ANXIETY OF HEMODIALYSIS PATIENT WITH ACCESS ARTERIOVENOUS FISTULA (AV-SHUNT): A QUALITATIVE STUDY

Background: Cannulation is an intervention that inserts a needle through the skin into a blood vessel. Av-shunt is the most recommended access for use in the hemodialysis therapy process. Psychosocial problems, especially feelings of anxiety and fear can be felt by patients due to AV-shunt. Anxiety is a scientific attitude experienced by each individual as a form of response in dealing with problems or threats Vascular access complications may threaten lives and reduce treatment satisfaction and life quality. Objectives: This study aimed to describe hemodialysis patient anxiety with arteriovenous fistula (AV-shunt) access. Methods: A descriptive qualitative study using the in-depth interview method with phenomenology approach. The study was carried out with four informants undergoing hemodialysis in RSUD dr. Haryoto Lumajang. Samples were taken using purposive sampling. Participant statements were recorded using a voice recorded, transcribed, coded, interpreted, and categorized to create a theme. Results: The study results produced three themes: (1) Emotional feeling perceived associated with AV-shunt experience: Anxiety, fear, and helplessness, (2) Physical and physical activity changes: Dark skin, dry skin, limp body, and fatigue, and (3) Patient knowledge regarding av-shunt, i.e., AV-shunt access and based on information sources. Conclusion: Patients with arteriovenous fistula (AV-shunt) access had anxieties caused by cannulation initial pain, fear, and sense of uselessness.

Gambaran Self Efficacy dan Kualitas Hidup Pada Pasien Yang Menjalani Hemodialisa: Literature Review

Chronic renal failure (CKD) is a condition that progressive and irreversible decline in kidney function. One of the therapies to maintain the life of CKD patients is hemodialysis. Hemodialysis is a procedure in which blood from the patient’s body is flowed into a dialyzer machine which is then carried out by the filtration process of metabolic waste substances. Hemodialysis is carried out for a lifetime that can affect patient’s quality of life. The quality of life among hemodialysis patients can be influenced by self-efficacy. Self-efficacy is believed to play an important role in self-management in the maintenance of health behavior. So that increasing self-efficacy can provide motivation to recover and improve the quality of life of hemodialysis patient. The study aimed to describe self-efficacy and quality of life in patients undergoing hemodialysis. The study accessed the Springer database, Garuda, and Google Scholar. The search was conducted with the keywords “self efficacy”, “quality of life”, and “hemodialysis”. The subjectof this study were patients undergoing hemodialysis. The are five articles reviewed. The result show that the majority of hemodialysis patients were male, age was ranged from 30 to 65 years old, the majority of the respondents did not work. The majority of the respondents undergo hemodialysis for more than 2 years. The self-efficacy was categorized in high and good category. The quality of life was categorized in good and low category. Self-efficacy and quality of life are two components that have a close relationship in the hemodialysis process. The highest self-efficacy contributes to the better of the quality of life among hemodialysis patients.Keywords: Hemodialysis; quality of life; self-efficacy AbstrakGagal ginjal kronik (GGK) merupakan suatu kondisi dimana terjadi penurunan fungsi ginjal secara progesif dan irreversibel. Salah satu terapi untuk mempertahankan hidup pasien GGK adalah hemodialisa. Hemodialisa adalah suatu tindakan dimana darah dari tubuh pasien dialirkan ke dalam mesin dializer yang selanjutnya dilakukan proses filtrasi dari zat-zat sisa metabolisme. Terapi hemodialisa dilakukan selama seumur hidup, sehingga dapat mempengaruhi terhadap kualitas hidup mereka. Kualitas hidup pasien hemodialisa dipengaruhi oleh beberapa faktor, salah satunya adalah self efficacy. Self efficacy diyakini memegang peran penting dalam manajemen diri dalam pemeliharaan perilaku kesehatan. Sehingga peningkatan self efficacy mampumemberikan motivasi untuk sembuh dan meningkatkan kualitas hidup pasien hemodialisa. Penelitian ini bertujuan untuk mengetahui gambaranself efficacy dan kualitas hidup pada pasien yang menjalani hemodialisa. Penelitian ini mengakses database Springer, Garuda, dan Google Scholar. Pencarian dilakukan dengan kata kunci “self efficacy”, “quality of life”, dan “hemodialysis”. Subjek penelitian ini adalah pasien yang menjalani hemodialisa. Hasil literatur review dari lima artikel menunjukkan bahwa pasien hemodialisa mayoritas berjenis kelamin laki-laki, usia terbanyak pada rentang 30-65 tahun, mayoritas tidak bekerja, mayoritas menjalani hemodialisa selama <2 tahun, self efficacy paling banyak pada kategori tinggi dan baik, dan kualitas hidup paling banyak pada kategori baik dan rendah.Self efficacy dan kualitas hidup merupakan dua komponen yang mempunyai keterkaitan erat dalam proses terapi hemodialisa. Semakin tinggi self eficacy yang dimilki individu, maka semakin baik pula kualitas hidup pasien hemodialisa.Kata kunci: Efikasi diri; hemodialisa; kualitas hidup

A case of a hemodialysis patient with secondary hyperparathyroidism who was resistant to etelcalcetide treatment but not to cinacalcet hydrochloride

Although both cinacalcet and etelcalcetide are calcimimetics that directly inhibit parathyroid hormone (PTH) secretion by activating the calcium (Ca)-sensing receptor (CaSR), their binding sites are different. We report a first case of a hemodialysis (HD) patient with secondary hyperparathyroidism (SHPT), in whom cinacalcet, but not etelcalcetide, could reduce serum intact PTH (i-PTH) levels. A HD patient received total parathyroidectomy (PTx) with auto-transplantation 16 years earlier. Due to SHPT relapse, cinacalcet was started at 7 years after PTx. His i-PTH levels had been controlled with both 75–100 mg of cinacalcet and 4.5 μg/week of calcitriol for a year before switching from cinacalcet to etelcalcetide. At 1 month following the switch, his serum i-PTH level increased to 716 pg/mL. The dose of etelcalcetide was gradually increased and finally reached the maximal dose of 45 mg/week. Because even the maximal dose of etelcalcetide for > 4 months did not reduce his serum i-PTH levels to < 700 pg/mL, etelcalcetide was switched to 50 mg/day of cinacalcet, which reduced the levels to 208 pg/mL at 2 months after the switch. Genomic sequencing test using whole blood revealed no mutation in the portion including Cys 482 of CaSR gene. The patient was resistant to etelcalcetide treatment but not to cinacalcet, suggesting the possibility that the enlarged parathyroid gland has some change in the portion including Cys 482 in the CaSR gene. Therefore, considering the possibility of etelcalcetide resistance during SHPT treatment should be kept in mind.