End Stage Renal Disease

Penurunan jumlah nefron akibat mekanisme apapun menyebabkan perubahan struktur dan fungsi dari nefron yang tersisa. Perubahan ini dimediasi oleh molekul vasoaktif terutama renin angiotensin system (RAS), sitokin dan growth factor. Ginjal akan meningkatkan aliran kapiler menuju glomerulus non sklerotik sebagai usaha untuk mempertahankan GFR. Namun terjadi hiperfiltrasi akibat hipertensi intraglomerulus dan semakin berkembangnya sklerosis pada glomerulus yang masih tersisa. Akibatnya terjadi penurunan GFR yang progresif, proteinuria, kecenderungan hipertensi, dan penyusutan ginjal. Proses ini terus berlanjut sampai ginjal tidak mampu lagi untuk melakukan filtrasi darah dari toksin dan zat-zat yang tidak diperlukan lagi oleh tubuh. Tahap terakhir ini dinamakan end-stage renal disease (ESRD) (Lewis, 2009).

Introduction: Various problems that arise due to kidney malfunction in the client with terminal renal failure above can result in despair and decreased motivation to recover. One way to overcome this problem is by motivational interviewing with a spiritual approach (gratitude, patience and sincerity). The purpose of this research was to identify the effects of motivational interviewing with spiritual approach on despair and recovery motivation of esrd patients who have undergone regular hemodialysis. Methods: This research used quasi experiment with pre- post test and posttest only design with control group design. Technical sampling by using simple method. The research sample were 32 respondents based on the inclusion criteria. The intervention was carried out for 4 weeks with 2 meetings / week. The independent variable of this study was motivational interviewing with a spiritual approach . The independent variable were despair and recovery motivation. This research used a questionnaire instrument to measure despair and recovery motivation and the validity and reliability tests have been conducted previously. Statistical tests have used paired t test, independent t test, mann whitney and wilcoxon signed rank test. Results: The result of statistical test showed that MI with spiritual approach has effected on decrease anxiety (p=0,001) and an improvement in recovery motivation (p = 0.001). Discussions: MI intervention assists patients in identifying, evaluating and responding to their deformities and beliefs. Helping patients develop a rational mindset, engage in reality testing, and reshape form behavior by changing internal messages. Conclusion: MI interventions with spiritual approaches have an effect on reducing despair and increasing recovery motivation in ESRD patients with regular HD. Suggestion: this research can be the initial data in conducting further research on one form of cognitive intervention (MI) with a spiritual approach in dealing with various psychological problems.

Menurut peneliti responden dengan jenis kelamin laki-laki lebih memiliki resiko yang lebih besar untuk mengalami End Stage Renal Disease karena pola dan gaya hidup laki-laki kurang baik dibandingkan dengan pola dan gaya hidup perempuan, dimana laki-laki mempunyai kebiasaan merokok, mengkonsumsi alkohol, mengkonsumsi minuman suplemen serta laki-laki memilki kadar kretinin yang lebih tinggi dari perempuan dimana hal ini dapat memperberat dari fungsi ginjal sebagai proses filtrasi, reabsorbsi, sekresi dan eksresi. Hal ini jika tidak mendapatkan perhatian khusus akan menyebabkan responden laki-laki memiliki resiko mengalami End Stage Renal Disease. Hasil penelitian ini juga menunjukkan bahwa klien yang mengalami End Stage Renal Disease yang menjalani terapi hemodialisa dilihat dari distribusi frekuensi tingkat pendidikan responden sebagian besar responden tingkat pendidikannya rendah yakni 12 klien (54,5%) sedangkan yang berpendidikan tinggi yakni 10 klien (45,5%).Hasil penelitian ini sejalan dengan penelitian yang dilakukan oleh Hanum, dkk (2015) dengan judul pengaruh pendidikan kesehatan secara individual tentang pembatasan asupan cairan terhadap pengetahuan pembatasan cairan dan IDWGklien hemodialisa. Dimana responden dengan tingkat pendidikan rendah berjumlah 24 (80%) sedangkan responden dengan tingkat pendidikan tinggi berjumlah 6 (20%).Secara umum seseorang yang memiliki tingkat pendidikan tinggi akan mempunyai pengetahuan luas dibandingkan dengan seseorang yang tingkat pendidikannya lebih rendah. Keyakinan biasanya diperoleh secara turun temurun dan tanpa adanya pembuktian terlebih dahulu, keyakinan ini dapat mempengaruhi pengetahuan seseorang baik keyakinan yang sifatnya positif maupun negatif (Notoadmojo, 2012).

Tujuan dari karya tulis ilmiah ini adalah mengetahui prevalensi DKD dan ESRD (end stage renal disease) serta gambaran tipe diabetes, kolesterol total, LDL, tekanan darah, HbA1c, indeks massa tubuh (IMT), dan stadium nefropati pada pasien diabetes rawat inap di Rumah Sakit Immanuel Bandung periode Oktober 2010 – September 2011.

The number of patients with End Stage Renal Disease (ESRD) in Indonesia is growing. Increasing prevalence of hypertension and diabe- tes mellitus contributes to higher prevalence of ESRD. The majority of patients (94%) with ESRD are undertaking hemodialysis (HD) at public and private hospitals. However, continuous ambulatory Peritoneal Dialysis (PD) has been prescribed to small portion of patients with ESRD. The aim of this study was to examine the cost effectiveness between HD and PD on ESRD patients. This study compared 78 HD patients at Hospital X in Bogor and 10 PD patients at Hospital Y in Jakarta. Patient’s quality of life (QoL) was measured using SF 36 questionnaires. The costs were measured by direct medical costs using CBGs prices, direct non-medical costs (transportation, food for patient and family), and indirect medical costs (opportunity costs). The study found that the HD cost per year per patient was IDR 133.4 million and the comparative cost for PD was IDR 81.7 million. The study found lower QoL of HD patients (46.2%) com- pared to QoL of PD patients (90%). In addition, PD patients had significant better quality of physical activities, emotional states, social function, and sanity. The study found the incremental costs for to HD to reach similar emotional states was IDR 2.0 million compared to PD and IDR 1.8 million for extra physical role gained. It is concluded that PD was more cost-effective than HD in achieving a certain level of quality of life among patients with ESRD in two hospitals in Indonesia.

Bilgic, A., Ibis, A., Tutal, E., Koc, S., Sezer, S. and Ozdemir, N. 2012. Association of Nutritional Status with Depression and Sleep Disorders in Elderly End Stage Renal Disease Patients - Does Chronic Inflammation Cause It All? Turkish Nephrology, Dialysis and Transplantation Journal. 21(2): 148-155

Calcific uremic arteriolopathy (CUA) merupakan salah satu komplikasi end-stage renal disease (ESRD), yang dapat meningkatkan morbiditas dan mortalitas. Faktor risiko CUA antara lain jenis kelamin (wanita), diabetes melitus, hiperfosfatemia, ESRD, gangguan mineral dan tulang, obesitas, warfarin, dan etnis Kaukasia. Gold standard diagnosis adalah penemuan patognomonik histopatologis spesimen biopsi kulit. Tatalaksana meliputi penanganan umum, perawatan luka, koreksi abnormalitas biokimia, sodium tiosulfat, dan beberapa terapi potensial seperti bisfosfonat, low- molecular-weight heparin, dan agen trombolitik. CUA berpotensi fatal, diagnosis sedini mungkin dan tatalaksana yang tepat dapat memperbaiki kondisi dan memberikan hasil memuaskan.

echocardiographic features, with resting peak pulmonary arterial pressure above 30 mm Hg (plus right atrial pressure) and associated reduction in T lco to <70% predicted. In many cases the diagnosis was further confirmed by right heart catheterisation, with resting or exercise associated mean pulmonary arterial pressure above 25 or 30 mm Hg, respectively. Isolated pulmonary hypertension was determined by these changes in the absence of significant lung fibrosis. Vital status at the end of December 1997 was determined for all patients. Two reviewers (CMB, AJS) inspected the death certificates obtained from the UK National Health Service Central Register. Patient death was attributed to a

United States Renal Data System (USRDS). (2011). Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases , Bethesda, MD, 201

Espahbodi, F., Khoddad, T., Esmaeili, L., 2014. Evaluation of Malnutrition and its Association With Biochemical Parameters in Patients With End Stage Renal Disease Undergoing Hemodialysis Using Subjective Global Assessment. Nephro Urol Mon., 6(3): e16385.