scholarly journals Gambaran kadar natrium dan klorida pada pasien penyakit ginjal kronik stadium 5 non-dialisis

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Ryan Yefta Tambajong ◽  
Glady I. Rambert ◽  
Mayer F. Wowor
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Salt Intake ◽  
Descriptive Study ◽  
Significant Progress ◽  
Chloride Level ◽  
Progressive Decline ◽  
Probability Sampling ◽  
Consecutive Sampling ◽  
Pathophysiological Process

Abstract: Chronic kidney disease (CKD) is a pathophysiological process with a variety of etiology, causing a progressive decline in kidney function, and generally ends with kidney failure. Although significant progress has been made for the treatment of CKD, it was not satisfying yet, especially at the final stage of the disease. Reducing salt intake is one of the options. Approximately, 60% of non-dialysis CKD patients suffered from hyponatremia with normal chloride levels. This study aimed to obtain the profile of the sodium and chloride levels in non-dialysis CKD patients. This was a descriptive study and was carried out at two hospitals, Prof. Dr. R. D. Kandou Hospital Manado and Advent Hospital Manado. Samples were blood samples of 35 patients suffering from stage 5 non-dialysis CKD determined by using consecutive sampling of non-probability sampling model. The results showed that based on the laboratory result, there were 19 patients diagnosed with stage 5 non-dialysis CKD with hyponatremia (54.3%) and 19 patients with imbalance chloride levels consisted of 8 patients with hypochloremia (22.9%) and 8 patients with hyperchloremia (22.9%). Conclusion: In stage five non-dialysis chronic kidney disease patients, sodium and chloride imbalance commonly occurred as hyponatremia, however, hypo and hyperchloremia had the same occurence. Keywords: sodium level, chloride level, stage 5 chronic kidney disease, non-dialysis Abstrak: Penyakit ginjal kronik (PGK) adalah suatu proses patofisologis dengan etiologi beragam, mengakibatkan penurunan fungsi ginjal yang progresif, dan umumnya berakhir dengan gagal ginjal. Meskipun kemajuan signifikan telah diperoleh dalam pengobatan PGK, hasil pengobatan tersebut belum memuaskan, terutama pada pasien dengan tahap akhir penyakit. Pengurangan asupan garam ialah salah satu opsi tersebut. Sekitar 60% dari pasien PGK non-dialisis mengalami hiponatremia dengan kadar klorida yang masih normal. Penelitian ini bertujuan untuk mengetahui gambaran kadar natrium dan klorida pada pasien PGK stadium 5 non-dialisis. Jenis penelitan ini deskriptif. Penelitian dilakukan pada dua rumah sakit, yaitu RSUP Prof. Dr. R. D. Kandou Manado dan Rumah Sakit Advent Manado. Sampel penelitian ialah sampel darah dari 35 pasien yang menderita PGK stadium 5 non-dialisis yang ditentukan dengan cara non-probability sampling jenis consecutive sampling. Hasil penelitian memperlihatkan bahwa berdasarkan hasil pemeriksaan laboratorium yang dilakukan terdapat 19 pasien (54,3%) yang terdiagnosis PGK stadium 5 non-dialisis mengalami hiponatremia dan 19 pasien mengalami gangguan keseimbangan kadar klorida, yang terdiri dari 8 pasien (22,9%) mengalami hipokloremia dan 8 pasien (22,9%) mengalami hiperkloremia. Simpulan: Pada pasien penyakit ginjal kronik stadium 5 non-dialisis, gangguan keseimbangan kadar natrium dan klorida yang sering terjadi ialah hiponatremia, sedangkan kejadian hipokloremia dan hiperkloremia ditemukan sama banyak.Kata kunci: kadar natrium, kadar klorida, penyakit ginjal kronik stadium 5, non dialisis

scholarly journals Gambaran kadar kreatinin serum pada pasien penyakit ginjal kronik stadium 5 non dialisis

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Astrid A. Alfonso ◽  
Arthur E. Mongan ◽  
Maya F. Memah
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Creatinine Level ◽  
Research Method ◽  
Research Result ◽  
Laboratory Result ◽  
Cross Sectional ◽  
Progressive Decline ◽  
Probability Sampling ◽  
Consecutive Sampling

Abstract: Chronic kidney disease is a pathophysiology process with various etiology, causing a progressive decline on kidney function, and in general ends with kidney failure (stage 5). For the last forty years, creatinine serum had been the most common and affordable detection serum to measure kidney performance. The amount of creatinine serum is increased on non-dialysis chronic kidney disease patients. Approximately, 57% of non-dialysis chronic kidney disease patients have 7-12 mg/dL creatinine level. Research objective: To understand the description of creatinine serum level on non-dialysis chronic kidney disease patients. Research method: Cross sectional descriptive, to obtain the data of creatinine serum on non-dialysis chronic kidney disease patients carried out on December 2015 – January 2016 at two hospitals, which are RSUP. Prof. Dr. R. D. Kandou Manado and Rumah Sakit Advent Manado. The research sample were the blood sample from 35 people suffering a stage five non dialysis chronic kidney disease, which determined by consecutive sampling from non-probability sampling model. Result: Based on the laboratory result, the 35 patients diagnosed with a stage five non dialysis chronic kidney disease are undergoing an increase on creatinine serum (100%). Conclusion: Based on the research result, it can be concluded that the increase of creatinine level is occurred on stage five non dialysis chronic kidney disease patients.Keywords: creatinine serum, stage five chronic kidney disease, non-dialysis.Abstrak: Penyakit ginjal kronik adalah suatu proses patofisiologi dengan etiologi yang beragam, mengakibatkan penurunan fungsi ginjal yang progresif, dan pada umumnya berakhir dengan gagal ginjal (stadium 5). Selama 40 tahun terakhir, kreatinin serum telah menjadi petanda serum paling umum dan murah untuk mengetahui fungsi ginjal. Kadar kreatinin serum meningkat pada pasien gagal ginjal non dialisis. Sekitar 57% dari pasien gagal ginjal non dialisis memiliki kadar kreatinin 7-12 mg/dL. Tujuan Penelitian: untuk mengetahui gambaran kadar kreatinin serum pada pasien penyakit ginjal kronik stadium 5 non dialisis. Metode Penelitan: deskriptif cross sectional, untuk mendapatkan data tentang kadar kreatinin serum pada pasien penyakit ginjal kronik stadium 5 non dialisis yang dilakukan sejak Desember 2015-Januari 2016 di dua rumah sakit yaitu RSUP. Prof. Dr. R. D. Kandou Manado dan Rumah Sakit Advent Manado. Sampel penelitian adalah sampel darah dari 35 orang yang menderita penyakit ginjal kronik stadium 5 non dialisis ditentukan dengan cara non-probability sampling jenis consecutive sampling. Hasil: Berdasarkan hasil pemeriksaan laboratorium yang dilakukan, terdapat 35 pasien yang terdiagnosis penyakit ginjal kronik stadium 5 non dialisis mengalami peningkatan kadar kreatinin serum (100%). Simpulan: Dari hasil penelitian dapat disimpulkan bahwa terjadi peningkatan kadar kreatinin serum pada pasien penyakit ginjal kronik stadium 5 non dialisis.Kata kunci: kreatinin serum, penyakit ginjal kronik stadium 5, non dialysis

scholarly journals Gambaran kadar ureum pada pasien penyakit ginjal kronik stadium 5 non dialisis

2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Irendem K. A. Loho ◽  
Glady I. Rambert ◽  
Mayer F. Wowor
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Laboratory Tests ◽  
Filtration Rate ◽  
Descriptive Study ◽  
Clinical Syndrome ◽  
Blood Samples ◽  
Pathophysiological Process ◽  
Ckd Stage ◽  
Observational Descriptive Study

Abstract: Chronic kidney disease (CKD) is a pathophysiological process with diverse etiology, resulting in a progressive decreased in renal function, and generally ends up with kidney failure. In CKD patient, the level of urea increases -uremia- a clinical syndrome that occurs in all organs due to the increased level of urea. During catabolism process, protein is broken down into amino acids and deamination ammonia which is further synthesized to become urea. Increased level of urea depends on the glomerular filtration rate (GFR). Decreased of GFR (<15ml / min) can cause renal failure and uremia. This study aimed to determine the levels of urea in patients with stage 5 CKD non-dialysis. This was an observational descriptive study. This study was conducted from December 2015 to January 2016 at two hospitals, Prof. Dr. R. D. Kandou Hospital and Adventist Hospital Manado. Samples were blood samples of all patients suffering from CKD stage 5 non-dyalisis within the specified time. The results of laboratory tests showed that of 35 patients diagnosed with stage 5 CKD non-dialysis all had increased urea levels (100%). Conclusion: There was an increase in urea level of patients with stage 5 chronic kidney disease non-dialysis either of outpatients or inpatients.Keywords: urea serum, stage 5 non-dialysis chronic kidney disease.Abstrak: Penyakit ginjal kronik (PGK) merupakan suatu proses patofisiologi dengan etiologi beragam, mengakibatkan penurunan fungsi ginjal yang progresif dan umumnya berakhir dengan gagal ginjal. Umumnya pada PGK terjadi peningkatan kadar ureum dan mengakibat-kan terjadinya uremia yaitu suatu sindrom klinik yang terjadi pada semua organ akibat meningkatnya kadar ureum. Dalam proses katabolisme, protein dipecah menjadi asam amino dan deaminasi ammonia yang selanjutnya disintesis menjadi urea. Peningkatan kadar ureum bergantung pada tingkat laju filtrasi glomerulus (LFG). Pada penurunan LFG (<15ml/mnt) dapat terjadi gagal ginjal dan uremia. Penelitian ini bertujuan untuk mengetahui gambaran kadar ureum pada pasien penyakit ginjal kronik stadium 5 non-dialisis. Jenis penelitian ini ialah deskriptif observasional. Penelitian dilakukan sejak Desember 2015-Januari 2016 di RSUP Prof. Dr. R. D. Kandou dan RS Advent Teling Manado. Sampel penelitian ialah sampel darah dari semua pasien yang menderita penyakit ginjal kronik stadium 5 nondialisis dalam kurun waktu yang ditentukan. Hasil pemeriksaan laboratorium dari 35 pasien yang terdiagnosis penyakit ginjal kronik stadium 5 non dialisis memperlihatkan peningkatan kadar ureum serum (100%). Simpulan: Terjadi peningkatan kadar ureum serum pada pasien penyakit ginjal kronik stadium 5 non-dialisis baik yang dirawat jalan maupun dirawat inap.Kata kunci: ureum, penyakit ginjal kronik stadium 5 non dialisis

scholarly journals Gambaran kadar kalsium pada pasien penyakit ginjal kronik stadium 5 non dialisis

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Nur Azizah Idris ◽  
Arthur E. Mongan ◽  
Maya F. Memah
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
The Body ◽  
Disease Stage ◽  
Cross Sectional ◽  
Probability Sampling ◽  
Consecutive Sampling ◽  
Ckd Stage ◽  
End Stage

Abstract: Calcium is the largest mineral in the body and is necessary in most biological processes. The body's calcium levels are influenced by a variety of renal disorders, one of which is chronic kidney disease. Chronic kidney disease is a pathophysiological process with diverse etiology, resulting in a progressive decline in renal function, and generally end up with kidney failure (stage 5 / end stage). This study aims to describe the levels of calcium in patients with non dialysis stage 5 chronic kidney disease. The method used in this study was a descriptive study conducted from December 2015-January 2016 at two hospitals, Prof. Dr. R. D Kandou hospital and Advent Teling hospital in Manado. The samples were blood samples of all patients with non-dialysis CKD stage 5 in the period and criteria set determined by non-probability sampling types consecutive sampling. Examination serum calcium using O-Cresolphthalein Complexon method. The result obtained 22 (62.9%) were decreased calcium levels (hypocalcemia), 12 (34.3%) calcium levels nomal and 1 (2.9%) with increased levels of calcium (hypercalcemia). The results of this study concluded that most of the non-dyalisis stage 5 chronic kidney disease patients (62,9%) were decline in calcium levels.Keywords: calcium, chronic kidney disease stage 5, non dialysisAbstrak: Kalsium sangat penting karena merupakan mineral terbanyak dalam tubuh dan diperlukan pada sebagian besar proses biologis. Kadar kalsium tubuh dipengaruhi oleh berbagai gangguan ginjal, salah satunya penyakit ginjal kronik. Penyakit ginjal kronik adalah suatu proses patofisiologis dengan etiologi yang beragam, mengakibatkan penurunan fungsi ginjal yang progresif, dan pada umumnya berakhir dengan gagal ginjal (stadium 5/end stage). Penelitian ini bertujuan untuk mengetahui gambaran kadar kalsium pada pasien penyakit ginjal kronik stadium 5 non dialisis. Metode yang digunakan pada penelitian ini adalah deskriptif cross sectional dilakukan sejak Desember 2015-Januari 2016 di dua rumah sakit yaitu RSUP. Prof. Dr. R. D. Kandou Manado dan Rumah Sakit Advent Manado. Sampel penelitian adalah sampel darah dari semua pasien PGK stadium 5 non dialisis dalam kurun waktu dan kriteria yang telah ditentukan dengan cara non-probability sampling jenis consecutive sampling. Pemeriksaan kalsium serum dengan metode O-Cresolphthalein Complexon. Hasilnya didapatkan 22 orang (62,9%) yang mengalami penurunan kadar kalsium (hipokalsemia), 12 orang (34,3%) kadar kalsium nomal dan 1 orang (2,9%) dengan peningkatan kadar kalsium (hiperkalsemia). Kesimpulannya sebagian besar terjadi penurunan kadar kalsium (62,9%) pada pasien penyakit ginjal kronik stadium 5 non dialisis.Kata kunci: kalsium, penyakit ginjal kronik stadium 5, non dialisis

Avaliação da Resiliência em Pacientes com Insuficiência Renal Crônica Submetidos à Hemodiálise / Assessment of Resilience in Patients With Chronic Kidney Disease Undergoing Hemodialysis

1970 ◽  
Vol 6 (1) ◽  
pp. 5-13
Author(s):  
Renata Izabel dos Santos ◽  
Otávia Regina Souza Costa
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Health Status ◽  
Chronic Renal Failure ◽  
Kidney Disease ◽  
Renal Insufficiency ◽  
Social Economic ◽  
Descriptive Study ◽  
Psychological Resilience ◽  
Resilience Scale

RESUMOObjetivo: Avaliar o nível de resiliência dos portadores de insuficiência renal crônica em tratamento de hemodiálise. Materiais e Métodos: Estudo prospectivo, quantitativo e de abordagem descritiva. A amostra foi constituída por 61 pacientes em tratamento dialítico. Para obtenção dos resultados, foi utilizada a escala de resiliência, desenvolvida por Wagnild e Young (1993) e adaptada por Pesce et al., (2005). Foi aplicado, também, um questionário para caracterização pessoal, familiar, social, econômica e de saúde do grupo. Resultados: Foi constatado que 61% dos pacientes apresentaram tendência à resiliência. O gênero masculino obteve maior pontuação, sugerindo maior tendência à resiliência, bem como os pacientes que são praticantes de uma religião.  Conclusão: Os resultados assinalam que os pacientes em tratamento dialítico no hospital apresentam capacidade à resiliência, o que sugere melhor adaptação ao tratamento.Palavras-chave: Avaliação, Resiliência psicológica, Insuficiência renal crônica.ABSTRACTObjective: To evaluate de the level of resilience in patients with chronic renal failure undergoing dialysis. Materials and Methods: Prospective, quantitative and descriptive study. The sample consisted of 61 patients on dialysis. To obtain the results we used Resilience Scale developed by Wagnild and Young (1993) and adapted by Pesce et al., (2005). A questionnaire to characterize personal, familiar, social, economic and health status was applied. Results: It was found that 61% of patients showed trend to resilience. Males had higher scores, suggesting more likelihood to resilience, as well as patients who were practitioners of a religion. Conclusion: The results indicate that the majority of patients on dialysis have capability of resilience, which suggests better adaptation to treatment.Keywords: Evaluation, Psychological resilience, Chronic renal insufficiency.

scholarly journals Altered dietary salt intake for people with chronic kidney disease

2021 ◽  
Vol 2021 (6) ◽  
Author(s):  
Emma J McMahon ◽  
Katrina L Campbell ◽  
Judith D Bauer ◽  
David W Mudge ◽  
Jaimon T Kelly
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Salt Intake ◽  
Dietary Salt ◽  
Dietary Salt Intake

scholarly journals An In-Depth Review of the Evidence Linking Dietary Salt Intake and Progression of Chronic Kidney Disease

2006 ◽  
Vol 26 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Charlotte Jones-Burton ◽  
Shiraz I. Mishra ◽  
Jeffrey C. Fink ◽  
Jeanine Brown ◽  
Weyinshet Gossa ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Salt Intake ◽  
Dietary Salt ◽  
Dietary Salt Intake

scholarly journals HUBUNGAN KOMPLIKASI INTRA HEMODIALISIS DENGAN KUALITAS HIDUP PADA PASIEN CHRONIC KIDNEY DISEASE (CKD) STAGE V YANG MENJALANI HEMODIALISIS DI RUANG HEMODIALISA BRSU TABANAN TAHUN 2017

2018 ◽  
Vol 2 (1) ◽  
pp. 9
Author(s):  
Kadek G Pebriantari ◽  
IGA Puja Astuti Dewi
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Significant Relationship ◽  
Chi Square ◽  
Cross Sectional ◽  
Probability Sampling ◽  
Ckd Stage ◽  
Non Parametric

ABSTRAKLatar Belakang. Hemodialisis aman dan bermanfaat untuk pasien, namun bukan berarti tanpa efek samping. Berbagai komplikasi dapat terjadi pada saat pasien menjalani hemodialisis. Komplikasi ini dapat mengakibatkan timbulnya masalah baru yang lebih kompleks, yaitu dapat mempengaruhi kualitas hidup bahkan menimbulkan kematianTujuan. Untuk mengetahui hubungan komplikasi intra hemodialisis dengan kualitas hidup  pada pasien Chronic Kidney Disease (CKD) Stage V yang menjalani hemodialisis.Metode. Jenis penelitian adalah analitik korelasional dengan pendekatan cross-sectional. Sampel pada penelitian ini berjumlah 166 responden diambil dengan teknik non probability sampling yaitu total sampling. Pengumpulan data menggunakan kuesioner dan lembar observasi,dianalisa dengan uji non parametric (Chi Square).Hasil. Rata – rata jumlah komplikasi intra hemodialisis adalah kurang dari dua komplikasi (sedikit komplikasi). Hipertensi intra hemodialisis adalah komplikasi terbanyak yang ditemukan (52,3%). Kejang dan penurunan kesadaran merupakan komplikasi yang tidak pernah dialami oleh responden selama penelitian (0%).Kualitas hidup pasien CKD stage V yang menjalani HD di BRSU Tabanan masuk dalam kategori kualitas baik. Hasil uji statistik diperoleh nilai p < 0.001 bahwa ada hubungan yang signifikan antara komplikasi intra hemodialisis dengan  kualitas hidup pada pasien yang menjalani HD. Dari hasil analisis diperoleh pula nilai OR = 0,005, artinya responden yang memiliki banyak komplikasi mempunyai peluang 0,005 kali memiliki kualitas hidup buruk dibanding responden yang memiliki sedikit komplikasi.Kesimpulan. Ada hubungan yang signifikan antara komplikasi intra hemodialisis dengan  kualitas hidup pada pasien yang menjalani hemodialisis.KataKunci: Komplikasi Intra Hemodialisis, Kualitas Hidup, Hemodialisis ABSTRACTBackground: Hemodialysis is safe and beneficial to the patient. However, there are various complications may occur when the patients undergo hemodialysis. These complications can lead to the emergence of new problems which are more complex and affect to the quality of life and even cause death.Aim: To determine the relationship of intra hemodialysis complications with quality of life in patients with Chronic Stage Kidney Disease (CKD) Stage V who undergo hemodialysis.Method:This study employed correlational analytic design with cross-sectional approach. To conduct this study, there were 166 respondents recruited as the sample by using probability sampling with total sampling technique. The data were collected by using questionnaire and observation sheet. Further, the data were analyzed by non-parametric test (Chi Square).Finding: The findings indicated that the average number of intra hemodialysis complications is less than two complications (few complications). There were found that 52.3% patients who had complication of hypertension intra hemodialysis. On the other hand, there was 0%of the respondents experienced seizures and decreased awareness complications during the study. The quality of life of CKD stage V patients underwenthemodialysis at BRSU Tabanan is categorized as good quality. The statistical test obtained p <0.001, it meant that there was a significant relationship between intra hemodialysis complications with quality of life in patients underwenthemodialysis. It also found that the analysis results of OR = 0.005, it meant that respondents who had many complications have a chance of 0.005 times experienced poor quality of life rather than the patients who had few complications.Conclusion: There is a significant relationship between intra hemodialysis complications and quality of life in patients undergo hemodialysis. Keywords: Complications of Intra Hemodialysis, Quality of Life, Hemodialysis

scholarly journals Gambaran Anemia pada Subjek Penyakit Ginjal Kronik Stadium 4 dan 5 di Poliklinik Ginjal-Hipertensi RSUP Prof. Dr. R. D. Kandou

e-CliniC ◽  
2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Yordhan Tamsil ◽  
Emma Sy. Moeis ◽  
Frans Wantania
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medical Records ◽  
Iron Status ◽  
Descriptive Study ◽  
Transfusion Therapy ◽  
Female Age ◽  
Stage 4 ◽  
Almost All ◽  
Age Range

Abstract: Anemia is a complication of chronic kidney disease (CKD) that often occurs. Moreover, it can occur earlier than other complications of CKD in almost all patients with late stage kidney disease. This study was aimed to obtain the profile of anemia in subjects with stage 4 and 5 of chronic kidney disease. This was a retrospective and descriptive study using medical records of patients with CKD associated with anemia for two years. The results showed that of 428 CKD patients, 131 suffered from anemia (30.60%). The majority of patients were female (54.19%), age range 60-69 years (44.27%), non-dialysis stage 5 of CKD patients (74.04%), had sufficient iron status (79.38%). However, 15,26% of the 131 patients got blood transfusion therapy. In conclusion, the majority of CKD patients were stage 5 ND, female, age range of 60-69 years, had sufficient iron status, and were not treated with blood transfusion.Keywords: chronic kidney disease, anemia Abstrak: Anemia merupakan komplikasi penyakit ginjal kronik (PGK) yang sering terjadi, bahkan dapat terjadi lebih awal dibandingkan komplikasi PGK lainnya dan hampir pada semua pasien penyakit ginjal tahap akhir. Penelitian ini bertujuan untuk mengetahui gambaran anemia pada subyek penyakit ginjal kronik stadium 4 dan 5 di Poliklinik Ginjal-Hipertensi RSUP Prof. Dr. R. D. Kandou. Jenis penelitian ialah metode deskriptif retroskpektif dengan mengunakan data rekam medik pasien PGK dengan anemia selama dua tahun. Hasil penelitian memperlihatkan dari 428 pasien PGK didapatkan 131 pasien dengan anemia pada PGK (30,60%). Mayoritas pasien ialah jenis kelamin perempuan (54,19%), usia 60-69 tahun (44,27%), dan PGK derajat 5 non-dialisis (74,04%), memiliki status besi cukup (79,38%). Terdapat 15,26% dari pasien yang mendapatkan terapi transfusi darah. Simpulan penelitian ini ialah pasien terbanyak dengan derajat 5 ND, jenis kelamin perempuan, rentang usia 60-69 tahun, dengan status besi cukup, dan tidak mendapat terapi transfusi darah.Kata kunci: penyakit ginjal kronik, anemia

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