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"[ABSTRAKLatar Belakang. Pendekatan holistik di bidang Psikosomatik menekankan faktor spiritualitas dan dukungan pada sisi spiritualitas dapat meningkatkan pelayanan serta memperbaiki kondisi psikologis pada pasien. Selama prosedur hemodialisis respon inflamasi akan meningkat dibuktikan dengan peningkatan konsentrasi interleukin-6 (IL- 6). Aspek spiritual yang dapat menurunkan respon inflamasi masih perlu diteliti.Tujuan. Untuk mengetahui gambaran aspek spiritual pasien yang menjalani hemodialisis kronik dan untuk mengetahui korelasi aspek spiritual dengan kadar IL-6 serum pada pasien yang menjalani hemodialisis kronik.Metode. Penelitian ini merupakan studi cross sectional dilakukan pada 51 pasien hemodialisis kronik di unit Hemodialisis RSUP. H. Adam Malik dan RSU. Dr. Pirngadi Medan mulai bulan Juli-Agustus 2014. Pemeriksaan kadar IL-6 serum diukur dengan metode quantitative enzyme-linked immunosorbent assay (ELISA) dilakukan pengambilan sampel darah dan pengukuran spiritual dilakukan dengan pengisian kuesioner FACIT Sp-12 pada pagi hari 30 menit sebelum hemodialisis berlangsung.Hasil. Skor subskala meaning (makna) 10.67 (SB 2.66), peace (damai) 9.63 (SB 2.19) dan faith (iman) 11.47 (SB 2.91). Nilai median kadar IL-6 serum pada penelitian ini adalah adalah 5,63 (1,48-28,88) pg/mL. Nilai median FACIT Sp-12 adalah 30,00 (18-48). Hasil uji korelasi antara tingkat spiritual dengan kadar IL-6 serum menunjukkan koefisien korelasi -0,330 dengan nilai p = 0,018 yang secara statistik menunjukkan korelasi negatif yang lemah.Simpulan. Spiritual pada pasien hemodialisis kronik tinggi. Terdapat korelasi negatif yang lemah antara aspek spiritual dengan kadar IL-6 pada pasien hemodialisis kronik.

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ABSTRACTBackground: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.Methods: Cross sectional study on 51 chronic haemodialysis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immunosorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACITSp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.Results: . Subscale meaning 10.67 (SB 2.66), peace 9.63 (SB 2.19) and faith 11.47 (SB 2.91). Median serum IL-6 level is 5,63 ( 1,48-28,88 ) pg/mL. Median FACIT Sp-12 is 30,00 (18-48). Correlation test between serum IL-6 level and spiritual aspect have shown statistically weak negative correlation (correlation coefficient -0,330, p = 0.018).Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study.;Background: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.Methods: Cross sectional study on 51 chronic haemodialysis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immunosorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACITSp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.Results: . Subscale meaning 10.67 (SB 2.66), peace 9.63 (SB 2.19) and faith 11.47 (SB 2.91). Median serum IL-6 level is 5,63 ( 1,48-28,88 ) pg/mL. Median FACIT Sp-12 is 30,00 (18-48). Correlation test between serum IL-6 level and spiritual aspect have shown statistically weak negative correlation (correlation coefficient -0,330, p = 0.018).Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study., Background: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.Methods: Cross sectional study on 51 chronic haemodialysis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immunosorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACITSp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.Results: . Subscale meaning 10.67 (SB 2.66), peace 9.63 (SB 2.19) and faith 11.47 (SB 2.91). Median serum IL-6 level is 5,63 ( 1,48-28,88 ) pg/mL. Median FACIT Sp-12 is 30,00 (18-48). Correlation test between serum IL-6 level and spiritual aspect have shown statistically weak negative correlation (correlation coefficient -0,330, p = 0.018).Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study.]"

"ABSTRAKInterdialytic weight gain IDWG merupakan masalah yang dijumpai pada pasien hemodialisis HD dan mempengaruhi probabilitas kesintasan akibat adanya akumulasi cairan. Penelitian ini bertujuan untuk mengetahui kesintasan tiga tahun pertama pasien HD kronik berdasarkan IDWG. Desain penelitian menggunakan studi kohort retrospektif dengan metode Kapplan-Meier untuk analisis kesintasan pada 72 responden. Hasil penelitian menunjukkan bahwa terdapat 87.5 responden mengalami IDWG berlebih dengan 16.7 responden mengalami event, dan tidak terdapat hubungan yang signifikan antara IDWG berlebih dan HID terhadap kesintasan tiga tahun. Hal ini disebabkan terpenuhinya dosis HD dan kecepatan aliran darah yang mempengaruhi tercapainya adekuasi HD. Hasil penelitian ini dapat memotivasi perawat untuk memantau IDWG, pencapaian dosis HD dan berat badan pada akhir sesi HD.

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ABSTRACTInterdialytic weight gain IDWG is a problem in hemodialysis patients and influencing the probability of survival due to fluid accumulation. This study aims to assess the survival the first three years of chronic hemodialysis patients based interdialytic weight gain. The study design used a retrospective cohort study using Kapplan Meier method for survival analysis on 72 respondents. The results showed that there were 87.5 of respondents experiencing excessive IDWG with 16.7 of them experienced event, and there was no significant association between excessive IDWG and intradialysis hypotension against the survival of three years. This could be resulted by the fulfillment of the hemodialysis dose and quick of blood Qb which affect the achievement of hemodialysis adequacy. The results of this study can motivate nurses in monitoring IDWG, achieving hemodialysis dose and body weight at the end of hemodialysis session. "

"Latar Belakang. Hemodialisis (HD) menjadi pilihan utama terapi pengganti ginjal di Indonesia. Pada tahun 2016, Indonesia memiliki angka mortalitas satu tahun pasien dengan penyakit ginjal kronik (PGK) yang diterapi dengan HD (PGK-HD) lebih tinggi dibandingkan dengan negara lain. Saat ini, Indonesia belum memiliki banyak data terkait insidens dan faktor-faktor yang memengaruhi mortalitas pasien HD kronik.Tujuan. Mengetahui insidens dan faktor-faktor yang memengaruhi mortalitas satu tahun pasien HD kronik.Metode. Penelitian dilakukan dengan desain studi kohort prospektif di Rumah Sakit Dr. Cipto Mangunkusumo (RSCM) sejak 2020 hingga Desember 2021 dengan mengikuti 193 pasien yang masih hidup setelah tiga bulan dilakukan HD inisiasi. Pasien kemudian diobservasi selama sembilan bulan untuk mengetahui insidens mortalitas satu tahun dan faktor-faktor yang berkaitan. Data dianalisis menggunakan analisis bivariat diikuti dengan analisis multivariat cox regresi untuk mengetahui faktor-faktor yang memengaruhi mortalitas.Hasil. Rerata usia pasien penelitian adalah 52 tahun dan etiologi terbanyak pasien PGK-HD yaitu diabetes melitus (DM). Selama observasi, terdapat tiga pasien loss to follow up, dan terdapat 55 pasien meninggal. Insidens satu tahun mortalitas pada penelitian ini adalah 28,49% (IK 95% 22,25-35,42%). Setelah dilakukan analisis multivariat pada penelitian ini didapatkan tiga variabel yang secara signifikan memengaruhi mortalitas yaitu interdialytic weight gain (IDWG) ≥5% (OR 3,58, IK 95% 1,16-10,91), kadar hemoglobin <10 g/dL (OR 3,4, IK 95% 1,79-7,15), dan serum kalsium <8,5 mg/dL (OR 3,79, IK 95% 1,75-8,23).Kesimpulan. Insidens mortalitas satu tahun pasien HD kronik sebesar 28,49%. IDWG ≥5%, kadar hemoglobin <10 g/dL, dan serum kalsium <8,5 mg/dL merupakan faktor-faktor yang memengaruhi mortalitas satu tahun.

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Background. Hemodialysis (HD) is the main kidney replacement therapy in Indonesia. In 2016, Indonesia had a higher one-year mortality rate of chronic kidney disease (CKD) patients treated with hemodialysis (CKD-HD) compared to other countries. Currently, HD centers in Indonesia lack data related to the incidence and factors related to mortality in CKD-HD patients.

Aims. To determine the incidence and factors related to one-year mortality in Chronic HD patients.

Methods. This prospective cohort study was conducted at Dr. Cipto Mangunkusumo Hospital (RSCM) from January 2020 to December 2021, following 193 patients who survived three months after initial dialysis. Patients were observed for nine months to know the one-year mortality incidence and related factors. The data were analyzed using bivariate analysis followed by multivariate cox regression analysis to review factors related to mortality.

Results. The mean age was 52 years-old and the most common etiology of CKD-HD was diabetes mellitus (DM). During follow-up, three patients dropped out due to loss to follow up and 55 patients died. One-year mortality incidence was 28.49% (95% CI 22,25-35,42%) in this study. After multivariate analyses, we found three significant variables for one-year mortality: interdialytic weight gain (IDWG) ≥5% (OR: 3.58, 95% CI: 1.16.88-10.91), hemoglobin level <10 g/dL variables, (OR: 3.4, 95%CI 1.79-7.15), and calcium serum <8.5 mg/dL (OR: 3,79, 95% CI 1.75-8.23).  

Conclusion. The incidence of one-year mortality in CKD-HD patients was 28.49%. IDWG ≥5%, hemoglobin <10 g/dL, and calcium serum <8.5 mg/dL are significant factors related to one-year mortality."

"Latar Belakang: Pasien penyakit ginjal kronis (PGK) memiliki risiko lebih tinggi untuk jatuh ke dalam frailty karena berbagai perubahan fisiologis terkait penyakit dan berisiko mengalami dampak kesehatan yang lebih buruk. Pemahaman mengenai faktor-faktor yang berhubungan dengan kejadian frailty pada pasien PGK yang menjalani hemodialisis  sangat di perlukan untuk menginformasikan pengetahuan dan mendapatkan solusi. Penelitian ini bertujuan untuk mengetahui prevalensi frailty pada pasien hemodialisis dan faktor yang berhubungan dengan terjadinya frailty pada pasien hemodialisis.Metode: Penelitian ini merupakan penelitian potong lintang dengan menggunakan data primer. Sembilan puluh satu pasien dari unit hemodialisis RSCM dari berbagai kelompok demografis disertakan dalam studi. Sampling menggunakan metode total sampling. Frailty dinilai dengan kuesioner Frailty Index 40 item. Riwayat medis diperoleh dari rekam medis RS dan dilakukan pemeriksaan laboratorium. Dilakukan uji bivariat menggunakan Chi-Square terhadap usia, jenis kelamin, lama dialisis, status gizi, adekuasi dialisis, hemoglobin, CRP, albumin, kalsium darah, fosfat darah, dan Charlson Comorbidity Index (CCI). Identifikasi faktor yang berhubungan dengan terjadinya frailty dilakukan dengan uji binary regression dengan metode backward stepwise regression.Hasil: Dua puluh enam (28,6%) pasien mengalami frailty. Faktor yang berhubungan dengan kejadian terhadap frailty pada pasien hemodialisis yaitu jenis kelamin perempuan (PR 1,064; IK 95% 1,064-1,065), skor CCI (PR 27,168; IK 95% 3,838-192,306), lama (vintage) hemodialisis (PR 1,227; IK 95% 1,226-1,227), hemoglobin (PR 3,099; IK 95% 1,325-7,254), albumin (PR 1,387; IK 95% 1,386-1,388), CRP (PR 1,432; IK 95% 1,431-1,433), dan fosfat (PR 1,110; IK 95% 1,110-1,111).Kesimpulan: Prevalensi frailty pada populasi studi ini yaitu 28,6%. Jenis kelamin perempuan, peningkatan skor CCI, lama (vintage) hemodialisis, anemia, hipoalbuminemia, dan fosfat yang rendah ditemukan sebagai faktor yang berhubungan secara signifikan  terhadap kejadian frailty pada pasien hemodialisis di RSCM.

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Background: Patients with chronic kidney disease (CKD) have a higher risk of falling into frailty due to various physiological changes related to the disease and are at risk for worse health impacts. Understanding the factors that correlate with the incidence of frailty in CKD patients undergoing hemodialysis is needed to inform knowledge and obtain solutions. This study aims to determine the prevalence of frailty in hemodialysis patients and predictors of frailty in hemodialysis patients.

Methods: This study is a cross-sectional study using primary data. Ninety-one patients from the RSCM hemodialysis unit from various demographic groups were included in the study. Sampling using the total sampling method. Frailty is assessed with a 40-item Frailty Index questionnaire. Medical history was obtained from hospital medical records, and laboratory examinations were carried out. A bivariate test using Chi-Square was performed on age, sex, duration of dialysis, nutritional status, dialysis adequacy, hemoglobin, CRP, albumin, blood calcium, blood phosphate, and the Charlson Comorbidity Index (CCI). The binary regression test with the backward stepwise regression method identifies factors associated with frailty.

Results: Twenty-six (28.6%) patients experienced frailty. Factors related to the incidence of frailty in hemodialysis patients were female gender (PR 1.064; 95% CI 1.064-1.065), CCI score (PR 27.168; 95% CI 3.838-192.306), duration (vintage) of hemodialysis (PR 1.227; 95% CI 1.226-1.227), anemia (PR 3.099; 95% CI 1.325-7.254), albumin (PR 1.387; 95% CI 1.386-1.388), CRP (PR 1.432; 95% CI 1.431-1.433), and phosphate (PR 1.110; CI 95% 1.110-1.111).

Conclusion: The prevalence of frailty in this study population is 28.6%. Female gender increased CCI score, old (vintage) hemodialysis, anemia, hypoalbuminemia, and low phosphate were factors significantly related to the incidence of frailty in hemodialysis patients at RSCM."

"Latar Belakang: Angka kematian pasien penyakit ginjal tahap akhir (PGTA) akibat penyakit kardiovaskular (PKV) sangat tinggi, khususnya pada pasien hemodialisis kronik (HDK), PKV juga dipengaruhi oleh kondisi malnutrisi dan inflamasi. Malnutrition Inflammation Score (MIS) dipakai sebagai prediktor morbiditas dan mortalitas pasien HDK. Asymmetric dimethylarginine (ADMA) dan symmetric dimethylarginine (SDMA) adalah hasil dari proteolisis protein termetilasi yang merupakan penanda inflamasi dan malnutrisi dan ditemukan meningkat pada pasien hemodialisis.Tujuan: Mencari korelasi rasio ADMA/SDMA terhadap MIS pada pasien Penyakit ginjal kronik (PGK) yang menjalani HDK 2x seminggu. Metode: Penelitian dengan desain potong lintang yang dikerjakan pada bulan Juli 2022 pada pasien HDK > 3 bulan. Kadar ADMA, SDMA, dan MIS diambil dan dicatat saat sebelum pasien memulai sesi hemodialisis. Analisis bivariat dilakukan dengan analisis Spearman dan Mann – Whitney dan analisis multivariat dengan regresi linier.Hasil: Sebanyak 23 sampel adalah laki-laki (48,9%) dengan rerata usia 51,2 tahun. Median Albumin adalah 4,0 g/dl dan median TIBC adalah 220 mcg/dl. Median ADMA adalah 82ng/ml, median SDMA 599 ng/ml, rasio ADMA/SDMA 0,14, dan skor MIS 4 (3-6). Skor MIS >5 adalah sebesar 34% dengan <5 sebesar 66%. Dalam analisis bivariat dan multivariat setelah dikontrol penggunaan penghambat ACE, tidak ditemukan hubungan antara rasio ADMA/SDMA dengan MIS (p=0,154).Simpulan: Tidak ditemukan korelasi antara rasio ADMA/SDMA terhadap MIS pada pasien PGK yang menjalani HDK 2x seminggu. 

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Background: The mortality rate of patients with nd tageidney isease (ESKD) due to cardiovascular disease (CVD) is very high, especially in chronic hemodialysis (HD) patients. CVD is also affected by malnutrition and inflammatory conditions. Malnutrition Inflammation Score (MIS) is used as a predictor of morbidity and mortality in HD patients. Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are the results of proteolysis of methylated proteins which are markers of inflammation and malnutrition and are found to be increased in hemodialysis patients.

Objective: To find a correlation between the ratio of ADMA/SDMA to MIS in chronic kidney disease (CKD) patients who underwent HD 2x a week.

Methods: A cross-sectional study conducted in July 2022 in HD patients > 3 months. ADMA, SDMA, and MIS levels were taken and recorded before the patient started the hemodialysis session. Bivariate analysis was performed using Spearman and Mann-Whitney analysis and multivariate analysis using linear regression.

Results: A total of 23 samples were male (48.9%) with an average age of 51.2 years. The median Albumin is 4.0 g/dl and the median TIBC is 220 mcg/dl. The median ADMA was 82 ng/ml, the median SDMA was 599 ng/ml, the ADMA/SDMA ratio was 0.14, and the MIS score was 4 (3-6). MIS score > 5 is 34% with < 5 is 66%. In bivariate and multivariate analysis after adjusted for the use of ACE inhibitors, no relations were found between the ADMA/SDMA ratio and MIS (p=0.154).

Conclusion: No correlation was found between the ratio of ADMA/SDMA to MIS in CKD patients who underwent HD 2x a week."