BAB 7 PENUTUP
7.2 Saran
Terkait didapatkannya hasil terjadi peningkatan pada parameter tekanan darah sistol, tekanan darah diastol, dan nilai MAP dengan beberapa faktor
yang dapat menyebabkannya (yaitu volume overload, aktivitas simpatik
yang berlebihan, aktivasi sistem Renin-Angiotensin-Aldosteron, disfungsi
sel endotel, faktor dialisis (asupan natrium, kalsium, hipokalemia), faktor
medis (obat penstimulasi eritropoetin, penghentian obat antihipertensi, dan
kekakuan vaskular) disarankan untuk dilakukan penelitian lebih lanjut pada
faktor-faktor tersebut guna mengetahui penyebab pasti terjadinya
peningkatan parameter-parameter hemodinamik yang diamati selama
proses hemodialisis.
DAFTAR PUSTAKA
Anderson, A.H. et al., 2015. Time-updated systolic blood pressure and the progression of chronic kidney disease: A cohort study. Annals of Internal Medicine, 162(4), pp.258–265.
Bansal, N. et al., 2015. Blood pressure and risk of all-cause mortality in advanced chronic kidney disease and hemodialysis the chronic renal insufficiency cohort study. Hypertension, 65(1), pp.93–100.
Berns, J.S., 2017. Patient education: Hemodialysis (Beyond the Basics) -
UpToDate. Available at: https://www.uptodate.com/contents/hemodialysis-beyond-the-basics?view=print [Accessed September 13, 2018].
Brzenzinski, W., 1990. Blood Pressure; Clinical Methods - The History, Physical and Laboratory Examinations. Clinical Methods, 3rd edition, pp.95–97. Available at:
http://www.ncbi.nlm.nih.gov/books/NBK201/#_ncbi_dlg_citbx_NBK201. Brzezinski, W.A., 1990. Blood Pressure,
Van Buren, P.N. & Inrig, J.K., 2016. Mechanisms and Treatment of Intradialytic Hypertension. Blood Purification, 41(1–3), pp.188–193.
Dorland, W.A.N., 2002. Kamus kedokteran dorland,
Gerasimoula, K. et al., 2015. Quality of Life in Hemodialysis Patients. Materia Socio Medica, 27(5), p.305. Available at:
http://www.scopemed.org/fulltextpdf.php?mno=203853.
Hill, N.R. et al., 2016. Global prevalence of chronic kidney disease - A systematic review and meta-analysis. PLoS ONE.
Inrig, J.K., 2010. Intradialytic Hypertension: A Less-Recognized Cardiovascular Complication of Hemodialysis. American Journal of Kidney Diseases, 55(3), pp.580–589. Available at: http://dx.doi.org/10.1053/j.ajkd.2009.08.013. Jha, V. et al., 2013. Chronic kidney disease: Global dimension and perspectives.
The Lancet.
Kalantar-Zadeh, K. et al., 2003. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney International.
Kidney Disease: Improving Global Outcomes (KDIGO), 2013. Chapter 1: Definition and classification of CKD. Kidney International Supplements. Kovesdy, C.P. et al., 2013. Blood Pressure and Mortality in U.S. Veterans With
Chronic Kidney Disease. Annals of Internal Medicine, 159(4), p.233. Available at:
http://online.liebertpub.com/doi/abs/10.1089/ind.2013.0013%5Cnhttp://annal s.org/article.aspx?doi=10.7326/0003-4819-159-4-201308200-00004.
Kuipers, J. et al., 2016. Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions - A three-months, prospective study of 3818
haemodialysis sessions Dialysis and Transplantation. BMC Nephrology, 17(1), pp.1–11. Available at: http://dx.doi.org/10.1186/s12882-016-0231-9. Lertdumrongluk, P. et al., 2015. Changes in pulse pressure during hemodialysis
treatment and survival in maintenance dialysis patients. Clinical Journal of the American Society of Nephrology.
Mardare, N.G. et al., 2005. Intradialytic changes in reflective properties of the arterial system during a single hemodialysis session. Hemodialysis International.
Nasri, H. & Rafieian-Kopaei, M., 2015. Diabetes mellitus and renal failure: Prevention and management. Journal of Research in Medical Sciences. National Kidney Foundation, 2002. K/DOQI clinical practice guidelines for
chronic kidney disease: evaluation, classification, and stratification.
American journal of kidney diseases : the official journal of the National Kidney Foundation.
Navaneethan, S.D. et al., 2017. Blood pressure parameters are associated with all-cause and all-cause-specific mortality in chronic kidney disease. Kidney
International, 92(5), pp.1272–1281. Available at: http://dx.doi.org/10.1016/j.kint.2017.04.030. NIDDK, 2017. Hemodialysis | NIDDK. Available at:
https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis [Accessed October 28, 2018].
Peralta, C.A. et al., 2012. Blood Pressure Components and End-stage Renal Disease in Persons With Chronic Kidney Disease. Archives of Internal Medicine, 172(1), p.41. Available at:
http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinternmed.20 11.619.
Prodjosudjadi, W. & Suhardjono, A., 2009. End-stage renal disease in Indonesia: Treatment development. Ethnicity and Disease.
Putri, A.Y. & Thaha, M., 2014. Role Of Oxidative Stress On Chronic Kidney Disease Progression. Acta Medica Indonesiana.
Reeves, P.B. & McCausland, F.R., 2018. Mechanisms, clinical implications, and treatment of intradialytic hypotension. Clinical Journal of the American Society of Nephrology, 13(8), pp.1297–1303.
Rule, A.D. et al., 2009. Kidney stones and the risk for chronic kidney disease.
Clinical Journal of the American Society of Nephrology.
Sarnak, M.J. & Jaber, B.L., 2000. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney
International.
Shafiee, M. et al., 2017. The Impact of Hemodialysis Frequency and Duration on Blood Pressure Management and Quality of Life in End-Stage Renal Disease Patients. Healthcare, 5(3), p.52. Available at:
http://www.mdpi.com/2227-9032/5/3/52.
Sivarajan, V. Ben & Bohn, D., 2011. Monitoring of standard hemodynamic parameters: Heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2. Pediatric Critical Care Medicine, 12(4 SUPPL.).
Titapiccolo, J.I. et al., 2012. Blood pressure variability and cardiovascular autonomic control during hemodialysis in peripheral vascular disease patients. Physiological Measurement.
Vadakedath, S. & Kandi, V., 2017. Dialysis: A Review of the Mechanisms Underlying Complications in the Management of Chronic Renal Failure.
Cureus.
VanDeVoorde, R.G. & Mitsnefes, M.M., 2011. Hypertension and CKD. Advances in Chronic Kidney Disease.
Velasquez, M.T. et al., 2016. Ambulatory Blood Pressure in Chronic Kidney Disease: Ready for Prime Time? Kidney International Reports, 1(2), pp.94– 104. Available at: http://dx.doi.org/10.1016/j.ekir.2016.05.001.
www.kidney.org, 2017. Glomerular Filtration Rate (GFR) | National Kidney Foundation. Available at: https://www.kidney.org/atoz/content/gfr [Accessed October 28, 2018].
Lampiran 2
HASIL ANALISIS DATA SPSS 1. Uji Normalitas Data (Shapiro-Wilk)
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Sistol 1 .160 15 .200* .909 15 .130
Diastol 1 .164 15 .200* .933 15 .303
MAP1 .149 15 .200* .928 15 .252
Nadi 1 .188 15 .162 .889 15 .064
a. Lilliefors Significance Correction
*. This is a lower bound of the true significance.
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Sistol 2 .141 15 .200* .971 15 .872
Diastol 2 .144 15 .200* .970 15 .860
MAP2 .164 15 .200* .962 15 .729
Nadi 2 .093 15 .200* .969 15 .849
a. Lilliefors Significance Correction
*. This is a lower bound of the true significance.
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Sistol 3 .171 14 .200* .942 14 .441
Diastol 3 .129 14 .200* .969 14 .860
MAP3 .179 14 .200* .925 14 .259
Nadi 3 .149 14 .200* .942 14 .448
a. Lilliefors Significance Correction
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Sistol 4 .149 11 .200* .928 11 .390
Diastol 4 .168 11 .200* .962 11 .797
MAP4 .182 11 .200* .959 11 .759
Nadi 4 .239 11 .078 .817 11 .016
a. Lilliefors Significance Correction
*. This is a lower bound of the true significance.
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Sistol 5 .190 6 .200* .964 6 .848
Diastol 5 .261 6 .200* .879 6 .267
Nadi 5 .221 6 .200* .903 6 .389
MAP5 .262 6 .200* .888 6 .309
a. Lilliefors Significance Correction
*. This is a lower bound of the true significance.
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Sistol Post HD .145 15 .200* .966 15 .788
Diastol Post HD .084 15 .200* .981 15 .978
MAPPostHD .099 15 .200* .970 15 .860
Nadi Post HD .199 15 .115 .779 15 .002
a. Lilliefors Significance Correction
