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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

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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 :
[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.

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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.

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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
Gangguan mineral tulang GMT merupakan salah satu komplikasi pada penyakitginjal kronik PGK . GMT-PGK menyebabkan gangguan sistemik padametabolisme mineral yang mengakibatkanabnormalitaskadar mineral, kelainanturn overtulang dan kalsifikasi pembuluh darah. Pada pasien PGK yang menjalanidialisis rutin GMT dapat meningkatkan angka mortalitas sebesar 20 . Penelitianini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan gangguanmineral tulang pada pasien yang menjalani hemodialisis rutin. Desain penelitian iniadalahcross sectional, menggunakan 72 responden pasien hemodialisis rutin diRSUPN. DR. Cipto Mangunkusumo Jakarta, dipilih dengan menggunakan TeknikConcecutive sampling. Data mengenai faktor-faktor yang berhubungan dengangangguan mineral tulang ini diperoleh melalui wawancara dan data rekam medikpasiendalam tiga bulan terakhir. Analisis yang digunakan adalahuji chi-square,hasil uji statistik menyatakan terdapat hubungan yang bermakna antara faktor usia,jenis kelamin, status nutrisi: obesitas, lama menjalani hemodialysis dan kepatuhanpenggunaan pengikat posfatdengan GMT p0,05 . Penelitian inimerekomendasikan kepada praktisi kesehatan untuk membuat suatu protokoluntukdeteksi dini terjadinya resiko GMTpada pasien PGKyang menjalani hemodialisisberdasarkan faktor-faktor tersebut.

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ABSTRACT
Mineral and bone disorder MBD is complications which may occur in chronickidney disease CKD . CKD MBD is characterized by systemic disorder of mineralmetabolism which leads to abnormality of blood mineral level, alterationof boneturnover, and calcification blood vessels that may result in an increased morbidityand mortality. MBD may increase mortality rate of CKD patients undergoingregular hemodialysis up to 20 . This study aimed to identify factors affectingmineral andbone disorder among patients undergoing regular hemodialysis. Thestudy design wascross sectionalwith total sample of 72 patients undergoingregular hemodialysis in RSUPN. DR. Cipto Mangunkusumo selected by consecutivesampling. Data regarding factors affecting mineral and bone disorder wereobtained through interview and medical record of the past three months. The datawere analyzed by chi square test. The result suggested that there was a significantcorrelation between age, sex, nutritional status obesity, time since firsthemodialysis and adherence to phosphate binder regimen and MBD p0.05 . Developing a protocol for early detection of complications dueto bone and mineral disorder is recommended for patient with CKD undergoingregular Hemodialysis.

Abstrak :
Pola hidup yang tidak sehat merupakan salah satu penyebab terjadinya penyakit ginjal kronik. Masyarakat perkotaan sangat rentan memiliki pola hidup tidak sehat, yang pada akhirnya dapat menyebabkan penyakit ginjal kronik. Penyakit ginjal kronik merupakan suatu keadaan dimana ginjal mengalami kerusakan yang bersifat permanen yang pada akhirnya akan berdampak pada penurunan fungsi dari ginjal. Perubahan fisik yang terjadi pada penderita penyakit ginjal kronik terkait dengan tanda dan gejala dari keparahan penyakit yang dialami tentu akan berpengaruh pada kondisi psikososial pasien. Masalah psikososial yang muncul pada penderita penyakit ginjal kronik yang dirawat di Rumah Sakit adalah ansietas. Karya Ilmiah Akhir ners ini bertujuan untuk menggambarkan asuhan keperawatan anisetas pada pasien yang mengalami penyakit Ginjal Kronik khusunya dengan teknik relaksasi. Pasien yang mampu mengatasi rasa cemasnya akan dapat meningkatkan keefektifan dari pengobatan fisik yang sedang dijalani. Sehingga, diperlukannya peran perawat dalam memberikan asuhan keperawatan psikososial agar masalah ansietas tidak menimbulkan dampak yang merugikan bagi klien. ...... Unhealthy lifestyle caused of chronic kidney disease. Urban communities are particularly vulnerable to unhealthy lifestyles, which can lead to chronic kidney disease. Chronic kidney disease is a condition which the kidney are permanently damaged and ultimately have an impact to the function of the kidney. Physical changes that occur in patients with chronic kidney disease associated with signs and symptom rsquo s the severity of the disease. It will certainly affect the psychosocial condition of patients. Psychosocial problems that arise in hopitalized patients with chronic kidney is anxiety. This Scientific works aims to describe the nursing care of anxiety in patients with Chronic Kidney disease especially with relaxation techniques. Patients who are able to overcome their anxiety will improve the effectiveness of the physical treatments that are being undertaken. Thus, the nurse 39 s role in providing psychosocial nursing care is necessary so that anxiety problems do not cause adverse impact to the patient.

Abstrak :

Latar Belakang: Penyakit Ginjal Kronik (PGK) adalah kondisi serius dengan morbiditas dan mortalitas tinggi, ditandai oleh kerusakan ginjal selama lebih dari tiga bulan. Hemodialisis adalah tatalaksana umum untuk PGK lanjut, yang dijalani oleh 19,33% pasien di Indonesia. Risiko Penyakit Kardiovaskular (PKV) pada PGK stadium 4-5 mencapai 50%, dengan 40% kematian terkait PKV. Padahal sebanyak 12,5% pasien CKD ditemukan pada pasien yang sudah memiliki penyakit kardiovaskular. Maka biomarker seperti Pentraxin-3 (PTX3) penting untuk diagnosis dan prognosis, terutama karena telah ditemukan lebih efektif daripada C-Reactive Protein (CRP) dan biomarker inflamasi lain. PTX3 juga bersifat kardioprotektif dan dapat memprediksi kejadian Major Adverse Cardiovascular Events (MACE) tetapi belum pernah ada penelitian yang memprediksi MACE pada pasien PGK. Penelitian ini termasuk dalam penelitian CARE-CKD di Rumah Sakit Cipto Mangunkusumo (RSCM) dan menganalisis kemampuan PTX3 dalam memprediksi MACE pada pasien PGK.

Tujuan: Mengetahui kadar, nilai potong, dan kemampuan PTX3 dalam memprediksi MACE pada pasien PGK yang menjalani HD di RSCM, dengan kalibrasi dan diskriminasi baik setelah dikontrol faktor jenis kelamin, usia, IMT dan infeksi.

Metode: Penelitian ini menggunakan desain kohort retrospektif. Data sekunder dari pasien PGK yang menjalani hemodialisis dianalisis untuk melihat hubungan kadar PTX3 dengan kejadian MACE selama satu tahun. Analisis statistik menggunakan SPSS versi 26.

Hasil:

Pada 74 pasien PGK yang menjalani HD di RSCM, kadar PTX–3 median adalah 0,9 ng/mL. Dari mereka, 11 pasien mengalami MACE dengan PTX–3 median 1,324 ng/mL. Analisis ROC menunjukkan AUC 0,630. PTX–3 dapat memprediksi MACE, dengan cut-off 1,317 ng/mL.

Simpulan: Pentraxin 3 dapat menjadi prediktor MACE pada pasien PGK yang menjalani HD yang baik setelah dikontrol oleh variable perancu. ......

Background: Chronic Kidney Disease (CKD) is a serious condition with high morbidity and mortality, characterized by kidney damage for over three months. Hemodialysis is a common treatment for advanced CKD, undertaken by 19.33% of patients in Indonesia. The risk of Cardiovascular Disease (CVD) in CKD stages 4-5 reaches 50%, with 40% of deaths related to CVD. Therefore, biomarkers like Pentraxin-3 (PTX3) are crucial for diagnosis and prognosis, as PTX3 has been found to be more effective than C-Reactive Protein (CRP) and other inflammatory biomarkers. PTX3 also has cardioprotective properties and can predict Major Adverse Cardiovascular Events (MACE), though no studies have yet predicted MACE in CKD patients. This research is part of the CARE-CKD study at Cipto Mangunkusumo Hospital and will analyze PTX3's ability to predict MACE in CKD patients.

Objective: To determine the levels, cut-off value, and predictive ability of PTX3 for Major Adverse Cardiovascular Events (MACE) in Chronic Kidney Disease (CKD) patients undergoing hemodialysis at Cipto Mangunkusumo Hospital, with good calibration and discrimination after controlling for gender, age, BMI, and infection factors.

Methods: This study utilized a retrospective cohort design. Secondary data from CKD patients undergoing hemodialysis were analyzed to examine the relationship between PTX3 levels and MACE occurrences over one year. Statistical analysis was conducted using SPSS version 26.

Results: In 74 CKD patients undergoing HD at Cipto Mangunkusumo Hospital, the median PTX-3 level was 0.9 ng/mL. Among them, 11 patients experienced MACE with a median PTX-3 level of 1.324 ng/mL. ROC analysis indicated an AUC of 0.630. PTX-3 can predict MACE, with a cut-off of 1.317 ng/mL.

Conclusions: Pentraxin 3 could be a predictor of MACE in CKD patients undergoing HD after calibration of confounding factors.

Abstrak :
ABSTRAK Penyakit 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.