FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEPATUHAN PEMBATASAN CAIRAN PASIEN GAGAL GINJAL TERMINAL YANG MENJALANI HEMODIALISIS DI SATU RUMAH SAKIT SWASTA DI INDONESIA BARAT [FACTORS ASSOCIATED WITH ADHERENCE TO FLUID RESTRICTION TOWARDS PATIENTS WITH END STAGE RENAL DISEASE UNDERGOING HEMODIALYSIS IN A PRIVATE HOSPITAL, WEST INDONESIA]

<p><em>End Stage Renal Disease is the final stage of the Chronic Kidney Disease (CKD) with a Glomerular Filtration Rate (GFR) value of less than 15 ml / min / 1.73m². End Stage Renal Disease can be treated with hemodialysis therapy </em>(<em>National Kidney Foundation</em>, <em>2015</em>; <em>Thomas, 2014</em>).<em> The hemodialysis provides fluid resctrictions for patients who undergo. There are many factors that make fluid restrictions adherence difficult to do. (Chironda&amp;Bhengu, 2015). The biggest and dominant factor is psychological factor, which is self compassion. </em><em>Self compassion is the attitude of giving compassion to oursel</em><em>ves</em><em>, so that when a patient undergoing hemodialysis in difficult conditions is able to assume the situation is the same as other people, and does not punish themselves and have motivation in undergoing a therapeutic regimen.</em><em> </em><em>The purpose of this study was to identify </em><em>factors</em><em> </em><em>that have corelation to </em><em>fluid adherence in end stage renal disease patients undergoing hemodialysis. This study used a cross sectional method, with 89 end stage renal disease patients who underwent hemodialysis three times a week</em><em> </em><em>and who were selected using a purposive sampling technique. The results showed that the majority of patients had high self compassion (69.7%). The corelation of self compassion with fluid adherence was not significant (p=0,076), other factors affecting fluid adherence were age (p=0.033), gender (p= 0,937), marital status (p = 0.473), working status ( p = 0,885), level of education (p= 0,126), length of undergoing hemodialysis (p = 0,425), and social support (p =0,206) The results of multivariate analysis showed that the most dominant facto</em><em>r</em><em>s related to fluid restriction adherence was age. This research is expected to be a reference for nurses in developing nursing studies in end stage renal disease patients undergoing hemodialysis</em><em></em></p><p><strong>BAHASA INDONESIA ABSTRAK: </strong>Gagal ginjal terminal merupakan tahap akhir dari kondisi <em>Chronic Kidney Disease</em> (CKD) dengan nilai <em>Glomerulus Filtrasi Rate</em> (GFR) kurang dari 15 ml/menit/1,73m². Gagal ginjal terminal dapat ditangani dengan terapi hemodialisis. Adanya hemodialisis ini memberikan pembatasan cairan pada pasien yang menjalaninya. Kepatuhan pembatasan cairan pada sebagian pasien sulit untuk dilakukan dengan alasan banyak faktor, yakni usia, jenis kelamin, tingkat pendidikan, status bekerja, lama menjalani hemodialisis, status menikah, dan dukungan sosial. Faktor yang terbesar dan dominan adalah faktor psikologis, yakni <em>self compassion.</em> <em>Self compassion</em> merupakan sikap memberikan belas kasih kepada diri sendiri, sehingga ketika seorang pasien yang menjalani hemodialisis dalam kondisi sulit mampu menganggap situasinya adalah sama dengan orang lain, dan tidak menghukum diri sendiri serta memiliki motivasi dalam menjalani regimen terapi. Tujuan penelitian ini adalah untuk mengidentifikasi faktor-faktor yang berhubungan dengan kepatuhan pembatasan cairan pasien gagal ginjal terminal yang menjalani hemodialisis. Penelitian ini menggunakan metode <em>cross sectional, </em>sebanyak 89 pasien pasien gagal ginjal terminal yang menjalani hemodialisis dalam tiga kali seminggu yang dipilih menggunakan teknik <em>purposive sampling. </em>Hasil penelitian menunjukkan bahwa mayoritas pasien memiliki <em>self compassion</em> tinggi (69,7%). Hubungan <em>self compassion</em> dengan kepatuhan pembatasan cairan tidak signifikan (p=0,076), faktor lain yang mempengaruhi kepatuhan pembatasan cairan adalah adalah usia (p=0,033), jenis kelamin (p=0,937), status menikah (p=0,473), status bekerja<em> </em>(p=0,885), tingkat pendidikan (p=0,126), lama menjalani hemodialisis (p=0,425), dan dukungan sosial (p=0,206). Hasil analisis multivariat menunjukkan faktor yang paling dominan berhubungan dengan kepatuhan pembatasan cairan adalah usia. Penelitian ini diharapkan dapat menjadikan acuan bagi perawat dalam mengembangkan pengkajian keperawatan pada pasien gagal ginjal terminal yang menjalani hemodialisis.</p>

DETERMINANTS OF DIET AND FLUID ADHERENCE AMONG END STAGE RENAL DISEASE PATIENTS UNDERGOING HAEMODIALYSIS AT MOI TEACHING AND REFERRAL HOSPITAL, UASIN GISHU COUNTY, KENYA

Purpose: This study was conducted to establish determinants of diet and fluid adherence among ERSD patients undergoing hemodialysis at Moi Teaching and Referral Hospital- Uasingishu county. Kenya. Methods: A descriptive cross-sectional study design was applied. Using Fisher’s formula, a sample size of 145 participants were conveniently recruited. Data collection was done by use of modified end stage renal disease adherence questionnaire (ESRD-AQ). Chi-square (χ2) was used to test statistical significance. Frequency tables and bar graphs were used for data presentation. SPSS version 22.0 was used for data analysis. Results: The study revealed that knowledge on nutritional requirements for renal patients was marginally associated with dietary and fluid intake with a higher proportion of those with low nutritional knowledge (83.6%) adhering to diet and a relatively smaller proportion in the same category (58.9%) complying with fluid intake. A significant relationship with dietary adherence was observed where participants practiced fluid restrictions (p=0.003) and the frequency in which health staff talk about the importance of following proper diet (p <0.0001). On social support domain, a significant association was observed in patients who agreed that various social support aspects help improve depression, self-esteem, self-management, etc. and who adhered to diet scored a significantly higher mean of 5.6 (95% CI = 5.5 – 5.6) in contrast to non-adherent counterparts who had a mean of 5.5 (p = 0.0006). Among the economic factors with significant association with diet adherence were; use of bus for transport (p=0.02); income of less than KSH. 30,000 (p=0.006); treatment cost (p=0.007) and ability to access material support that helps in adherence (p=0.003). Those who claimed that lack of transport was the main reason for missing dialysis practiced fluid adherence (p=0.01) with a smaller proportion (44%) adhering to fluid restriction in comparison to 70.8% who had transport and were non- adherent. Unique contribution to theory, practice and policy: The study findings are unique to the study site and it’s hoped that it can be used to inform hospital policy makers in addressing adherence challenges in ESRD patients on hemodialysis. The study recommends a holistic study on determinants of adherence to hemodialysis, medication use, dietary, and fluid compliance among patients undergoing HD at MTRH should be conducted in order to produce generalized results.

Case Commentary: Delayed Cerebral Vasculitis Associated with the Development of Ceftriaxone-Resistant Pneumococcal Meningitis

ABSTRACT Mizrahi and colleagues present a well-described case of the emergence of drug resistance in Streptococcus pneumoniae meningitis during therapy with ceftriaxone monotherapy with a low bactericidal concentration in the cerebrospinal fluid. Adherence to international guidelines could possibly have prevented the emergence of this resistant isolate and the adverse outcome.