Peran Gejala Depresi sebagai Faktor Prediktor Kematian dalam Enam Bulan pada Lansia yang Menjalani Hemodialisis

Pendahuluan. Depresi merupakan gangguan mental yang banyak ditemukan baik pada kelompok lansia maupun pada pasien yang menjalani hemodialisis. Depresi berdampak buruk terhadap kualitas hidup pasien. Penelitian yang menghubungkan depresi sebagai faktor prediktor kematian dalam enam bulan pada lansia yang menjalani hemodialisis belum pernah dilakukan di Indonesia. Penelitian ini bertujuan untuk mengetahui peran gejala depresi sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis.Metode. Penelitian dengan desain kohort prospektif dilakukan pada Februari – Agustus 2020 di Unit Hemodialisis Rumah Sakit Roemani Muhammadiyah Semarang. Adapun kriteria inklusi meliputi lansia (usia ≥60 tahun), menjalani hemodialisis ≥3 bulan, frekuensi hemodialisis 2 kali seminggu, bersedia mengikuti penelitian, dapat berkomunikasi dengan baik, dan tidak terdapat riwayat gangguan mental sebelumnya yang meliputi riwayat gangguan psikotik, dan gangguan mental akibat penggunaan zat. Sedangkan pasien dengan data tidak lengkap, pindah ke unit hemodialisis lain, HBsAg +, kadar Hemoglobin <7 mg/dl, skor RAPUH >2, dan memiliki stressor lain yang tidak terkait dengan hemodialisis atau Penyakit Ginjal Kronis (PGK) seperti faktor sosial, keluarga, dan pekerjaan dieksklusi dari penelitian ini. Depresi dinilai menggunakan kuesioner Beck Depression Inventory-II yang telah diterjemahkan ke dalam Bahasa Indonesia. Adapun pengisian kuesioner dilakukan oleh responden dengan panduan oleh peneliti dalam proses pengisiannya. Data yang terkumpul kemudian dianalisis menggunakan Kaplan Meier dan Cox Regression menggunakan SPSS 18.0.Hasil. Dari total 32 responden, mayoritas adalah laki-laki yaitu sebanyak 26 responden (81,3%). Rerata usia responden adalah 67,2 (simpang baku [SB] 7) tahun. Sebanyak 6 (18,7%) responden mengalami depresi dan 26 (81,3%) responden tidak mengalami depresi. Hasil analisis Cox Regression menunjukkan bahwa depresi berperan sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis (p=0.012), dan hazard ratio=10,149.Simpulan. Depresi berperan sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis.Kata Kunci: Depresi, geriatri, mortalitas, penyakit ginjal kronik, penyakit ginjal tahap akhirDepressive symptoms as a Predictor Factor of All-Cause Mortality within Six Months in Elderly Hemodialysis PatientsIntroduction. Depression is a mental disorder that is often found in the elderly and hemodialysis patients, resulting in bad effects on patients. There is no study on the relationship between depression and all-cause mortality risk in elderly hemodialysis patients in Indonesia. This study aimed to determine the role of depression as a predictor factor of all-cause mortality within 6 months in elderly hemodialysis patients. Methods. A prospective cohort study was conducted from February to August 2020 at the hemodialysis unit of Roemani Muhammadiyah Hospital, Semarang. The inclusion criteria were elderly patients (aged ≥60 years), undergoing hemodialysis ≥3 months, hemodialysis frequency twice a week, willing to participate in this study, able to communicate well, and has no history of mental disorders include a history of psychotic disorders and mental disorders due to substance use. Meanwhile, patients whose data were incomplete, transferred to another hemodialysis unit, HBsAg +, hemoglobin level <7 mg/dl. FRAILTY score >2, and had other stressors not related to hemodialysis or chronic kidney disease (CKD) such as social, family, and work factors were excluded from this study. Depression was assessed using the Beck Depression Inventory-II questionnaire. The collected data was then analyzed using Kaplan Meier and Cox Regression.Results. Of 32 respondents, most of them were male (81.3%). The mean age was 67.2 (SD 7) years. There were 6 (18.7%) respondents categorized into a depression group and 26 (81.3%) respondents into a non-depression group. Cox Regression analysis showed that depression was a predicting factor of all-cause mortality within six months in elderly hemodialysis patients (p value=0.012, and Hazard ratio=10.149). Conclusion. Depression is a predictor factor of all-cause mortality within six months in elderly hemodialysis patients.

Gambaran Kepuasan Pelayanan Dan Kepuasan Pasien Hemodialisa Di Rumah Sakit X

<p><em>Service to satisfy customers does not have to be at the expense of self-esteem or self-image because providing services is not based on the submission of one party to another, the service should be carried out to realize the best benefits for all parties. The purpose of this study was to describe the quality of services provided by the hemodialysis unit to outpatients and the satisfaction of hemodialysis patients during dialysis at hospital X. The research method used was quantitative, by distributing questionnaires to the patient's guardians. The results of the study, the results showed, 100% of respondents in the HD unit of Hospital X said it was true about the quality of services contained in the HD unit of Hospital X. The results showed, 100% said they were satisfied with the services provided by the HD unit of Hospital X. Maintained service well in the eyes of hemodialysis patients at X Hospital.</em></p>

Dialysate Sodium—One Size Unlikely to Fit All

The role of medical director of a hemodialysis unit has become increasingly complex. Among the many roles it encompasses, the delivery of safe and effective dialysis treatments requires constant review, synthesis, and interpretation of the medical literature. Despite decades of experience with hemodialysis, the evidence base for dialysate prescription is relatively limited, with the choice of dialysate sodium being a prime example. The ask of this exercise was to imagine ourselves as the medical director of a new hemodialysis unit and to consider factors influencing the choice of dialysate sodium. While fiscal considerations are indeed important, one hopes that these align with the delivery of clinical care to improve patient well-being. Therefore, my approach was to focus on exploring the clinical responsibilities of a medical director in the choice of dialysate sodium. As such, after reviewing the evidence to date, my ‘default’ dialysate sodium prescription would be 140 mmol/L, but I would retain the option of individualizing treatment for certain patients until further evidence becomes available.

Vascular Access Blood Flow Estimation Based On Standardized Extracorporeal Blood Flow in Hemodialysis Patients

Background: Measurement of vascular access flow (Qa) is a recommendation in the care of hemodialysis patients. We developed an observational study to answer the following question: Can access blood flow be estimated?Methods: This observational study was carried out in the hemodialysis unit of the José Carrasco Arteaga Hospital in Cuenca-Ecuador. The sample calculation was 41 cases. Patients older than 17 years with stage 5d chronic renal failure and vascular access with arteriovenous fistula were included. The variables were descriptive of the population: Qa and extracorporeal blood flow (Qb). Qa measurement was performed with the Transonic ® monitor. Qb was measured at dynamic arterial line pressures (DALPs) of -60 mmHg, -100 mmHg, -160 mmHg, and -200 mmHg. The correlation coefficient "r" was obtained between Qa and Qb. SPSS 22.0 was used to analyze the information and perform a linear regression equation to estimate access blood flow (eQa).Results: Fifty-seven patients aged 62.9 ± 12.7 years with 29.4 ± 33 months on hemodialysis were included; 23 women (40.3%) and 45.6% had diabetic nephropathy. Fistulas were seen in 40 cases in the left upper limb (70.2%) and 17 (29.8%) in the right upper limb. The prevalence of aneurysms was 10.5%. The 50th percentile of Qb was 415 mL/min with a DALP of -200 mmHg. The mean access flow was 1516 ± 878 ml/min. The correlation between Qb and Qa was statistically more significant between Qb and DALP of -200 mmHg. The association had a coefficient Rs = 0.643 (IC 0.453 to 0.771) P <0.0001. The estimated access flow eQa = (Qb at DALP of -200 mmHg (mL/min) * 16.63) - 5449.71.Conclusions: It was possible to estimate access blood flow with parameters for easy intradialysis measurements. The equation obtained, if applied to the same patient with the same DALP, could become a useful parameter for monitoring vascular access.Trial registration: ClinicalTrials.gov Identifier: NCT00522704. Registered 14 March 2008, https://clinicaltrials.gov/ct2/show/NCT00522704

Effect of Metabolic Acidosis on Immunoregulation in Prevalent Hemodialysis Patients

Objective to evaluate the relationship between IL-10 and serum bicarbonate and metabolic acidosis in prevalent hemodialysis patients. Methods Type of Study: prospective case control study. Study Setting: The study was conducted at Ain Shams University hospital hemodialysis unit. Sample Size: 40 patients with ESRD on regular HD and 20 healthy control. Study Population: Maintenance hemodialysis patients Results The results suggested that serum IL-10 level was significantly higher in chronic HD patients than healthy subjects and this is compatible with the idea that higher levels of IL‑10 are needed in HD patients to limit their strong inflammatory activation associated with uremia and the dialysis technique. There was no significant differences in IL-10 levels noticed between patients with different causes of ESRD. This study also showed negative correlation between IL-10 and serum bicarbonate levels. We also found that there was significant positive correlation between baseline levels of IL-10 and CRP which may be because of dialysis inadequacy that is associated with chronic inflammatory state resulting in high CRP levels. Conclusion The incidence and prevalence of ESRD have risen dramatically which may be due to the increasing prevalence of diabetes and hypertension. Although regular hemodialysis decreases levels of mortality in these patients, it is still considered a condition associated with inflammation. The current study revealed high IL-10 levels among HD patients who had metabolic acidosis. Further research needs to be done to reveal beneficial effects of these finding.

ANALISIS KEPATUHAN MENJALANI HEMODIALISA DENGAN KUALITAS HIDUP PASIEN GAGAL GINJAL KRONIK

Compliance with hemodialysis therapy is one of the important things to note, if the patient is not compliant, it can cause a buildup of harmful substances in the body and if left unchecked, it can lead to death. The purpose of this study was to determine the relationship between adherence to undergo hemodialysis therapy with the quality of life of patients with chronic renal failure in the Hemodialysis Unit of the Jakarta Hajj Hospital. This research method is a quantitative study using primary data (questionnaires) and using cross-sectional research. Data collected by using questionnaires. The number of samples were 54 people who were in the hajodialysis unit at the Jakarta Hajj Hospital for the past three months. The results of the study of 54 respondents who have moderate compliance there are 11 people (20.4%), and good compliance a number of 43 people (79.%), in general patients obedient. While from the aspect of quality of life, there were 6 respondents (11.1%) who experienced less quality of life, 35 people had a moderate quality of life (75.%) and 13 people (24.1%) had a good quality of life, in general the quality of life of patients was moderate. After analyzing the relationship between adherence to undergo hemodialysis with quality of life using the Chi Square test p value = 0.468˃0.05, meaning that Ho is accepted, so it can be concluded that there is no relationship between adherence to hemodialysis with the quality of life of patients at Jakarta Hajj Hospital .ABSTRAKKepatuhan menjalani terapi hemodialisa merupakan salah satu hal yang penting untuk diperhatikan, jika pasien tidak patuh dapat menyebabkan terjadinya penumpukan zat-zat berbahaya dalam tubuh dan apabila hal tersebut dibiarkan maka dapat mengakibatkan kematian. Tujuan penelitian untuk mengetahui hubungan antara kepatuhan menjalani terapi hemodialisa dengan kualitas hidup pasien gagal ginjal kronik di Unit Hemodialisa RS Haji Jakarta. Metode penelitian ini merupakan penelitian kuantitatif dengan menggunakan data primer (kuisioner) dan memakai metode penelitian cross-sectional. Data yang dikumpulkan dengan cara menggunakan kuisioner. Jumlah sampel sebanyak 54 orang yang berada di unit hemodialisa Rumah Sakit haji Jakarta selama tiga bulan terakhir. Hasil penelitian dari 54 responden yang memiliki kepatuhan sedang terdapat 11 orang (20.4 %), dan kepatuhan baik sejumlah 43 orang (79.6 %), secara umum pasien patuh. Sementara dari aspek kualitas hidup diperoleh responden yang mengalami kualitas hidup kurang sejumlah 6 orang (11.1%), kualitas hidup sedang sejumlah 35 orang (75.%) dan kualitas hidup baik 13 orang (24.1%), secara umum kualitas hidup pasien sedang. Setelah dilakukan analisa hubungan antara kepatuhan menjalani hemodialisa dengan kualitas hidup dengan menggunakan uji Chi Square diperoleh p value = 0.468˃0.05, artinya Ho diterima, sehingga dapat disimpulkan tidak ada hubungan antara kepatuhan menjalani hemodialisa dengan kualitas hidup pasien di Rumah Sakit Haji Jakarta.