acid and serine were found to be higher than Mayo reference value and internal data of

healthy adults. A significant relationship was found between gender and phenylalanine,

isoleucine, leucine; hypoalbuminemia (albumin <4g/dL) with glycine; hypoalbuminemia

(<3.5 g/dL) with arginine, aspartate acid, asparagine, histidine, lysine, methionine, and

ornithine. Significant correlation was obtained between age with BCAA (isoleucine,

leucine, valine), and methionine; and hemoglobin with isoleucine. This study is the first

study of the amino acid profile in CKD patients with hemodialysis in Indonesia and the

first study using DBS samples in adults. Knowing the amino acid profile in CKD can be

used as a basis for the of amino acid supplementation that is suitable for the population

of CKD patients with hemodialysis in Indonesia."

"Gangguan metabolisme mineral dan tulang pada penyakit ginjal kronik (GMT-PGK) merupakan salah satu komplikasi yang ditemukan pada pasien PGK yang menjalani hemodialisis (PGK-HD). Manifestasi GMT-PGK dapat merupakan kelainan sistemik ataupun hanya ditemukan di tulang yang disebut sebagai renal osteodystrophy(ROD). Risiko kematian akibat GMT-PGK mencapai 17,5%. Di Indonesia, pemeriksaan penanda tulang terkait GMT-PGK belum secara rutin dikerjakan karena belum tercakup dalam pembiayaan Jaminan Kesehatan Nasional (JKN). Tujuan penelitian ini menganalisis profil kalsium, fosfat, PTH, dan vitamin D 25(OH) pada pasien PGK-HD. Penelitian ini merupakan studi potong lintang yang melibatkan 124 pasien hemodialisis rutin di Unit Hemodialisis RS Cipto Mangunkusumo (RSCM) yang berlangsung pada bulan Juni sampai Oktober 2022. Penelitian ini menggunakan data sekunder dari semua pasien hemodialisis yang memiliki data jenis kelamin, usia, durasi HD, fosfat, kalsium total, vitamin D 25(OH), dan PTH. Profil parameter tulang di dominasi turnover tinggi (75,8%), normokalsemia (78%), hiperfosfatemia (57,3%), dan status defisiensi vitamin D (82,3%). Pada penelitian ini didapatkan korelasi hanya pada parameter durasi HD dan PTH. Profil kelainan tulang berdasarkan penelitian ini lebih didominansi kelainan turnover tinggi sehingga dapat menjadi dasar untuk pemberian suplementasi analog vitamin D dan atau kalsimimetik dalam pengendalian peningkatan PTH pada pasien HD. Hiperfosfatemia masih mendominasi proporsi pasien HD sehingga tatalaksana terhadap hiperfosfatemia perlu lebih ditingkatkan dan disarankan untuk pemeriksaan berkala.

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Chronic kidney disease–mineral and bone disorder (CKD-MBD) is one of the complications found in CKD patients undergoing hemodialysis (CKD-HD). Manifestations of CKD-MBD can be a systemic disorder or only found in the bone which is known as renal osteodystrophy (ROD). The risk of death from CKD-MBD reaches 17.5%. In Indonesia, examination of bone markers related to CKD-MBD has not been routinely carried out because it has not been covered by the National Health Insurance financing. The aim of this study was to analyze the profile of calcium, phosphate, PTH, and vitamin D 25(OH) in patients with chronic kidney disease undergoing routine hemodialysis. This research is a cross-sectional study involving 124 routine hemodialysis patients at the Hemodialysis Unit of Cipto Mangunkusumo Hospital (RSCM) which took place from June to October 2022. This study used secondary data from all hemodialysis patients who had data on gender, age, duration of HD, phosphate, total calcium, vitamin D 25(OH), and PTH. Bone parameter profile was dominated by high turnover (75.8%), normocalcemia (78%), hyperphosphatemia (57.3%), and vitamin D deficiency status (82.3%). In this study, correlation was found only on the HD and PTH duration parameters. The profile of bone abnormalities based on this study is more dominated by high turnover disorders so it can be a basis for administering supplementation of vitamin D analogues and or calcimimetics in controlling increased PTH in HD patients. Hyperphosphatemia still dominates the proportion of HD patients so that the management of hyperphosphatemia needs to be further improved and periodic checks are recommended."