Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar Belakang: Pruritus menjadi salah satu gejala yang dialami oleh pasien dengan penyakit ginjal kronik (PGK). Pruritus yang berasosiasi dengan PGK mayoritas terjadi pada pasien yang menjalani hemodialisis (HD) dan dapat terjadi pada resipien transplantasi ginjal (RTG). Gejala pruritus yang tidak ditangani dengan baik dapat memberikan dampak terhadap kualitas hidup. Belum terdapat penelitian yang membandingkan proporsi derajat keparahan pruritus, kualitas hidup, dan korelasi berbagai faktor biokimia antara pasien HD dengan RTG di Indonesia. Tujuan: Membandingkan derajat keparahan pruritus, kualitas hidup, serta korelasi kadar hs-CRP, kalsium, fosfat, dan e-GFR antara pasien PGK yang menjalani HD dengan RTG. Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang. Setiap SP dilakukan anamnesis, pemeriksaan fisis, dan pemeriksaan laboratorium. Skala gatal 5 dimensi (5-D) digunakan untuk evaluasi derajat keparahan pruritus dan Indeks Kualitas Hidup Dermatologi (IKHD) digunakan dalam menilai kualitas hidup. Analisis statistik yang sesuai dilakukan untuk membuktikan hipotesis penelitian dengan nilai kemaknaan yang digunakan adalah p <0,05. Hasil: Dari 30 SP di masing-masing kelompok, proporsi pruritus derajat sedang-berat sebesar 76,7% pada kelompok HD sedangkan pada kelompok RTG sebanyak 83,3% mengalami pruritus derajat ringan (RR = 4,6; IK 95% = 2,02–10,5; p <0,001). Median skor IKHD pada kelompok HD adalah sebesar 5 (3–6) sedangkan pada kelompok RTG sebesar 3 (2–4) (p <0,001). Terdapat korelasi positif yang bermakna antara hs-CRP dengan skor skala gatal 5-D pada kelompok HD (r = 0,443; p <0,05). Terdapat korelasi negatif yang bermakna antara e-GFR dengan skor skala gatal 5-D pada RTG (r = -0,424; p <0,05). Tidak terdapat korelasi yang bermakna secara statistik antara kadar kalsium dan fosfat dengan skor skala gatal 5-D pada kedua kelompok. Kesimpulan: Pasien HD lebih banyak mengalami pruritus derajat sedang-berat dibandingkan pada RTG. Pruritus pada kelompok HD berdampak ringan hingga sedang terhadap kualitas hidup sedangkan pada kelompok RTG pruritus berpengaruh ringan terhadap kualitas hidup. Pada pasien HD, semakin tinggi kadar hs-CRP maka semakin meningkat skor skala gatal 5-D. Pada pasien RTG, semakin menurun nilai e-GFR maka semakin meningkat skor skala gatal 5-D. ...... Background: Pruritus is one of the symptoms experienced by patients with chronic kidney disease (CKD). Most patients with chronic kidney disease-associated pruritus (CKD-aP) occur in dialysis patients and could also happen in kidney transplant (KT) recipients. Inappropriate management of pruritus could impact the quality of life (QoL). No studies have compared the severity of pruritus, QoL, and the correlation of various biochemical factors between hemodialysis (HD) and KT recipients in Indonesia. Objective: To compare the severity of pruritus, QoL, and the correlation of hs-CRP, calcium, phosphate, and e-GFR levels between HD and KT recipients. Methods: This is a cross-sectional analytic observational study. Medical history, physical examination, and laboratory examination were conducted on each subject. The 5-dimensional (5-D) itch scale was used to evaluate the severity of pruritus. Dermatology Life Quality Index (DLQI) was used to assess the QoL. Appropriate statistical analysis was conducted to prove the research hypothesis with a significance value of p <0.05. Results: Out of 30 subjects in each group, the proportion of moderate to severe pruritus was 76.7% in the HD group. In the KT group, 83.3% experienced mild pruritus (RR = 4.6; CI 95% = 2.02– 10.5; p <0.001). The median DLQI score in the HD group was 5 (3–6), while in the KT group was 3 (2–4) (p <0.001). There was a significant positive correlation between hs-CRP and the 5-D itch scale in the HD group (r = 0.443; p <0.05). The KT group had a significant negative correlation between e-GFR and the 5-D itch scale (r = -0.424; p <0.05). Both groups had no statistically significant correlation between calcium and phosphate levels and the 5-D itch scale. Conclusion: Moderate-to-severe pruritus was more common in HD patients than in KT recipients. Pruritus in HD patients had a mild to moderate effect on QoL, whereas pruritus in KT recipients had a mild impact on QoL. A higher level of hs-CRP in HD patients results in a higher 5-D itch scale. In KT recipients, the lower the e-GFR value, the higher the 5-D itch scale.

Abstrak :
ABSTRAK Latar Belakang: Prevalensi penyakit ginjal kronik (PGK) meningkat pada usia lanjut. Berdasarkan Riskesdas 2013, prevalensi PGK lebih tinggi pada usia 55-75 tahun dibandingkan usia kurang dari 55 tahun. Pada usia lanjut terjadi perubahan struktur dan fungsi ginjal, serta adanya riwayat penyakit komorbid seperti diabetes melitus (DM), hipertensi, penyakit jantung dan pembesaran prostat, menjadi faktor risiko yang meningkatkan terjadinya PGK. Komplikasi yang dapat timbul pada penderita PGK antara lain frailty dan protein energy wasting, yang menyebabkan penurunan kapasitas fungsional dan kualitas hidup, serta peningkatan morbiditas dan mortalitas. Terapi nutrisi yang adekuat berperan penting untuk mencegah protein energy wasting dan komplikasi lain yang dapat timbul pada PGK. Metode: Laporan serial kasus ini memaparkan empat kasus PGK pada pasien usia di atas 60 tahun. Dua pasien memiliki penyakit komorbid DM dan hipertensi, dan dua lainnya hanya hipertensi. Keempat pasien dalam serial kasus ini termasuk PGK derajat IV dan V. Pada dua kasus dilakukan hemodialisis, sementara pada dua lainnya belum dilakukan. Masalah yang timbul pada keempat kasus adalah terdapat gejala-gejala sindroma uremia yaitu mual, muntah, anoreksia, lemas, sesak, dan anemia sehingga asupan makanan tidak adekuat dan terjadi penurunan kapasitas fungsional. Kebutuhan energi pasien dihitung dengan menggunakan persamaan Harris-Benedict ditambah faktor stres dan pemberian protein disesuaikan dengan sudah atau belum dilakukan hemodialisis. Komposisi karbohidrat dan lemak disesuaikan dengan rekomendasi theurapeutic lifestyle changes (TLC) dan American Diabetes Association (ADA). Suplementasi mikronutrien diberikan sesuai dengan kondisi pasien. Pemantauan pasien dilakukan setiap hari dengan memperhatikan perubahan gejala klinis, tanda vital, imbang cairan, kapasitas fungsional, analisis dan toleransi terhadap makanan, serta hasil pemeriksaan laboratorium. Hasil: Pemantauan yang dilakukan pada empat pasien selama perawatan di rumah sakit menunjukkan terjadi perbaikan gejala klinis serta peningkatan asupan makanan dan kapasitas fungsional. Kesimpulan: Terapi nutrisi dapat mendukung terapi utama pada penderita PGK usia lanjut dalam memperbaiki keadaan klinis dan kapasitas fungsional, serta mencegah komplikasi lebih lanjut

---

ABSTRACT Background: The prevalence of chronic kidney disease (CKD) increases in the elderly. Based on Riskesdas 2013, the prevalence of CKD is higher in the age of 55-75 years old compared to below 55 years of age. In the elderly, there are alterations in kidney structure and function, as well as history of comorbidities include diabetes mellitus, hypertension, heart disease and prostate hypertrophy that increase the factor CKD. Complication that may occur in patients with CKD including frailty and protein energy wasting, which can cause decreased functional capacity and quality of life, and increased morbidity and mortality. Adequate nutrition therapy plays an important role in preventing protein energy wasting and other complications that may arise in CKD. Methods: This case series report describes four cases of CKD in patients aged above 60 years old. Two patients have comorbid disease diabetes mellitus and hypertension and the others have only hypertension. The four patients in this case series are in CKD stage IV and V. Two cases with hemodialysis, while in the others has not done yet. Problems arising in all cases are uremic syndrome symptoms such as nausea, vomiting, anorexia,fatigue, dypsnea, and anemia causing inadequate food intake and decreased functional capacity. Energy requirements of the patients calculated using the Harris-Benedict equation added by stress factor and the amount of protein depends on whether the hemodialysis has or has not been applied. Carbohydrate and fat composition appropriated to the theurapeutic lifestyle changes (TLC) and the American Diabetes Association (ADA) recommendations. Micronutrients supplementation was given in accordance to patient's condition. Patient monitoring is carried out every day by observing changes in clinical symptoms, vital signs, fluid balance, functional capacity, dietary analysis and food tolerance, and laboratory resultsResults: Monitoring conducted in the four patients during treatment at the hospital showed the improvements in clinical symptoms, and increased in food intake and functional capacity.

Abstrak :
Penyakit ginjal dengan berbagai manifestasinya memerlukan berbagai pemeriksaan penunjang untuk melengkapi data penderita. Pada umumnya pemeriksaan penunjang ini digunakan sebagai alat bantu diagnostik, untuk melihat hasil penanggulangan/pengobatan penderita, dan untuk mengikuti perjalanan penyakit. Salah satu pemeriksaan penunjang untuk membedakan kelainan ginjal glomeruler dan tubular adalah analisa protein urin menggunakan tehnik sodium dodecyl sulfate polyacrylamid gel electrophoresis (SDS-PAGE). Dengan pemeriksaan ini dapat dibedakan pola ekskresi protein pada kelainan ginjal glomeruler, tubuler, atau campuran keduanya. β-N-acetylglucosaminidase (β-NAG) adalah enzim yang dibentuk oleh lisosom sel tubulus proksimal dan dilepaskan ke dalam urin. Karena itu dianggap lebih spesifik untuk menentukan adanya kelainan tubulus dibandingkan dengan tes lainnya seperti β2-mikroglobulin. Pada penelitian ini kami mencari hubungan antara pola ekskresi protein dan aktivitas β-NAG dalam urin penderita dengan berbagai kelainan ginjal. Hasil menunjukkan adanya peningkatan β-NAG pada kasus-kasus dengan pola ekskresi protein tubuler dan campuran. Dua kasus (4,17%) dengan pola glomeruler memberikan hasil aktivitas β-NAG yang meningkat; kasus ini adalah sindroma nefrotik dan hipertensi. Pada sindroma nefrotik dengan proteinuria glomeruler non-selektif memang pernah dilaporkan adanya peningkatan β-NAG yang diduga berasal dari serum. Peningkatan β-NAG pads kasus hipertensi pada penelitian ini, tidak diketahui mekanismenya.

---

Protein Pattern And Β-Nag Activity In The Urine From Patients With Several Different Kidney AbnormalitiesKidney disease and its manifestation require different kind of laboratory tests to complete the data of the patients. In general, these tests are used as a diagnostic aid, and also in monitoring the therapy and the progress of the disease. It is important to differentiate between glomerular and tubular disorders. Sodium dodecyl sulfate polyacrylanude gel electrophoresis (SDS-PAGE) is one of the techniques that can be used to differentiate these abnormalities by looking at the protein excretion pattern in the urine. For renal tubular disorder, the determination of β-N-acetylglucosaminidase (β-NAG) is a useful test to detect the alteration of the tubular apparatus. This test is more specific than the others, such as β2-microglobulin, because β-NAG is produced by the lysosomes of the cells of proximal tubules. The aims of our study is to find a correlation between urine protein excretion pattern and β-NAG activity, and the abnormalities of the kidney. We found that β-NAG activity was increased in patients with tubular and mixed type pattern of proteinuria. The increased activity of this enzyme was also seen in 2 patients (4.7%) with glomerular pattern; one with nephrotic syndrome and the other with hypertension. In nephrotic syndrome with non-selective proteinuria, it is conceivable that some of the urine β-NAG was plasma origin. In hypertension, the mechanisme of the increasing of β-NAG activity in the urine is still unknown.

Abstrak :
Latihan fisik saat hemodialisis dapat meningkatkan sirkulasi sehingga proses difusi ureum dan kreatinin dari ekstravaskuler terutama di otot menuju ke intavaskuler semakin meningkat. Penelitian ini bertujuan untuk mengetahui pengaruh latihan fisik saat hemodialisis terhadap kadar ureum dan kreatinin, dimana desain penelitian ini menggunakan pre test - post test without control dengan jumlah sampel 31 responden. Pengaruh latihan fisik saat hemodialisis terhadap kadar ureum dan kreatinin diuji dengan paired t-test. Rata - rata kadar ureum sebelum latihan fisik 46,84 mg/dl dengan standar deviasi 14,94. Kadar ureum sesudah latihan fisik sebesar 43,23 mg/dl dengan standar deviasi 15,05. Sedangkan rata - rata kadar kreatinin sebelum latihan 4,4 mg/dl dengan standar deviasi 1,49 dan rata - rata kreatinin sesudah latihan sebesar 4,15 mg/dl. Hasil uji statistik menunjukkan ada perbedaan yang signifikan antara kadar ureum dan kreatinin sebelum dan sesudah latihan fisik nilai p = 0,000. Hasil penelitian ini dapat dijadikan dasar untuk melakukan penelitian lebih lanjut dengan desain penelitian yang berbeda untuk melihat faktor - faktor lain yang mempengaruhi penurunan kadar ureum dan kreatinin setelah diberi latihan fisik. ...... Exercise during hemodialysis can improves circulation, so the process of diffusion of urea and creatinine from extravascular especially in muscles leading to intavaskuler can be increased. This study aimed to determine the effect of physical exercise during hemodialysis on urea and creatinine levels. The design was pretest - post test without control with 31 respondents. Effect of physical exercise during hemodialysis on urea and creatinine levels the were tested by paired t-test. Mean urea levels before physical exercise was 46.84 mg / dl, with a standard deviation of 14.94. Urea levels after exercise was 43.23 mg / dl with a standard deviation of 15.05. Mean creatinine levels before exercise 4.4 mg / dl with a standard deviation of 1.49 and mean creatinine after exercise of 4.15 mg / dl. Statistical test results showed a significant difference between urea and creatinine levels before and after physical exercise with p value = 0.000. This results could be used as a basis for further research with different research designs looking for other factors affecting the decreased levels of urea and creatinine after being given physical exercise.

Abstrak :
[ABSTRAK
Latar Belakang: Penyakit ginjal kronik (PGK) merupakan penyakit progresif dan ireversibel yang mempunyai berbagai komplikasi serius serta belum ada terapi yang dapat memperbaiki kerusakan ginjal yang telah terjadi. Beberapa studi menunjukkan stres oksidatif berperan dalam patogenesis penyakit ini. Stres oksidatif terjadi akibat ketidakseimbangan produksi ROS dan pertahanan antioksidan. Nrf2 merupakan faktor transkripsi yang terlibat dalam mekanisme pertahanan sel dalam mengatasi stres oksidatif. Penelitian ini bertujuan untuk mengetahui aktivitas kuersetin sebagai aktivator Nrf2 dalam menghambat progresivitas penyakit ginjal yang diinduksi nefrektomi 5/6. Metode: Tikus Sprague-Dawley jantan dikelompokkan secara acak dalam kelompok kontrol normal (C), kontrol nefrektomi 5/6 (Nx), nefrektomi 5/6 yang diberi kuersetin dengan dosis 100 mg/kgbb/hari/p.o. (NxQ), nefrektomi 5/6 dan diberi kaptopril dengan dosis 10 mg/kgbb/hari/p.o. (NxK). Hewan coba diterminasi diakhir perlakuan untuk diambil darah, urin, dan organ ginjalnya. Pemeriksaan yang dilakukan adalah pemeriksaan proteinuria, kreatinin urin dan plasma, ureum plasma, kadar MDA plasma dan jaringan, aktivitas glutation peroksidase (GPx), kerusakan jaringan (histopatologi) dan ekspresi Nrf2 (imunohistokimia). Hasil: Hasil penelitian menunjukkan bahwa nefrektomi 5/6 dapat menimbulkan peningkatan proteinuria, ureum plasma, dan derajat fibrosis ginjal secara signifikan. Nefrektomi 5/6 cenderung meningkatkan kreatinin plasma, kadar MDA ginjal, aktivitas GPx, dan menurunkan MDA plasma serta ekspresi Nrf2. Kuersetin tidak mempengaruhi proteinuria, ureum dan kreatinin plasma, dan derajat fibrosis ginjal. Kuersetin cenderung menurunkan kadar MDA dan meningkatkan aktivitas enzim GPx serta ekspresi Nrf2. Kesimpulan: Kuersetin tidak mempengaruhi proteinuria, ureum dan kreatinin plasma serta kerusakan struktur jaringan atau fibrosis ginjal. Kuersetin cenderung menurunkan kadar MDA dan meningkatkan aktivitas enzim GPx serta cenderung meningkatkan ekspresi Nrf2.

---

ABSTRACT
Background: Chronic Kidney Disease (CKD) is a progressive and irreversible condition that has several serious complications and currently there has no single therapy that can repair kidney damage was occurred. Some studies suggest a role of oxidative stress in the pathogenesis of this disease. Oxidative stress is caused by an imbalance of ROS production and antioxidant defenses. Nrf2 is a transcription factor involved in cell defense mechanisms againts oxidative stress. This study was aimed to determine the quercetin activity as Nrf2 activator in inhibit the progression of 5/6 nephrectomy induced CKD in male rats. Method: Sprague-Dawley rats were randomly divided into normal control group (C), untreated 5/6 nephrectomy (Nx), quercetin-treated 5/6 nephrectomy, NxQ (100 mg / kg / day orally), captopril-treated 5/6 nephrectomy, NxK (10 mg / kg / day orally). Animal models was sacrificed at the end of intervention to take blood to measure creatinine, urea, and MDA, urine to measure protein and creatinine, and kidney organ to measure levels of MDA, glutathione peroxidase (GPx) activity, and renal damage (histopathology) and Nrf2 expression (immunohistochemistry). Results: The results showed that 5/6 nephrectomy may cause an increased of proteinuria, plasma urea, and grade of renal fibrosis significantly. 5/6 nephrectomy has trend to increased plasma creatinine, renal MDA levels, GPx activity, and decreased plasma MDA and Nrf2 expression. Quercetin did not decrease proteinuria, plasma urea and creatinine, and renal fibrosis grading. Quercetin tend to reduced levels of MDA, increased GPx enzyme activity, and expression of Nrf2. Conclusion: Quercetin does not affect proteinuria, plasma urea,plasma creatinine, and tissue damage or kidney fibrosis. Quercetin tend to reduced levels of MDA and increased the activity of GPx and Nrf2 expression.;Background: Chronic Kidney Disease (CKD) is a progressive and irreversible condition that has several serious complications and currently there has no single therapy that can repair kidney damage was occurred. Some studies suggest a role of oxidative stress in the pathogenesis of this disease. Oxidative stress is caused by an imbalance of ROS production and antioxidant defenses. Nrf2 is a transcription factor involved in cell defense mechanisms againts oxidative stress. This study was aimed to determine the quercetin activity as Nrf2 activator in inhibit the progression of 5/6 nephrectomy induced CKD in male rats. Method: Sprague-Dawley rats were randomly divided into normal control group (C), untreated 5/6 nephrectomy (Nx), quercetin-treated 5/6 nephrectomy, NxQ (100 mg / kg / day orally), captopril-treated 5/6 nephrectomy, NxK (10 mg / kg / day orally). Animal models was sacrificed at the end of intervention to take blood to measure creatinine, urea, and MDA, urine to measure protein and creatinine, and kidney organ to measure levels of MDA, glutathione peroxidase (GPx) activity, and renal damage (histopathology) and Nrf2 expression (immunohistochemistry). Results: The results showed that 5/6 nephrectomy may cause an increased of proteinuria, plasma urea, and grade of renal fibrosis significantly. 5/6 nephrectomy has trend to increased plasma creatinine, renal MDA levels, GPx activity, and decreased plasma MDA and Nrf2 expression. Quercetin did not decrease proteinuria, plasma urea and creatinine, and renal fibrosis grading. Quercetin tend to reduced levels of MDA, increased GPx enzyme activity, and expression of Nrf2. Conclusion: Quercetin does not affect proteinuria, plasma urea,plasma creatinine, and tissue damage or kidney fibrosis. Quercetin tend to reduced levels of MDA and increased the activity of GPx and Nrf2 expression., Background: Chronic Kidney Disease (CKD) is a progressive and irreversible condition that has several serious complications and currently there has no single therapy that can repair kidney damage was occurred. Some studies suggest a role of oxidative stress in the pathogenesis of this disease. Oxidative stress is caused by an imbalance of ROS production and antioxidant defenses. Nrf2 is a transcription factor involved in cell defense mechanisms againts oxidative stress. This study was aimed to determine the quercetin activity as Nrf2 activator in inhibit the progression of 5/6 nephrectomy induced CKD in male rats. Method: Sprague-Dawley rats were randomly divided into normal control group (C), untreated 5/6 nephrectomy (Nx), quercetin-treated 5/6 nephrectomy, NxQ (100 mg / kg / day orally), captopril-treated 5/6 nephrectomy, NxK (10 mg / kg / day orally). Animal models was sacrificed at the end of intervention to take blood to measure creatinine, urea, and MDA, urine to measure protein and creatinine, and kidney organ to measure levels of MDA, glutathione peroxidase (GPx) activity, and renal damage (histopathology) and Nrf2 expression (immunohistochemistry). Results: The results showed that 5/6 nephrectomy may cause an increased of proteinuria, plasma urea, and grade of renal fibrosis significantly. 5/6 nephrectomy has trend to increased plasma creatinine, renal MDA levels, GPx activity, and decreased plasma MDA and Nrf2 expression. Quercetin did not decrease proteinuria, plasma urea and creatinine, and renal fibrosis grading. Quercetin tend to reduced levels of MDA, increased GPx enzyme activity, and expression of Nrf2. Conclusion: Quercetin does not affect proteinuria, plasma urea,plasma creatinine, and tissue damage or kidney fibrosis. Quercetin tend to reduced levels of MDA and increased the activity of GPx and Nrf2 expression.]

Abstrak :
Morbiditas pasien penyakit ginjal kronis memengaruhi jenis dan jumlah terapi obat yang potensial dapat menimbulkan beragam masalah terkait obat. Salah satu peran Apoteker adalah mengidentifikasi dan mencegah terjadinya masalah terkait obat. Penelitian ini bertujuan untuk mengetahui hubungan antara polifarmasi dan masalah terkait obat serta mengevaluasi jenis dan jumlah masalah terkait obat pada pasien ginjal kronis di ruang rawat inap RS PMI Bogor. Penelitian ini menggunakan rancangan studi potong lintang. Data primer adalah data masalah terkait obat. Data sekunder dari formulir pemantauan terapi obat oleh farmasi klinik. Penelitian dilakukan di ruang instalasi farmasi RS PMI Bogor periode 28 September?05 Desember 2015. Analisis univariat dilakukan untuk memperoleh gambaran distribusi frekuensi serta proporsi dari variabel yang diteliti. Analisis multivariat uji regresi logistik menguji hubungan variabel bebas, perancu, dan masalah terkait obat. Evaluasi dilakukan terhadap 682 terapi obat dari 92 orang pasien penyakit ginjal kronik. Persentase pasien dengan polifarmasi sebesar 83,7% dan pasien dengan masalah terkait obat sebesar 73,9%. Jumlah obat penyebab masalah terkait obat sebanyak 73 obat (55,3%). Jumlah masalah terkait obat dalam kategori masalah obat sebesar 207 masalah dengan persentase efek pengobatan yang tidak optimal sebesar 67,6%. Ada hubungan bermakna antara pasien yang mendapat obat polifarmasi dan kejadian masalah terkait obat (p=0,000). Pasien penyakit ginjal kronis dengan polifarmasi berisiko 21,67 kali mengalami kejadian masalah terkait obat.

---

Morbidity in patients with chronic kidney disease affects variety of types and number of drug treatment, then it is potential to cause variety of types and number of drug-related problems. Pharmacists play a role in identifying and preventing drug-related problems. This study aimed to determine the relationship between polypharmacy and drug-related problems, as well as evaluating the type and number of drug-related problems in chronic kidney disease inpatient in Indonesian Red Cross Bogor hospital. This study was retrospective cross sectional study design. The primary data was obtained by identifying drug related problems. The secondary data was taken from drug therapy monitoring form by the clinical pharmacy. The study was conducted at the hospital pharmacy at PMI Bogor hospital during 28 September to 5 December 2015. Univariate analysis was performed to get the distribution frequency and proportion of the variables, such as the characteristics of the patient and drug therapy, as well as the number and types of drug-related problems with the classification of Pharmaceutical Care Network Europe (PCNE). Multivariate logistic regression analysis was conducted to test whether there was a relationship between the confounding variable with drug-related problems. An evaluation was taken on 682 drug treatment of 92 chronic kidney disease patients. The number of patients who experience polypharmacy was 83.7%. The number of patients experiencing drug-related problems was 73.9%. The number of problem in drug-related problems classification was 207 problems, with the nonoptimal treatment effect (67.6%). There was a significant association between patients who received polypharmacy and the incidence of drug-related problems (p=0.000). Chronic kidney disease patients who received polypharmacy had the risk of 21,667 times to experience drug-related problems.

Abstrak :
Latar belakang: Penyakit ginjal kronik PGK masih merupakan masalah kesehatan yang serius pada anak dengan morbiditas yang semakin meningkat dan memiliki dampak terutama pada kualitas hidup anak. Data Riskesdas 2013 menunjukkan prevalens PGK pada penderita ge; 15 tahun di Indonesia sebesar 0,2 . Penelitian di Kuwait melaporkan peningkatan prevalens PGK pada anak dari 188 1996 menjadi 329 per satu juta populasi anak pada tahun 2003. Tujuan: Mengetahui kualitas hidup anak PGK serta hubungannya dengan derajat keparahan, lama diagnosis, dan faktor-faktor yang berhubungan demografi. Metode: Penelitian potong lintang antara Juli 2016-Mei 2017. Subyek penelitian adalah anak berusia 2-18 tahun yang didapatkan secara consecutive sampling dan menggunakan kuesioner baku PedsQL trade; modul generik versi 4.0 yang diisi orangtua dan anak. Hasil: Total subjek adalah 112 anak. Kualitas hidup terganggu didapatkan dari laporan orangtua 54,5 dan laporan anak 56,3 . Fungsi sekolah dilaporkan paling sering terganggu pada laporan anak dan fungsi fisis pada laporan orangtua. Faktor yang berhubungan dengan kualitas hidup adalah lama diagnosis >60 bulan p=0,004 , jenis kelamin perempuan p=0,019 , dan jenjang pendidikan menengah p=0,003. Simpulan: Lebih dari separuh anak PGK menurut orangtua 54,5 dan anak 56,3 memiliki gangguan kualitas hidup terutama pada fungsi sekolah dan fungsi emosi. Lama diagnosis >60 bulan, jenis kelamin perempuan, dan jenjang pendidikan menengah merupakan faktor yang berhubungan dengan kualitas hidup anak PGK. ...... Background: Chronic kidney disease CKD is still serious health problem in children with increasing morbidity affect children's quality of life. From Riskesdas 2013, prevalence of patients CKD ge 15 years old in Indonesia is 0,2 . Research in Kuwait shows increasing prevalence children with CKD from 188 1996 to 329 per millions of the age related population in 2003. Aim: To assess the quality of life children with CKD as well as relationship with duration of diagnosis, severity, and related factors demographic. Methods: A cross sectional analytic study. Subjects were recruited from July 2016 May 2017 through consecutive sampling. CKD children aged 2 18 years were involved, patients and their parents were asked to fill out the PedsQL trade generic score scale version 4.0 questionnaire. Result: A total of 112 children were recruited, quality of life was affected from parents's reports 54,5 and children's reports 56,3. The school and emotional have lowest score affected parameter studied. Factor related to quality of life children with CKD were duration of diagnosis 60 months p 0,004 , female p 0,019 , and middle school p 0,003. Conclusion: More than half children with CKD have disturbance quality of life in general from parents's reports 54,5 and children's reports 56,3 . Duration of diagnosis 60 months, female, and middle school were related with quality of life children with CKD.

Abstrak :
ABSTRAK
Pasien penyakit ginjal kronis stadium 1-4 berisiko mengalami gagal ginjal terminal. Laju penurunan fungsi ginjal pada populasi tersebut dapat diperlambat dengan perilaku manajemen diri yang baik. Tujuan penelitian ini adalah menganalisis faktor-faktor yang berhubungan dengan perilaku manajemen diri pasien berisiko gagal ginjal terminal. Penelitian ini dilakukan dengan desain cross-sectional terhadap 129 pasien penyakit ginjal kronis stadium 1-4 di RSUP Fatmawati Jakarta. Sampel diperoleh dengan teknik consecutive sampling. Hasil analisis regresi liner berganda menunjukkan durasi penyakit, stadium penyakit, status pekerjaan, jumlah penyakit penyerta, peranan petugas kesehatan, tingkat penegtahuan manajemen diri, dan efikasi diri menjadi faktor determinan perilaku manajemen diri pasien berisiko gagal ginjal terminal (p=0,000; r=0,781; R2=0,587). Faktor yang paling dominan adalah efikasi diri (p=0,000; r=0,495) setelah dikontrol oleh variabel lain. Efikasi diri yang baik dapat meningkatkan perilaku manajemen diri. Perlu adanya upaya untuk meningkatkan perilaku manajemen diri dengan meningkatkan efikasi diri, pengetahuan, dan peran petugas kesehatan dalam pelayanan kesehatan.

---

ABSTRACT
Early stage chronic kidney disease (CKD) patients are at risk of developing end stage kidney disesae (ESKD). The decline of kidney function can be delayed by an adequate self-management behavior. Purpose of this study was to analyze factors associated with self-management behavior of patients at risk ESKD. This study was conducted using cross-sectional design of 129 patients at stage 1-4 CKD in Fatmawati Hospital, Jakarta. Samples were obtained by consecutive sampling technique. The results of multiple linear regression showed duration of CKD, stage of CKD, occupational status, number of comorbidities, role of health workers, level of self-management knowledge, and self-efficacy as determinants of self-management behavior in patients at risk of ESKD (p = 0,000; r = 0,781 ; R2 = 0.587). The most dominant factor is self-efficacy (p = 0,000; r = 0,495) after being controlled by other variables. A good self-efficacy can enhance self-management behavior. Health services need to improve self-management behavior patients at risk of developing ESKD by increasing self-efficacy, knowledge, and the role of health workers.

---