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"Coronary artery disease (CAD) is an important cause of death in end-stage renal disease (ESRD) patients on regular hemodialysis. The high risk of CAD occurrence in ESRD patients is partially due to a high prevalence of established atherosclerotic risk factors, which are hypertension, diabetes and dyslipidemia. However, unique renal-related risk factors are also likely to contribute to this high risk of CAD. The high prevalence of hyperhomocysteinemia in ESRD patients is of interest because of the probable cardiovascular risk associated with the increase of total plasma homocysteine concentration. The aim of this study was to evaluate the role of homocysteine as a risk factor for CAD in non-diabetic ESRD patients on regular hemodialysis.Total fasting plasma homocysteine, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, hypertension and smoking habit were documented from 80 non-diabetic ESRD patients on regular hemodialysis (48 men, 32 women; mean age 54.5±6.5 years). Twenty-two (27.5%) among these patients suffered from CAD according to ECG and echocardiographic criteria. The risk of CAD was analyzed using a stepwise multiple logistic regression. Total fasting plasma homocysteine concentration and other risk factors for CAD were also determined in 80 age- and sex-matched normal controls.Total fasting plasma homocysteine concentration was significantly higher in non-diabetic ESRD patients than in normal controls (26.0±1.5 versus 14.6±1.3 fimol/L; p<0.01). Hyperhomocysteinemia was observed in 92.5% ESRD patients. Homocysteine concentration was significantly higher in ESRD patients with CAD than without CAD (33.8±1.4 versus 23.5+1.5 umol/L; p<0.01). High total plasma homocysteine concentration and hypertension were independently associated with CAD in non-diabetic ESRD patients on regular hemodialeine concentration in the upper tertile (>30.6 jxmol/L) had an adjusted odds ratio of 2.95 (CI, 1.02 to 8.53; p<0.05). In ESRD patients, the intake of folic acid is the only factor associated with total plasma homocysteine concentration. The increase of total plasma homocysteine concentration in normal controls was associated with increased age and smoking habit.This study concludes that a high total plasma homocysteine concentration is an independent risk factor for coronary artery disease in non-diabetic ESRD patients on regular hemodialysis."

"Latar belakang: Hipertensi pulmonal (HP) telah banyak dilaporkan terjadi pada populasi hemodialisis (HD). Namun data mengenai insidensi HP serta bagaimana mekanisme terjadinya masih sangat sedikit. Beberapa faktor risiko dan protektif terjadinya HP telah diidentifikasi melalui studi-studi di mancanegara. Penelitian ini bertujuan untuk mengevaluasi hubungan penggunaan penghambat kanal kalsium dengan kejadian hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialisis. Metode: Penelitian potong lintang dilakukan terhadap 100 pasien HD rutin di unit HD RSCM yang sedang mengkonsumsi penghambat kanal kalsium jenis dihidropiridin (nifedipin, amlodipin, felodidpin) 1x sehari per oral selama minimal 1 tahun. Hipertensi pulmonal dinilai dengan menggunakan ekokardiografi doppler yang dilakukan 1 jam pasca HD oleh satu orang operator independen yang tidak mengetahui latar belakang klinis pasien. Selanjutnya dilakukan analisis uji statistik chi square dengan batas kemaknaan < 0.05, serta analisis multivariat dengan regresi logistik antara variabel penghambat kanal kalsium dengan hipertensi pulmonal untuk mendapatkan Crude OR, antara variabel perancu dengan hipertensi pulmonal untuk mendapatkan nilai P < 0.25, dan antara variabel penghambat kanal kalsium dengan variabel perancu untuk mendapatkan fully adjusted OR. Hasil: Dari 100 subyek penelitian, HP didapatkan pada 27 subjek (27%). Pada kelompok pasien HP, 21 subjek (29.2%) memiliki akses fistula AV di brakial, TAP rata-rata 36 ± 20.6 mmHg, curah jantung ³ 5 l/min sebanyak 13 subjek (28.8%) dengan fraksi ejeksi ³ 50% sebanyak 18 subjek (20.7%). Etiologi PGK terbanyak pada kelompok HP adalah nefropati DM dengan 10 subjek (37%). Setelah dilakukan adjustment dengan disfungsi diastolik ventrikel kiri, fraksi ejeksi dan diabetes melitus sebagai faktor perancu, penggunaan penghambat kanal kalsium berhubungan dengan penurunan risiko terjadinya hipertensi pulmonal (adjusted OR 0.258; IK 95% 0.085 – 0.783; nilai P 0.017). Kesimpulan: Penggunaan penghambat kanal kalsium berhubungan dengan penurunan risiko terjadinya hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialis.

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Background and Aim of Study: Pulmonary hypertension (PH) has been reported in hemodialysis (HD) patients. However data regarding its incidence and mechanism are scarce. Many published journal abroad had been identify the risk and protective factors in this syndrome. This study evaluated the use of Calcium Channel Blocker (CCB) on Pulmonary Hypertension at End-Stage Renal Disease (ESRD) patients who undergo hemodialysis.

Methods: A Cross – Sectional study conducted on hundreds HD patients in RSCM who consumed CCB for at least a year with oral single dose. PH was screened by Doppler echocardiography one hour following dialysis done by one independent operator without knowing clinical background of the patients. Furthermore, statistical analysis was done using chi square and define as significance if the value is <0.05. Moreover, multivariate analysis with logistic regression between CCB and PH variable in order to get Crude OR, between confounder variables and PH in order to get P value < 0.25, and between CCB and confounder variables in order to get fully adjusted OR.

Results: Out of 100 HD patients, PH was detected in 27 patients (27%). Of those with PH, brachial AV shunt was seen in 21 patients (29.2%), mean PAP was 36 ± 20.6 mmHg, and cardiac output ³ 5 l/min was seen in 13 patients (28.8%) with EF ³ 50% seen in 18 patients (20.7%). The common etiology of CKD in group of PH was diabetic nephropathy seen in 10 patients (37%). The used of CCB is associated with lower risk of PH (adjusted OR 0.258; 95% CI 0.085 – 0.783; P value 0.017) after adjusted with variable left ventricular diastolic dysfunction, ejection fraction, and diabetes melitus as confounders.

Conclusion: This study demonstrates that the use of CCB is associated with lower risk of PH in ESRD patients with hemodialysis."

"Kualitas tidur yang baik merupakan salah satu faktor kualitas hidup yang baik. Stres emosional seperti depresi menjadi penyebab kualitas tidur buruk. Depresi dan kualitas tidur secara tidak langsung dapat mempengaruhi kejadian morbiditas dan mortalitas penyakit gagal ginjal terminal. Tujuan penelitian ini adalah mengidentifikasi hubungan antara tingkat depresi dengan kualitas tidur pasien gagal ginjal terminal yang menjalani hemodialisis. Penelitian ini merupakan penelitian deskriptif korelasi dengan metode cross sectional. Sampel yang digunakan sebanyak 92 responden dengan teknik purposive sampling. Dengan analisis bivariat menggunakan uji spearman, korelasi antara tingkat depresi dengan kualitas tidur tidak bermakna dengan nilai p 0,332. Penelitian ini menyimpulkan bahwa mayoritas responden tidak memiliki tanda klinis depresi dan kualitas tidur baik. sehingga perlu dikembangkan intervensi yang dapat meningkatkan kualitas tidurnya.

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Good sleep quality is one of the factors of quality of life. Emotional stress such as depression causes poor sleep quality. Depression and sleep quality indirectly may affect the incidence of morbidity and mortality of end stage renal disease. The purpose of this study was to identify the relation between depression and sleep quality in patients on end stage renal disease with hemodialysis. This research is was descriptive and correlation design with cross sectional study. There were 92 respondents that were selected by purposive sampling method. The study result shows correlation between depression and sleep quality not significant with p value 0,332 that were analysed by bivariate analysis and spearman test. The study conclude that the majority of respondents had no clinical signs of depression and good sleep quality. Therefore, it is recommended to develop nursing interventions that can improve sleep quality. "

"Manajemen diri merupakan tata laksana multidisiplin terbaru yang memberdayakan pasien gagal ginjal terminal untuk aktif dalam mempertahankan status kesehatannya. Pelaksanaan manajemen diri masih tergolong rendah. Dukungan sosial dianggap sebagai salah satu faktor yang dapat mempengaruhi manajemen diri. Penelitian ini bertujuan untuk mengidentifikasi adanya hubungan antara dukungan sosial dengan manajemen diri pasien gagal ginjal terminal yang menjalani hemodialisis. Desain penelitian yang digunakan adalah cross sectional dengan jumlah sampel sebesar 107 responden dipilih dengan consecutive sampling. Data dikumpulkan secara daring dari 4 komunitas pemerhati pasien gagal ginjal di Indonesia menggunakan instrumen Medical Outcome Study Social Support Survey dan Hemodialysis Self-Management Instrument. Hasil penelitian dengan uji Chi square menunjukkan terdapat hubungan antara dukungan sosial dengan manajemen diri (p value <0,05). Penelitian ini merekomendasikan dukungan sosial sebagai bagian integral dari tatalaksana manajemen diri yang diberikan melalui kerja sama antara tenaga kesehatan, komunitas pemerhati pasien gagal ginjal, dan pendamping pasien.

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Self-management is the latest multidisciplinary intervention that empowers end-stage renal disease patients to be active in maintaining their health status. The implementation of self-management is still relatively low. Social support is considered as one of the factors that can affect self-management.

This study aims to identify the relationship between social support and self-management in end-stage renal disease patients undergoing hemodialysis. The design of the study is cross-sectional with a sample of 107 respondents selected by consecutive sampling. Data was collected online from 4 chronic kidney disease community in Indonesia using the Medical Outcome Study Social Support Survey and Hemodialysis Self-Management Instrument.

The result with the Chi-square test showed that there is a relationship between social support and self-management (p-value <0.05). This study recommends social support as a part of self-management intervention provided through cooperation between health workers, chronic kidney disease communities, and patient companions."

"Kelainan regio orofasial pada GGT pasien gagal ginjal terminal (GGT) yang menjalani hemodialisis. Beberapa kelaian orofasial pada pasien gagal ginjal terminal yang menjalani hemodialisis telah dilaporkan. Namun, sampai saat ini, terutama di Indonesia, data yang ada tentang hal tersebut masih sangat terbatas.Tujuan: Penelitian ini bertujuan untuk mengetahui kelainan orofasial pada pasien GGT yang menjalani hemodialisis di Rumah Sakit Cipto Mangunkusumo, Indonesia.Metode: Desain penelitian adalah studi observasi potong lintang. Subjek penelitian dipilih berdasarkan metode consecutive sampling. Sebanyak 93 pasien yang memenuhi kriteria inklusi merupakan subjek penelitian ini. Subjek berpartisipasi dalam wawancara menggunakan kuesioner yang menanyakan tentang adanya keluhan subjektif, pemeriksaan klinis dan pengukuran saliva.Hasil: Serostomia (82,8%), dysgeusia (66,7%), rasa metal (57%), rasa baal perioral (24,7%) merupakan gejala yang sering ditemukan. Temuan klinis meliputi tongue coating (100%), deposit kalkulus (97,8%), mukosa mulut yang pucat (94,6%), sialosis (75,3%), bau uremik (40,9%), bercak hemoragik (39,8%), angular keilitis (37,7%), perdarahan gingival (15,1%), dan kandidiasis oral (3,2%). Perubahan saliva terkait peningkatan viskositas (86%), pH (80,6%), kapasitas dapar (76,3%). Selanjutnya terjadi pengurangan tingkat hidrasi mukosa (79,6%) dan laju alir saliva tanpa stimulasi (22,6%) dan dengan stimulasi (31,2%).Simpulan: Temuan kelaianan orofasial pada penelitian ini membutuhkan perhatian dan penanganan yang menyeluruh untuk meningkatkan kualitas hidup pasien dengan gagal ginjal terminal GGT.

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Several orofacial disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis have been reported. However, up to the present, particularly in Indonesia, such data still limited.

Objective: the purpose of this study was to assess the orofacial disorders in patients with ESDR undergoing hemodialysis at Cipto Mangunkusumo Hospital, Indonesia.

Methods: The study was conducted through observation using a cross-sectional design. The subjects were selected by consecutive sampling. Ninety-three patients fulfilled the inclusion criteria and enrolled in this study. They participated in the structural interview-using questionnaire assessing subjective complaints; clinical examinations; and salivary measurements.

Results: Xerostomia (82.8%) dysgeusia (66.7%), metal taste (57%), perioral anesthesia (24.7%) were the common symptoms. Clinical findings consisted of tongue coating (100%), calculus deposits (97.8%), pallor of oral mucous (94.6%), sialosis (75.3%), uremic odor (40,9%), haemorrhagic spot (39.8%), angular cheilitis (37.7%), gingival bleeding (15.1%), and oral candidiasis (3.2%) were also found. Salivary changes showed the increase of salivary viscosity (86%), pH (80.6%), buffer capacity (76.3%) whereas decrease of mucous hydration level (79.6%) and the flow rates of unstimulated (22.6%) and stimulated (31.2%) whole saliva were observed.

Conclusion:

The findings of orofacial disorders required attention and further comprehensive management to enhance the quality of life of patients with ESDR."

"Penyakit ginjal tahap akhir (PGTA) dan terapi hemodialisis mengakibatkan sejumlah dampak dan perubahan yang signifikan pada kualitas hidup pasien. Fungsi seksual dan citra tubuh harus dipertimbangkan sebagai salah satu prediktor yang mempengaruhi kualitas hidup pada pasien hemodialisis. Tujuan penelitian untuk mengetahui hubungan fungsi seksual dan citra tubuh terhadap kualitas hidup pasien penyakit ginjal tahap akhir. Desain penelitian yang digunakan cross sectional dengan consecutive sampling dengan 107 responden. Analisis data menggunakan uji chi square, eta dan regresi logistik berganda. Hasil analisis bivariat menunjukkan hubungan signifikan antara fungsi seksual (p value 0,027), dan citra tubuh (p value 0,001) dengan kualitas hidup. Variabel confounding: pendapatan bulanan, jumlah penyakit penyerta, lama menjalani hemodialisis, kepatuhan hemodialisis, dan komunikasi seksual berhubungan signifikan dengan kualitas hidup, namun usia, jenis kelamin, dan pendidikan terakhir tidak berhubungan dengan kualitas hidup. Hasil analisis regresi logistik berganda menunjukkan fungsi seksual, citra tubuh, dan pendapatan bulanan berhubungan dengan kualitas hidup, sedangkan lama menjalani hemodialisis, jumlah penyakit penyerta dan kepatuhan hemodialisis sebagai faktor confounding. Pendapatan bulanan merupakan faktor yang paling berpengaruh terhadap kualitas hidup (OR 4,390). Oleh karena itu, perlu dilakukan peningkatan keterampilan pengkajian dan pengembangan intervensi dalam masalah psikososial pasien hemodialisis terutama fungsi seksual dan citra tubuh pasien dengan memperhatikan status ekonomi.

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End-stage renal disease and hemodialysis therapy cause some significant impacts and changes in the patient’s quality of life. Sexual function and body image could be considered as the predictors affecting the quality of life of hemodialysis patients. This study aims to to determine the relationship of sexual function and body image with the quality of life of end-stage renal disease patients. The research design was cross sectional with consecutive sampling of 107 respondents. Data analysis used chi square test, eta test and multiple logistic regression. The bivariate analysis indicated that there was a significant relationship between sexual function (p value 0,027) and body image (p value 0,001) with quality of life. In addition, confounding factor: monthly income, comorbidities, duration of HD, hemodialysis adherence, and sexual communication were significantly correlated with quality of life. However, there were not significantly correlated between age, gender, education with quality of life. The result of multiple logistic regression analysis showed that there was a significant relationship between sexual function, body image, and monthly income with quality of life, while duration of HD, co-morbidities and hemodialysis adherence as confounding factors. Monthly income became the most influential factor on quality of life (OR 4,390). Therefore, it was necessary to improve assessment skills and develop nursing interventions in psychosocial problems of hemodialysis patients, especially sexual function and body image of patients with regard to economic status."

"Latar Belakang: Hipertensi merupakan kasus terbanyak pada pasien hemodialisis HD . Tekanan nadi sentral merupakan prediktor yang kuat terhadap mortalitas dengan penyebab apa pun, banyak faktor yang mempengaruhi tekanan nadi sentral, baik secara langsung maupun tidak langsung, di antaranya adalah interdialytic weight gain IDWG . IDWG dikatakan berhubungan dengan mortalitas akibat penyebab apa pun, namun belum jelas mekanismenya. Tujuan: Mengetahui tekanan nadi sentral dan korelasinya dengan IDWG pada pasien penyakit ginjal tahap akhir PGTA yang menjalani HD di RSCM. Metode: Penelitian ini merupakan studi potong lintang pada pasien PGTA yang menjalani HD di RSCM. Dilakukan pemeriksaan tekanan nadi sentral dengan alat sfigmokor, dan dihitung IDWG dalam satu bulan terakhir, selanjutnya dikorelasikan. Hasil: Didapatkan 67 subyek yang memenuhi kriteria inklusi. Median usia 53.0 rentang inter-kuartil [RIK] 44.0-62.0 tahun, subyek dengan jenis kelamin perempuan lebih banyak ditemukan. Lamanya menjalani HD median 51,3 RIK 23,8-88,8 bulan. Median tekanan nadi sentral 45 RIK 32,67-56,67 mmHg. Rerata IDWG adalah 2,71 simpang baku [SB] 1,08 kg atau 5,04 SB 1,88 . Tekanan nadi sentral tidak berkorelasi dengan IDWG dengan r = 0,088 p=0,478. Simpulan: Tekanan nadi sentral pada pasien PGTA yang menjalani HD di RSCM mediannya sebesar 45 RIK 32,67-56,67 mmHg. Tekanan nadi sentral tidak berkorelasi dengan IDWG.

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Background: Hypertension is the most prevalent case in patients undergoing hemodialysis HD . Central pulse pressure is a strong predictor of mortality of any cause. Many factors are related to central pulse pressure, either directly or indirectly, including interdialytic weight gain IDWG. IDWG are said to be associated with mortality of any cause in HD patients, but the mechanism underlying that association remained unclear.

Objective: To find central pulse pressure and its correlation with IDWG in end stage renal disease ESRD patients undergoing HD in Rumah Sakit Cipto Mangunkusumo, Indonesia.

Methods: Cross sectional study on all ESRD patients undergoing HD in Rumah Sakit Cipto Mangunkusumo. Central pulse pressure was measured using Sphygmocor. IDWG of patients within the last month were obtained, and then a correlation analysis was conducted on both variables.

Results: This study included 67 subjects that met inclusion criteria. The median range age of participants was 53.0 44.0 62.0 years old, with more female subjects present. The median range of duration of HD was 51.3 23.8 88.8 months. Median range of central pulse pressure was 45 32,67 56,67 mmHg. The mean of IDWG was 2.71 standard deviation SD 1.08 kg or 5.04 SD 1.88. This study found that there were no correlation between central pulse pressure and IDWG, r 0.088 p 0.478.

Conclusions: Median range of central pulse pressure in ESRD patients undergoing HD in CMGH was 45 32,67 56,67 mmHg. Central pulse pressure had no correlation with IDWG. "

"Pasien dengan Gagal Ginjal Terminal (GGT) membutuhkan terapi pengganti ginjal berupa hemodialisis (HD). Untuk mencapai keberhasilan HD diperlukan kepatuhan pasien terhadap pembatasan cairan. Kepatuhan cairan dapat tercapai saat pasien mampu melakukan penyesuaian diri dengan penyakit GGT dan terapi HD. Penyesuaian diri pasien HD terhadap penyakit GGT dan pembatasan cairan dapat berhubungan dengan penerimaan diri. Tujuan penelitian ini yaitu mengetahui hubungan penerimaan diri dengan kepatuhan pembatasan cairan pasien HD. Penelitian ini menggunakan desain cross sectional dengan consecutive sampling pada 121 responden. Pengumpulan data dengan kuesioner kepatuhan cairan dan self acceptance scale serta studi dokumentasi. Analisis yang digunakan yaitu Chi-Square dan regresi logistic. Hasil penelitian didapatkan responden yang patuh terhadap pembatasan cairan sebanyak 79,3% dan penerimaan diri sebanyak 78,5%. Hasil analisis didapatkan adanya hubungan yang signifikan antara penerimaan diri dengan kepatuhan cairan (p=0,024) namun tidak terdapat hubungan yang signifikan antara penerimaan diri dengan IDWG (p=0,154). Ada hubungan variabel konfonding lama menjalani HD dengan kepatuhan cairan (p=0,033), variabel konfonding adekuasi HD dengan IDWG (P= 0,011). Namun, pada variabel konfonding lainnya tidak terdapat hubungan signifikan dengan kepatuhan cairan, diantaranya adalah: usia, jenis kelamin, pendidikan dan komorbiditas. Selanjutnya pada analisis multivariat variabel yang paling dominan mempengaruhi kepatuhan cairan adalah penerimaan diri (p=0,006) setelah dikontrol variabel jenis kelamin dan lama menjalani HD serta mampu memprediksi sebesar 21% terhadap kepatuhan pembatasan cairan. Rekomendasi penelitian ini adalah perawat perlu mengidentifikasi serta melakukan upaya meningkatkan penerimaan diri pasien untuk meningkatkan kepatuhan cairan dengan intervensi seperti therapy reality dan terapi berpikir positif. Perawat harus lebih memperhatikan adekuasi HD dan berat badan kering pasien untuk menghindari peningkatan IDWG. Selain itu, rekomendasi untuk peneliti selanjutnya diharapkan dapat menggunakan instrumen penelitian yang mampu melihat waktu yang dibutuhkan pasien HD untuk mencapai tahap acceptance serta melakukan analisis lanjutan pada hasil penelitian ini tentang kesenjangan hasil antara kepatuhan cairan yang tinggi berdasarkan kuesioner namun mayoritas responden pada IDWG berat.

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Patients with End Stage Renal Disease (ESRD) requires a renal replacement therapy in the form of hemodialysis (HD). To achieve success of HD requires patient compliance with fluid restrictions. Fluid adherence can be achieved when the patients is able to adjust to ESRD and HD therapy. Adjustment of patients HD to ESRD and fluid restriction can be related to self acceptance. This study aimed to identify the relationship between self acceptance and fluid adherence in ESRD patients undergoing HD. This study used cross sectional design with consecutive sampling of 121 respondents. Data collection used fluid adherence questionnaires, self acceptance scale and documentation studies. The analysis used chi square and logistic regression. The result showed that 79,3% of respondents had adherence to fluid restriction and 78,5% of them had self acceptance. The analysis result also showed there was a significant relationship between self acceptance and fluid adherence (p=0,024), but no significant relationship between self-acceptance and IDWG (p=0.154). There was significant relationship between confounding variable of the length of time undergoing HD and fluid adherence (p=0.033), adequacy HD and IDWG (p=0,011). However, other confounding variables were not significant relationship with fluid adherence, which were: age, gender, education, and comorbidities. Furthermore, the multivariat analysis found that self acceptance was the most dominant variable affecting fluid adherence (p=0.006) after controlling by variables of the sex and the length of time undergoing HD, which can predicted 21% to fluid adherence. Recommendations for this study are nurses need to identify and make efforts to increase patient self-acceptance to improve fluid compliance with interventions such as reality therapy and positive thinking therapy. Nurses should more attention to HD adequacy and dry weight of the patient to avoid an increase in IDWG. In addition, recommendations for further researchers are expected to use research instruments that are able to see the time needed for HD patients to reach the acceptance stage and carry out further analysis on the results of this study regarding the gap in results between high fluid adherence based on the questionnaire but the majority of respondents on the IDWG severe."