Kebijakan Medik pada Pasien Gagal Ginjal Kronik dengan Hemodialisis di RS Hasan Sadikin Bandung

https://doi.org/10.22146/jkki.36360

Dewi Marhaeni Diah Herawati(1*), Eko Fuji Ariyanto(2)

(1) Departemen Ilmu Gizi Medik Fakultas Kedokteran Universitas Padjajaran
(2) Departemen Ilmu Gizi Medik Fakultas Kedokteran Universitas Padjajaran
(*) Corresponding Author

Abstract


Background: Prevalence of Chronic Kidney Disease in dialysis’s patients in Indonesia has increased. Some of them occurred with malnutrition inflammation complex syndrome and lead to death. This study aims to determine the intake of protein and energy, and determine factors that cause the low intake of nutrition. Methods: Design of the study was mixed methods using embedded concurrent strategy. Research paradigm was constructivism whereas qualitative research conducted in-depth interviews and observations. Quantitative research has been done with a descriptive approach, observational, using secondary data and perform 24 Hour Recall and Food Frequency Questionnaire (FFQ). The study was conducted at Hemodialysis Unit, Hasan Sadikin Hospital from June to September 2013, with a total sampling. Qualitative and quantitative data analysis has been done, followed by analysis of policy and analysis for policy for establishing a medical policy for chronic kidney disease patients receiving medical hemodialysis. Result: The average protein intake of the patients was 1.32 g/ kg/day. Interval of protein intake of 0.5 g/kg /day (lowest) until 2.8 g/kg/day (highest). 24% of patients had protein intake under 1 g /kg BW/day and 22.8% was above 1.5 g/kg BW/day. Average energy intake was 2001 kcal patient/day (930 kcal/ day - 3196.9 kcal/day). The qualitative analysis resulted in seven themes which causes nutrient low intake. The themes were underlying diseases (such as diabetes mellitus and hypertension), length of dialysis, frequency and number of dialysis, effects of dialysis, body’s response, cost factor, counseling, and education. Most of the respondents felt suffer from anemia and complained of nausea and vomiting. Body responses varied widely among them. Conclusion: Protein intake of dialysis patients as recommended by K/DOQI, but not in accordance with energy intake. Protein and energy intake of Jakeman's holder patients were lower than the recommendation of K/DOQI. The cause of lower intake of nutrients due to the underlying disease, length of dialysis, frequency and number of dialysis, effects of dialysis, body responses, cost factors and lack of counseling and education. Counseling and education of the patient's hospital are needed. The government should encourage medical policy in the management of patients with chronic kidney failure are comprehensive, in primary care, secondary and tertiary. The government must provide competent personnel, facilities and supporting infrastructure, service standards and standard operating procedures are required for each level of service.

 

Latar Belakang: Prevalensi pasien Penyakit Ginjal Kronik (PGK) yang menjalani hemodialisis di Indonesia mengalami peningkatan. Beberapa diantaranya terjadi malnutrition inflammation complex syndrome dan berujung pada kematian. Penelitian bertujuan untuk mengetahui asupan protein dan energi, serta mengetahui faktor-faktor yang menyebabkan rendahnya asupan nutrisi. Metode: Desain penelitian adalah mixed method dengan menggunakan strategi conccurent embedded. Paradigma penelitian adalah constructivisme. Penelitian kuantitatif dengan pendekatan deskriptif, observational menggunakan data skunder dan melakukan 24 Hour Recall dan Food Frequency Questionaire (FFQ). Penelitian kualitatif dilakukan dengan wawancara mendalam dan observasi. Penelitian dilakukan di Unit Hemodialisis Rumah Sakit Hasan Sadikin Bandung bulan Juni-September 2013 dengan total sampling. Dilakukan analisis data kualitatif dan kuantitatif yang diikuti analysis of policy dan analysis for policy untuk merumuskan kebijakan medik pada pasien PGK yang menjalani hemodialisis. Hasil: Rata-rata asupan protein pasien adalah 1,32 gr/kg BB/ Hari. Asupan protein terendah 0,5 gr/kg BB/hari, tertinggi 2,8 gr/kg BB/hari. Asupan protein pada 24% pasien dibawah 1 gr/ kg BB/hari; 22,8% diatas 1,5 gr/kg BB/hari. Rata-rata asupan energi pasien 2001 kkal/hari, asupan terendah 930 kkal/hari, tertinggi 3196,9 kkal/hari. Analisis kualitatif menghasilkan 7 tema yang menjadi penyebab rendahnya asupan nutrisi yaitu penyakit dasar (diabetes mellitus, hipertensi), lama dialisis, frekuensi dan jumlah dialisis, efek dialisis, respon tubuh, faktor biaya dan konseling serta edukasi. Efek dialisis yang paling dikeluhkan adalah anemia, mual dan muntah. Respon tubuh diantara pasien sangat bervariasi. Konseling dan edukasi dari pihak rumah sakit sangat dibutuhkan pasien. Kesimpulan: Asupan protein pasien sesuai rekomendasi K/ DOQI, namun belum sesuai untuk asupan energi. Asupan protein dan energi pasien Jamkesmas lebih rendah dari rekomendasi K/DOQI. Penyebab rendahnya asupan nutrisi disebabkan karena penyakit dasar yang menjadi penyebab PGK, lama dialisis, frekuensi dan jumlah dialisis, efek dialisis, respon tubuh, faktor biaya dan tidak adanya konseling dan edukasi. Pemerintah harus mendorong kebijakan medik dalam penanganan pasien gagal ginjal kronik yang komprehensif, di pelayanan primer, skunder dan tertier. Untuk tercapainya kebijakan medik tersebut pemerintah harus menyediakan tenaga yang kompeten, sarana dan prasarana pendukung, standar dan protap yang dibutuhkan untuk masing-masing level pelayanan.


Keywords


Hemodialysis patients; Malnutrition; Medical policy; Pasien hemodialysis; Malnutrisi; Kebijakan medik

Full Text:

PDF


References

  1. Widiana IGR. Distribusi geografis penyakit ginjal kronik di Bali: komparasi formula Cockcroft- Gault dan formula modification of diet in renal disease. J Peny Dalam. 2007;8(3):198-204.
  2. Suhardjono. Penyakit ginjal kronik adalah suatu wabah baru (global epidemic) di seluruh dunia. Annual meeting Perhimpunan Nefrologi Indonesia. 2009;1-9.
  3. Joel D. Pathophsyology of protein energy wasting in chronic renal failure. The Journal of Nutrition. 1999;129:247S-51S.
  4. Creswell JW, editor. Research Design: Qualitative, quantitaive and mixed methods approach.Third ed. California: SAGE Publications, Inc; 2009.
  5. Denzin NK, Lincoln YS. Qualitative research. Pustaka Pelajar. 2009.
  6. Alwasilah, A.C. Pokoknya kualitatif, dasar- dasar merancang dan melakukan penelitian kualitatif. Pustaka Jaya. Bandung. 2002.
  7. Buse K, Mays N, Walt G. Making health policy. London School of Hygiene and Tropical Medicine. 2005.
  8. Cano E, Fiaccadori E, Tesinsky P, Toigo G, Druml W. ESPEN Guidelineson enteral nutrition: adult renal failure clinical nutrition. 2006;25:295- 310.
  9. National Kidney Foundation. K/DOQI clinical practice guidlines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(4 suppl 3):S1-201.
  10. Kartono SD, Darmini F, RR. Penyusunan diet pada gagal ginjal kronik denagn dialisis. In Sediabutar RP, editor. Gizi pada gagal ginjal kronik. Jakarta: Perhimpunan Nefrologi Indonesia. 1992.
  11. Primadinta, Marwati T, Solikhah. Analisa cost sharing perhitungan tarif hemodialisis masyarakat miskin di Rumah Sakit Umum PKU Muhammadiyah Unit 1 Yogyakarta. Jurnal Kesmas. 2011; 5(3):162-232.
  12. Kusek JW. Cross-sectional study of health-related quality of life in African Americans with chronic renal insufficiency: The African American study of kidney disease and hypertension trial. Am J Kidney Dis. 2002;39(3):513-24
  13. Maor Y, King M, Olmer L, Mozes B. A Comparison of three measures: the time trade- off technique, global health-related quality of life and the SF-36 in dialysis patients. J Clin Epidemiologi. 2001;54(6):565-70.
  14. Anees M, Hameed F, Mumtaz A, Ibrahim M, Khan M. Dialysis-related factors affecting quality of life in patients on hemodialysis. Iranian Journal of Kidney Diseases. 2011;5(1)1:9-14
  15. Laporan Khusus Symposium international so- ciety of peritoneal dialysis. CDK-198. 2012;39 (10):788-791.



DOI: https://doi.org/10.22146/jkki.36360

Article Metrics

Abstract views : 752 | views : 527

Refbacks

  • There are currently no refbacks.


Copyright (c) 2014 Jurnal Kebijakan Kesehatan Indonesia : JKKI

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

The Jurnal Kebijakan Kesehatan Indonesia : JKKI [ISSN 2089 2624 (print); ISSN 2620 4703 (online)] is published by Center for Health Policy and Management (CHPM). This website is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. Built on the Public Knowledge Project's OJS 2.4.8.1.
 Web
Analytics View My Stats