scholarly journals The Effect of Coaching Support on Kidney Function in Chronic Kidney Disease Patients

2021 ◽  
Vol 9 (T4) ◽  
pp. 106-110
Author(s):  
Susanti Susanti ◽  
Difran Nobel Bistara
Keyword(s):  
Chronic Kidney Disease ◽  
Chronic Illness ◽  
Treatment Group ◽  
Kidney Disease ◽  
Kidney Function ◽  
Complex Disease ◽  
Early Stage ◽  
T Test ◽  
Control Group ◽  
Significant Difference

BACKGROUND: Chronic kidney disease (CKD) is a chronic illness with complex disease which could lead to other underlying diseases such as diabetes mellitus (DM), hypertension, and dyslipidemia. Urban population must manage their illness due to their occupation. Coaching support is an advanced method to help individuals manage their illnesses, especially chronic illness. Symptoms and complaints in early-stage renal disorders tend to be mild, making it difficult to diagnose only by clinical examination. Impaired kidney function can lead to progressive kidney damage. AIM: This study aimed was to analyze the effect of coaching support in maintaining kidney function in patients with CKD. METHODS: This research used quasi-experiment with pre-test and post-test with control group design. Respondents in this study were 40 CKD patients which were taken by consecutive sampling technique and divided into two groups, namely, control group and treatment group. Data were collected using blood urea nitrogen and creatinine values observation sheet. Coaching support was divided into four steps of therapy, identify the disturbance, identify based on experience, use a family support system, and evaluating the results. Data were analyzed using paired t-test and independent t-test with a significance of p < 0.05. RESULTS: This study found that there was a significant difference in kidney function between the control group and the treatment group (p = 0.000). Coaching support interventions were effective on kidney function in patients with CKD. The implementation of coaching support went well because respondents and families were proactive. CONCLUSION: Coaching support should be applied by nurses as daily activity management of CKD patients at early stage to inhibit the kidney function damage progression.

Abstract 13243: Diminished Daily Fluctuation of Heart Rate Variability in Patients with Chronic Kidney Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hisaki Makimoto ◽  
Katsuhito Fujiu ◽  
Kohei Shimizu ◽  
Eisuke Amiya ◽  
Kazuo Asada ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
High Frequency ◽  
High Frequency Component ◽  
Control Group ◽  
Holter Monitor ◽  
Significant Difference ◽  
High Incidence ◽  
Circadian Fluctuation

Introduction: Autonomic dysfunction is well known in patients with chronic kidney disease (CKD) and linked with cardiac death. In spite of a high incidence of morning death in CKD patients, circadian fluctuation in parasympathetic activation have not been studied in CKD. Hypothesis: We assessed the hypothesis that the cardiac autonomic circadian fluctuation is impaired in patients with CKD. Methods: The study population consisted of consecutive 101 patients (54 males, 70±10 years old) with CKD who underwent 24-hour Holter monitor. As a control group, 134 age and sex matched cases (66 males, 68±10 years old) without CKD who also underwent Holter monitor were recruited. Patients with diabetes orβ-blocker therapy were excluded. The high frequency component (HF), which reflected parasympathetic activity, and the low frequency to high frequency ratio (L/H ratio), which reflected, in part, sympathetic activity, were evaluated. To evaluate the contribution of CKD and other parameters to the cardiac autonomic fluctuation, the night (6PM-6AM) to day (6AM-6PM) ratio of HF and L/H ratio were analyzed utilizing a regression analysis. Results: The L/H ratio showed no significant difference during the night between the two groups, in contrast to the significant difference during the daytime. Patients with CKD showed significantly lower HF during the night as compared to control cases (P<0.05), although the daytime HF was not significantly different between the groups (Figure). Multivariate regression analysis demonstrated that CKD was independently associated with a lower night-to-day ratio of the HF and a higher night-to-day ratio of the L/H ration, even with the adjustment of age and comorbid hypertension. Conclusions: Our findings suggest that cardiac autonomic fluctuation is impaired in CKD patients. Whether a deterioration of autonomic activation might explain the high incidence of morning death in CKD patients needs to be clarified in future studies.

scholarly journals Efficacy and Safety of Tanshinone for Chronic Kidney Disease: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Yao Zhou ◽  
Shi-min Jiang ◽  
Li Li ◽  
Ying Wang ◽  
Lei Ding ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Treatment Group ◽  
Kidney Disease ◽  
Subgroup Analysis ◽  
Protein Level ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Efficacy And Safety ◽  
Urine Protein

Objective. To systematically evaluate the efficacy and safety of tanshinone for chronic kidney disease (CKD). Methods. Randomized controlled trials (RCTs) on the treatment of CKD using tanshinone were searched using 4 Chinese databases (China National Knowledge Infrastructure (CNKI), Value In Paper (VIP), Wanfang, and Chinese Biology Medicine (CBM)) and 3 English databases (PubMed, Cochrane Library, and Excerpta Medica Database (Embase)). The results included data on blood urine nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (GFR), 24 h urine protein, microalbuminuria (mALB), β2-macroglobulin (β2-MG), cystatin C (CysC), and safety events. The data were analyzed using Revman 5.3 and Stata 12.0 software. Results. Twenty-one studies were entered into this meta-analysis, which involved 1857 patients including 954 cases from the tanshinone treatment group and 903 cases from the control group. BUN levels in the tanshinone treatment group were significantly reduced compared with the control (standardized mean difference (SMD) = −0.65, 95% confidence interval (CI): −0.81 to −0.49, p<0.01). In addition, subgroup analysis indicated that tanshinone had a significant effect in reducing Scr levels at 14, 21, and 28 days. Scr levels in the tanshinone treatment group were significantly reduced compared with the control group (SMD = −1.40, 95% CI: −2.09 to −0.71, p<0.01); subgroup analysis based on treatment time also yielded the same results. GFR in the tanshinone treatment group was better than that in the control group (SMD = 0.83, 95% CI: 0.59 to 1.07, p<0.01). In terms of urine protein levels, 24 h urine protein level, mALB, and β2-MG of CKD patients were reduced to some degree compared with controls, and CysC levels in the tanshinone treatment group were also significantly reduced compared with the control group (SMD = −0.24, 95% CI: −0.44 to −0.03, p<0.05). Safety in the tanshinone treatment group did not differ significantly from that of the control group (risk ratio (RR) = 7.78, 95% CI: 0.99 to 61.05, p>0.05). Conclusion. This meta-analysis showed that tanshinone could control urine protein level in CKD patients, improve kidney function, and delay the evolution of CKD without significant side effects. However, the results were limited and should be interpreted with caution because of the low quality of the included studies. In the future, more rigorous clinical trials need to be conducted to provide sufficient and accurate evidence.

scholarly journals P0755CALCIUM/MAGNESIUM RATIO: NEW PREDICTOR OF INCREASED PULSE PRESSURE IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Eduarda Carias ◽  
Filipa Mendes ◽  
André Fragoso ◽  
Pedro Leão Neves ◽  
Ana Silva
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pulse Pressure ◽  
Descriptive Analysis ◽  
Risk Groups ◽  
T Test ◽  
Chaid Analysis ◽  
Stage 4 ◽  
Significant Difference ◽  
Calcium Magnesium

Abstract Background and Aims Cardiovascular disease (CVD) is the main cause of death in chronic kidney patient. Increase pulse pressure (PP) is associated with adverse cardiovascular outcomes and is an independent risk factor of progression of chronic kidney disease. In this study we aim to identify the risk factors associated with increased PP in a population with severely decreased glomerular filtration rate. Method This was a prospective analysis conducted in an outpatient nephropathy clinic between 2005-2018, enrolling 692 patients with stage 4 CKD. Patients were divided into two groups according to their pulse pressure. Group 1 mean PP&lt; 50 mmHg, Group2 mean PP &gt;50 mmHg. Based on the calcium/magnesium ratio (rCaMg), the subjects were also divided into 4 risk groups according to the following criteria: &lt;25th percentile (rCaMg &lt; 3.8mg/dl; n=168) – G1; 25-50th percentile (rCaMg: 3.8-4.7; n=171) – G2; 50-75th percentile (rCaMg: 4.7-8.6; n=188) – G3; and &gt;75th percentile (rCaMg: &gt; 8.6; n=165) - G4. We used descriptive analysis, Student's t test, Univariate logistics regression analysis and CHAID analysis to determine the relationship between variables and PP. Results Total of 682 patients, with mean age 70 (SD 12.5), female 54%. An independent t-test was conducted to compare groups. There was a significant difference in mean hemoglobin level (p=0.005), calcium (p=0.029), phosphorus (p=0.017), magnesium (p&lt;0.001), Ca/Mg ratio (p&lt;0.001) and eGFR (p=0.034). Phosphorus OR 1.906 (CI 1.338-2.715) p&lt;0.001, eGFR OR 1.440 (CI 1.023-2.027) p=0.037 were all associated with increased PP. We also compared PP with the subjects of the 4 groups based on calcium/magnesium ratio. Results: G2= OR 7.003 (CI 4.162-11.783) p&lt;0.001; G3= OR 5.136 (CI 3.205-8.230) p&lt;0.001; G4= OR 6.695 (CI 3.999-11.208) p&lt;0.001. After adjusting for confounding variables only sex OR 0.613 (CI 0.420-0.896) p=0.012 and rCa/Mg groups: G1 OR 7.392 (CI 4.362-12.527) p&lt;0.001, G2 OR 6.436 (CI 3.361-12.323) p&lt;0.001 and G3 OR 8.485 (CI 4.009-17.957) p&lt;0.001, showed significant differences. CHAID analysis identified rCa/Mg G2, G3, G4 (82.4%) as the more likely significant predictor to PP&gt; 50 mmHg (p&lt;0.001) in association with male gener (86.2%) (p=0.037). The model correctly classified 76.2% of patients and the estimate of the risk misclassification of events was 0.238±0.016. Conclusion These results suggest increased calcium/magnesium rate and male gender were associated with increased pulse pressure in a population with stage 4 CKD. Further studies are needed to understand this relationship.

scholarly journals Effect of Allopurinol on Inflammatory Markers in Chronic Kidney Disease Patients with Asymptomatic Hyperuricaemia

2017 ◽  
Vol 26 (1) ◽  
pp. 12-24
Author(s):  
ASM Tanim Anwar ◽  
Md Nizamuddin Chowdhury ◽  
Md Nazrul Islam ◽  
Parvez Iftekher Ahmed ◽  
Sohely Ahmed Sweety ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Treatment Group ◽  
Kidney Disease ◽  
Serum Uric Acid ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Control Group ◽  
Base Line

This was a hospital based prospective, interventional study which included CKD stage 3- 5 patients with higher level of uric acid (male>7mg/dl, female>6mg/dl). The objective of the study was to evaluate the effect of allopurinol on inflammatory markers in patients with chronic kidney disease (stage 3-5) with asymptomatic hyperuricaemia. One hundred and twenty patients were distributed in two groups. Sixty patients were placed in treatment group and sixty in control group. Purposive sampling technique was followed. In the study mean age was 49 (±9) years in treatment group and 45 (±11) years in control groups. Male were predominant in both groups. There were no significant difference in baseline characteristics between treatment group and control group (p>0.05). Sixty patients of treatment group were administered a dose of 100 mg/d of allopurinol. Follow up assessment was done at basally, at 4 months and at 8 month after starting treatment. No significant differences were seen between baseline SBP, DBP, Hb and HbA1c with 4th month and 8th month follow up in both treatment group and control group, but mean Hb was significantly decreased in control group from the baseline after 8 month. No significant change was found in case of mean ESR at 4th and 8th month in any group. But base line mean CRP was significantly reduced in treatment group and increased in control group at 4th and 8th month of follow up. Serum uric acid was decreased in treatment group while it was significantly raised from the base line at 4th month and 8th month in control group. While comparing between two groups results showed means of serum uric acid and CRP were significantly decreased in treatment group compared to control group after 8th month. There was a positive correlation between Uric Acid with CRP level after 8 month of allopurinol treatment although this finding was not statistically significant. So, allopurinol may have a protective role in CKD by decreasing serum uric acid level and reduction of inflammatory response in patients with chronic kidney disease stage 3 - 5 with asymptomatic hyperuricaemia.J Dhaka Medical College, Vol. 26, No.1, April, 2017, Page 12-24

scholarly journals THE EFFECT OF ACCEPTANCE AND COMMITMENT THERAPY (ACT) ON ANXIETY LEVELS IN ELDERLY LIVING AT PANTI SOSIAL TRESNA WERDHA (PSTW) BALI

2018 ◽  
Vol 4 (2) ◽  
pp. 83-90
Author(s):  
I Gusti Agung Tresna Wicaksana ◽  
Teguh Wahju S ◽  
Rinik Eko K ◽  
Putu Yudara S
Keyword(s):  
Treatment Group ◽  
Acceptance And Commitment Therapy ◽  
Psychosocial Problems ◽  
T Test ◽  
Anxiety Score ◽  
Control Group ◽  
Acceptance And Commitment ◽  
Significant Difference ◽  
Elderly Living ◽  
Paired T Test

Background: Panti werdha in Indonesia is considered as a nursing home for elderly. However, there are still psychosocial problems occur such as loneliness, sadness, and anxiety disorders. Acceptance and Commitment Therapy (ACT) may be able to solve psychosocial problems especially for anxiety.Objective: To analyze the extent of ACT's influence on the level of anxiety of the elderly living in the PSTW Bali.Methods: This study was a quasi-experimental study with pretest posttest with control group. Sixty elderly were recruited and divided into control and treatment groups with 30 samples of each group. Paired and Independent T-test were used for data analysis.Results: The paired T-test results in the control group showed significant differences of anxiety score between pretest and posttest after given generalist therapy (p 0.05). The result of paired T-test in the treatment group showed that there was a significant difference of anxiety score between pretest and posttest after given general and ACT therapy (p 0.05). The independent T-test showed that there was a significant difference of anxiety score between control group and treatment group (p 0.05).Conclusion: ACT psychotherapy is effective in decreasing anxiety in elderly who are living in PSTW Bali. 

scholarly journals Effect of Allopurinol in Chronic Kidney Disease Progression in Asymptomatic Hyperuricaemic Subjects

2017 ◽  
Vol 25 (1) ◽  
pp. 5-15
Author(s):  
ASM Tanim Anwar ◽  
Md Nizamuddin Chowdhury ◽  
Md Nazrul Islam ◽  
Parvez Iftekher Ahmed ◽  
Sohely Ahmed Sweety ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Treatment Group ◽  
Kidney Disease ◽  
Serum Uric Acid ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Control Group ◽  
And Control

This was a hospital based prospective, interventional study which included CKD stage 3- 5 patients with higher level of uric acid (male>7mg/dl, female>6mg/dl). The objective of the study was to evaluate the effect of allopurinol in chronic kidney disease (stage 3-5) progression in asymptomatic hyperuricaemic patients.One hundred and twenty patients were distributed in two groups. Sixty patients were placed in treatment group and sixty in control group. Purposive sampling technique was followed. In the study mean age was 49 (±9) years in treatment group and 45 (±11) years in control groups. Male were predominant in both groups. There were no significant difference in baseline characteristics between treatment group and control group (p>0.05). Sixty patients of treatment group were administered a dose of 100 mg/d of allopurinol. Follow up assessment was done at basally, at 4 months and at 8 month after starting treatment. No significant differences were seen between baseline SBP, DBP, Hb and HbA1c with 4th month and 8th month follow up in both treatment group and control group, but mean Hb was significantly decreased in control group from the baseline after 8 month. Serum uric acid was decreased in treatment group while it was significantly raised from the base line at 4th month and 8th month in control group. In treatment group serum creatinine was decreased and eGFR was raised from the baseline after 8 month. On the other hand, in control group serum creatinine was significantly raised and eGFR was significantly decreased from the baseline at 8th month. While comparing between two groups results showed means of serum uric acid was significantly decreased in treatment group compared to control group after 8th month. There was a negative correlation between Uric Acid with eGFR after 8 month of allopurinol treatment although this finding was not statistically significant. So, allopurinol may have a protective role in CKD progression by decreasing serum uric acid level in patients with chronic kidney disease stage 3 - 5 with asymptomatic hyperuricaemia.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 5-15

scholarly journals Dynamic thiol-disulfide balance and thioredoxin reductase enzyme levels in patients with chronic kidney disease.

2021 ◽  
Author(s):  
Huseyin Erdal ◽  
Oguzhan Ozcan ◽  
Faruk Turgut ◽  
Salim Neselioglu ◽  
Ozcan Erel
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Biochemistry ◽  
Colorimetric Method ◽  
Thioredoxin Reductase ◽  
Control Group ◽  
Total Thiol ◽  
Significant Difference ◽  
Patient Groups

Introduction: We aimed to measure the dynamic thiol-disulfide balance and thioredoxin reductase (TrxR) enzyme levels in patients with chronic kidney disease (CKD). Material and Methods: Thirty hemodialysis (HD), 30 CKD patients (stage3-5) and 30 controls were included in the study. The dynamic thiol-disulfide balance was determined by the colorimetric method developed by Erel et al. TrxR levels were determined by ELISA. Results: Native and total thiol levels of CKD and HD patients were significantly lower than that of the control group (p=0.001for both). However, disulfide levels were significantly higher in the HD group (p=0.001), but there was no significant difference between control and CKD groups(p=0.547). A notable negative correlation was found between the native and total thiol levels and IMA(r=-0.628;-0.631),BUN (r=-0.747;-0.747),and creatinine(r=-0.732;-0.721). There was a significant positive correlation between GFR and the thiol levels (r=0.835;0.824). TrxR levels were significantly higher in the patient groups compared to the controls (p=0.001).CRP levels of the patient groups were significantly higher compared to the controls (p=0.001). Conclusions: We have demonstrated that measurement of dynamic thiol-disulfide levels by using colorimetric method can contribute to the diagnosis and follow-up of the disease as a marker, because, it is easily applicable in routine clinical biochemistry laboratories and related with disease severity in CKD patients. Also, we showed that volume correction due to dialysis process should be consider in studies dealing with plasma thiol values and the final results should be given after the correction process.

scholarly journals ROLE OF HYPOXIA–INDUCED APOPTOSIS IN CHRONIC GLOMERULONEPHRITIS PROGRESSION IN CHILDREN

2014 ◽  
pp. 41-45
Author(s):  
V.G. Maidannyk ◽  
E.A. Burlaka ◽  
I.V. Bagdasarova ◽  
S.P. Fomina ◽  
V.M. Nepomnyaschiy
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Kidney Function ◽  
Filtration Rate ◽  
Control Group ◽  
Chronic Glomerulonephritis ◽  
Disease Course ◽  
Function Impairment

Aim of the study: to study the indicators of cellular hypoxia and apoptosis in pediatric patients with nephritic type of chronic glomerulonephritis. Material and methods: 52patients with active stage of nephrotic type ofChronic glomerulonephritis were inspected. All patients were divided into groups of Chronic Kidney Disease (CKD) by the level of glomerular filtration rate (GFR). Detection of the hypoxia–induced factor (HIF) and antiapoptotic factor Bcl–xL in serum performed using Western Blotting assay and immunohistochemically on material of kidney biopsies. Imaging was done using confocal laser microscopy. Results: it has been found that the disease course is accompanied by increased levels of hypoxia–induced factor HIF–1a and decreased expression of antiapoptotic factor Bcl–xL (in plasma and on biopsies). Detected changes significantly depended on the degree of proteinuria and declining of glomerular filtration rate. Dependence between the levels of hypoxia–induced damages and level of kidney function impairment was documented. In children with Chronic Kidney Disease (SKDIst.) HIF–1a was at level 128.6±2.3% (P<0.01, compared to Control group), in children with CKD II–III st. – 141.3±1.9% (P<0.01, compared to Control group and CKD I st.). Level of antiapoptotic defense in children with nephrotic type of Chronic glomerulonephritis was related to the level of kidney function impairment as well. In group of patient with CKDIst. Bcl–xL expression was down–regulated to 75.1±2.2%, in group with CKDII–IIIst. — to 60.1+1.8% (P<0.01 and P<0.001, compared to Control group, respectively). The level of evaluated changes has a dependence on levels ofproteinuria and kidney function impairment. Conclusion. Studied parameters might be used as predictors of unfavorable disease course.

scholarly journals Perbedaan Kadar Hemoglobin pada Penderita Gagal Ginjal Kronik Sebelum dan Setelah Melakukan Hemodialisa

2021 ◽  
Vol 8 (1) ◽  
pp. 146-151
Author(s):  
Virania Arvianti ◽  
◽  
Septian Septian ◽  
Aturut Yansen ◽  
◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Secondary Data ◽  
Sampling Technique ◽  
Chronic Kidney Failure ◽  
Wilcoxon Test ◽  
Cross Sectional ◽  
Significant Difference ◽  
Before And After

IntroductionAnemia is the most common occurrence in chronic kidney disease undergoing hemodialysis therapy. In the condition of chronic kidney disease, the decline in kidney function can occur slowly and chronically until the kidneys do not function at all. Hemodialysis is one of the therapies used to replaced kidney function. During hemodialysis, a decrease in hemoglobin levels often occurs, this is due to the disruption of the hormon erythropoietin. Objective:determine the differences in hemoglobin levels in patients with chronic kidney disease before and after hemodialysis at Bhayangkara TK. I Raden Said SukantoHospital. Method: The design of this research is cross sectional using secondary data and the sampling technique of this research was random sampling with a total of 133 patients. Result: The normality test was carried out first using the Kolmogorov-Smirnova test which showed the results were not normally distributed with a sig value of 0.001. the next test was the Wilcoxon test with a sig (2-tailed_ value of 0.002 with an average hemoglobin level of 8,81 g/dL before hemodialysis and 9,09 g/dL after hemodialysis. Conclusion:Based on the results of the study means that there is a significant difference in a patient with chronic kidney failure before and after hemodialysis.

scholarly journals Instructional Packages Geography Based on Ecosystem (PIGeoEk) Development in Improving Students’ Knowledge About Ecosystem Concepts and Relation to Students’ Environmental Behavior

2018 ◽  
Vol 3 (1) ◽  
pp. 1-22
Author(s):  
Ning Setianti
Keyword(s):  
Social Sciences ◽  
Treatment Group ◽  
Knowledge Transfer ◽  
Environmental Education ◽  
Research And Development ◽  
Environmental Behavior ◽  
T Test ◽  
Control Group ◽  
Gain Score ◽  
Significant Difference

The learning have been tended to put more emphasis on knowledge transfer. One of the efforts in improving students' knowledge about the concepts of ecosystem and relation to students’ environmental behavior is integrating Geography and environmental education developing instructional packages based on ecosystem for teachers of Geography. This study aims to develop an instructional packages geography based on ecosystem (PIGeoEk) in improving students' knowledge of the concepts of the ecosystem and related to students’ environmental behavior. A research and development (R & D) based on Borg and Gall (2007), refering to the Dick and Carey design (2009), steps has been applied by involving 80 students of grade XI majoring in social sciences of SMAN 5 Depok for treatment, and grade XI majoring in social sciences of SMAN 3 Depok as a control group. There are four instructional packages geography based on ecosystem (PIGeoEk) have been developed and instrument test used for measuring knowledge about the concepts of ecosystem and relation to students’ environmental behavior. The are four t-test have been applied to verify the effectiveness of Instructional Pakages. Research results indicate that there is a significant difference between mean of gain score obtained from post and pre test at treatment group compare to control group. Therefore, the instructional packages geography based on ecosystem (PIGeoEk) could be implemented in enhancing students' knowledge about the concepts of the ecosystem in relation to students’ environmental behavior effectively.

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