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"Latar belakang: Penyakit ginjal kronik menyebabkan beberapa perubahan fungsi tubuh dalam memetabolisme nutrisi. Hal ini menyebabkan ditemukannya kasus malnutrisi pada pasien PGK khususnya pada stadium akhir yang menjalani hemodialisis. Ini tentu perlu menjadi perhatian karena nutrisi sangat penting bagi pertumbuhan anak. Oleh karena itu, penelitian ini dilakukan untuk mencari pengaruh hemodialisis dan faktor yang berpengaruh lainnya terhadap status gizi anak. Metode: Penelitian dilakukan dengan desain potong lintang dengan mengambil data sekunder berupa stadium penyakit, durasi penyakit, faktor etiologi primer, komorbiditas dari rekam medis. Data status gizi anak diperoleh dengan mengukur berat badan serta tinggi, lingkar lengan atas lalu dimasukan ke aplikasi WHO Anthro. Data demografi, seperti tingkat pendidikan ayah & ibu, status ekonomi keluarga, usia, dan jenis kelamin diperoleh dengan pengisian Case Report Form (CRF). Terdapat sebanyak 20 responden yang memenuhi kriteria inklusi dan eksklusi dari penelitian ini. Hasil: Rerata penilaian status gizi dilihat dari indeks massa tubuh menurut umur menunjukkan hasil -2 SD < x < 1 SD dengan interpretasi gizi baik dan x <-2 SD (perawakan pendek) dilihat dari tinggi badan menurut umur. Berdasarkan analisis bivariat, tidak ditemukan adanya pengaruh signifikan antara durasi hemodialisis, frekuensi hemodialisis, etiologi, usia, jenis kelamin, dan komorbiditas (p>0.05) pada anak dengan gagal ginjal kronik yang sedang menjalani hemodialisis terhadap status gizinya. Kesimpulan: Status gizi pada anak PGK yang menjalani hemodialisis dinilai berdasarkan indeks massa tubuh dan tinggi badan menurut usia ditemukan hasil rata-rata gizi baik namun berperawakan pendek. Tidak ditemukan pengaruh durasi, frekuensi, etiologi, usia, jenis kelamin, dan komorbiditas pada anak dengan gagal ginjal kronik yang sedang menjalani hemodialisis terhadap status gizinya.

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Introduction: Chronic kidney disease causes several changes in the body's function in metabolizing nutrients. This has led to the discovery of cases of malnutrition in CKD patients, especially in ESRD patients undergoing hemodialysis. This certainly needs to be a concern because nutrition is very important for children's growth. Therefore, this study was conducted to find out the effect of hemodialysis and other influencing factors on the nutritional status of children. Method: The study was conducted with a cross-sectional design by taking secondary data in the form of disease stage, duration of disease, primary etiologic factors, and comorbidities from medical records. Data on the nutritional status of children was obtained by measuring weight and height,

and upper arm circumference and then entered into the WHO Anthro application. Demographic data, such as the education level of the father & mother, family economic status, age, and gender were obtained by filling out the Case Report Form (CRF). 20 respondents met the inclusion and exclusion criteria of this study. Result: The average nutritional status assessment seen from the body mass index according to age showed results of -2 SD < x < 1 SD with good nutrition interpretation and x <-2 SD (short stature) in terms of height according to age. Based on bivariate analysis, there was no significant effect between duration of hemodialysis, frequency of hemodialysis, etiology, age, sex, and comorbidities (p>0.05) in children with chronic kidney failure who were undergoing hemodialysis on their nutritional status. Conclusion: The nutritional status of CKD children undergoing hemodialysis was assessed based on body mass index and height according to age. The average results were good nutrition but short stature. There was no effect of duration, frequency, etiology, age, gender, and comorbidities in children with chronic renal failure undergoing hemodialysis on their nutritional status."

"Penyajian serial kasus ini bertujuan untuk menganalisis dukungan nutrisi optimal pada penderita paru-paru obstruktif kronis. Pemilihan kasus berdasarkan karakteristik yang terdapat pada pasien paru-paru obstruktif kronis, yaitu usia lansia, sedang mengalami eksaserbasi akut, terdapat komplikasi dan faktor komorbid, serta malnutrisi (underweight atau obesitas), yang dirawat di rumah sakit. Kebutuhan energi ditentukan dengan menggunakan perhitungan rumus Harris Benedict dan dikalikan dengan faktor stres yang sesuai. Komposisi protein 1,2–1,7 gr/kg BB/hari, lemak 25-30%, dan karbohidrat 50–60%. Hasil analisis dari dua kasus didapatkan rerata pencapaian asupan lebih dari 90% kebutuhan energi basal pada hari terakhir perawatan, satu kasus mencapai 70%, dan satu kasus lagi telah mencapai mencapai 85% kebutuhan energi total. Hanya satu kasus yang mendapat suplementasi mikronutrien lengkap dosis RDA. Monitoring dan evaluasi yang diberikan meliputi klinis, imbang cairan, toleransi asupan, dan analisis asupan. Dukungan nutrisi yang optimal, pemberian edukasi serta motivasi kepada pasien dan keluarganya, akan memberikan toleransi asupan yang baik disertai perbaikan klinis.

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The aim of this serial case is to analyze optimal nutritional support in patients with COPD. The cases selection based on the characteristics of COPD patients, i.e. older age, acute exacerbation, complications, and comorbidity factor, as well as malnutrition (underweight or obese), who were hospitalized. Basal energy requirement were determined by the Harris-Benedict equotion and was multiplied by stress factor to calculate total energy requirement. Macronutriens compositions for protein ranged from 1.2 - 1.7 g/kg bw /day, lipids 25-30%, and carbohydrate 50-60% of total calories requirement. Intake analysis from two cases showed a mean intake over 90% of basal energy needs on the last day of treatment, one case reached 70%, and other case reached up to 85% of total energy needs. Only one case received full-dose micronutrient supplementation equal to RDA. Monitoring and evaluation included clinical status, fluid balance, intake tolerance, and intake analysis. Optimal nutritional support, provision of education and motivation to patients and their families, will enhanced intake tolerance along with clinical improvement."

"The highly praised Nutritional health : strategies for disease prevention has been brought fully up to date to include all the new thinking and discoveries that have the greatest capacity to improve human health and nutritional advancement. About half the new edition will be revised and updated from the second edition while the other half will consist of major revisions of previous chapters or new subjects. Like the two previous editions the book will consist of general reviews on various topics in nutrition, especially those of much current interest.The authors provide extensive, in-depth chapters covering the most important aspects of the complex interactions between diet, its nutrient components, and their impacts on disease states, and on those health conditions that increase the risk of chronic dieases. "

"Latar belakang: Malnutrisi merupakan kondisi yang sering terjadi pada populasi pasien dengan penyakit ginjal kronik (PGK). Malnutrisi pada anak dengan PGK menjadi lebih kompleks karena dapat mengganggu potensi tumbuh kembang yang mereka miliki. Dalam kelompok usia 3-18 tahun dan yang telah menjalani hemodialisis (HD), terdapat satu parameter khusus yang dinilai, yaitu normalized protein catabolic rate (nPCR), tetapi belum pernah digunakan pada populasi anak GGT dengan HD di Indonesia. Dengan segala keterbatasan dalam pemantauan status nutrisi pasien anak GGT dengan HD, hendak dicari nilai nPCR, parameter antropometri, nilai asupan nutrisi, dan Kt/V pada populasi anak GGT dengan HD.Tujuan: Mengetahui nilai parameter nPCR, parameter antropometri, nilai asupan nutrisi, dan Kt/V pada populasi anak GGT dengan HD di Indonesia, khususnya di Rumah Sakit Cipto Mangunkusumo (RSCM) sebagai pusat rujukan nasional.Metode: Penelitian ini merupakan uji potong lintang yang dilakukan di Ruang Hemodialisis Anak RSCM pada anak 3-18 tahun. Kriteria inklusi meliputi pasien GGT yang menjalani HD rutin minimal 3 bulan di RSCM dan bebas infeksi/ episode rawat inap dalam 1 bulan terakhir. Subjek yang mengalami kenaikan berat badan pada 1 bulan setelah HD cenderung 4,3 kali lebih mungkin memiliki nilai nPCR ≥1 g/kg/hari dibandingkan subjek yang tidak mengalami kenaikan berat badan.Hasil dan Simpulan: Pada populasi anak GGT dengan HD rutin di RSCM, rata-rata nilai nPCR 0,85 g/kg/hari. Subjek yang mengalami kenaikan berat badan pada 1 bulan setelah HD cenderung 4,3 kali lebih mungkin memiliki nilai nPCR ≥1 g/kg/hari dibandingkan subjek yang tidak mengalami kenaikan berat badan. Berdasarkan antropometri, terdapat 96% subjek dengan kondisi wasted, 80% stunted, 36% reduced body mass, dan 68% kondisi reduced muscle mass. Rata-rata asupan protein harian adalah 1,28 g/kgBBI/hari dengan rata-rata asupan kalori harian 39,72 kkal/kgBBI/hari. Rata-rata nilai Kt/V adalah 1,45.

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Background: Malnutrition is a common condition in the chronic kidney disease (CKD) patients. Malnutrition in children with CKD is more complex as it could interfere with their growth and development potential. Normalized protein catabolic rate (nPCR) is a recent parameter that has already recommended as a tool for nutritional status in the pediatric population of 3-18 years old with CKD final stage that undergone hemodialysis (HD), but has never been used in Indonesia. Regarding limitations in monitoring nutritional status of pediatric patients with HD, we want to investigate the value of nPCR, anthropometric parameters, daily nutritional intake, and Kt/V in the pediatric end stage renal falilure (ESRF) with HD.

Objectives: Investigating the value of nPCR, anthropometric parameters, daily nutritional intake, and Kt/V in the pediatric ESRF population with HD in Indonesia, especially at Cipto Mangunkusumo Hospital (CMH) as a national referral center.

Methods: This study was a cross-sectional test conducted in the Pediatric Hemodialysis Center CMH among 3-18 years old subject. Inclusion criteria was ESRF patients who underwent routine HD for at least 3 months in CMH and free of infection / hospitalization episode within the last 1 month.

Results and Conclusions: Population of ESRF children with routine HD at CMH had the average nPCR value of 0,85 g/kg/day. Subjects who had weight gain in 1 month after HD tend to 4,3 times more likely had nPCR ≥1 g/kg/day than those who didn’t have weight gain. Based on anthropometry, there were 96% of subjects with wasted conditions, 80% stunted, 36% reduced body mass, and 68% reduced muscle mass conditions. The mean daily protein intake was 1,28 g/kgIBW/ day with an average daily calorie intake of 39,72 kcal/kgIBW/day. The mean Kt/V value was 1,45."

"Tata laksana nutrisi pada pasien penyakit ginjal kronik dalam hemodialisis, bertujuan menilai peran nutrisi, yang mencakup pemberian makronutrien, mikronutrien, manajemen cairan dan elektrolit dalam mengendalikan kerusakan ginjal. Gangguan fungsi ginjal dapat menyebabkan menurunnya asupan, dan perubahan metabolisme berbagai nutrien, sehingga dapat mengakibatkan pasien jatuh pada kondisi malnutrisi dan berbagai komplikasi. Serial kasus ini terdiri dari empat kasus penyakit ginjal kronik dengan berbagai etiologi dan komorbid. Pasien pada serial kasus ini, mempunyai rentang usia pasien antara 30 - 52 tahun. Umumnya pasien mengalami sesak napas, mual, muntah, anoreksia, edema dan berdasarkan hasil skrining gizi menunjukkan semua pasien memerlukan terapi nutrisi. Terapi nutrisi diberikan sesuai dengan kebutuhan masing-masing pasien, yang dihitung dengan rumus Harris Benedict dikalikan faktor stres dan pemberiannya dimulai dari kebutuhan energi basal, yang secara bertahap ditingkatkan hingga mencapai kebutuhan energi total. Kebutuhan protein disesuaikan dengan laju filtrasi glomerulus pada masing-masing pasien. Pemantauan terapi nutrisi pada satu orang pasien selama tujuh hari, sedangkan tiga pasiennya dilakukan pemantauan selama sepuluh hari atau lebih. Pemantauan mencakup toleransi asupan makanan, kapasitas fungsional, imbang cairan, parameter laboratorium dan antropometrik serta dilakukan edukasi setiap hari. Selama pemantauan didapatkan hasil bahwa, terjadi perbaikan klinis, toleransi asupan, sebagian besar pasien dapat mencapai kebutuhan kalori total. Kebutuhan protein dihitung kembali setelah dilakukan hemodialisis. Pemeriksaan kadar ureum, kreatinin dan perhitungan creatinine clearance test menunjukkan perbaikan, walaupun tidak mencapai kadar normal. Sejalan dengan perbaikan klinis, terjadi perbaikan kondisi pasien secara umum, termasuk kapasitas fungsional. Penilaian berat badan pasien menunjukkan penurunan berat badan, sejalan dengan perbaikan kondisi edema. Pemberian nutrisi pada pasien dengan penyakit ginjal kronik stadium 5, bersifat individual dan harus disertai edukasi nutrisi dan motivasi setiap hari. Dengan tata laksana nutrisi yang baik, diharapkan kualitas hidup pasien PGK akan lebih baik, dan dapat turut mengendalikan berbagai komplikasi yang mungkin terjadi.

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Treatment of nutrition in patients with Chronic Kidney Desease (CKD) aims to assess the role of nutrition, which includes the provision of macronutrient, micronutrient, fluid and electrolyte management in controlling renal impairment, in patients with CKD stage 5 on hemodialysis therapy. Impaired kidney function may lead to decreased intake, and changes in metabolism of various nutrients, which can lead to patient falls on the condition of malnutrition and other complications. This case series consisted of four cases of chronic kidney disease with various etiologies and comorbid.

Patients in this case series are two patients aged between 30 to 52 years old. Generally, patients experience shortness of breath, nausea, vomiting, anorexia, edema, and based on nutritional screening results showed all patients requiring nutritional therapy. Nutritional therapy is given according to the needs, that is count by Harris Benedict equation, and each patient at the beginning, provided the basal energy needs, which gradually increased to reach the total energy needs. Protein needs are given according to the glomerular filtration rate, and increased when the patient was in hemodialysis. Nutritional therapy in one patient is monitored for seven days, while three of the patients are monitored for ten days or more. Monitoring includes food intake tolerance, functional capacity, fluid balance, anthropometric and laboratory, and nutrition education is conducted every day.

The result of treatment during monitoring period shows that, there is improvement of general status, tolerance intake, most patients could achieve total caloric needs. Examination of the levels of urea, creatinine and calculation of creatinine clearance test showed improvement, although did not reach normal levels. During the monitoring, in line with the clinical improvement, the patient's condition was generally improving, including functional capacity. Assessment of the patient's weight showed weight loss, along with the improvement of the condition of edema.

Nutrition treatment in patients with chronic kidney disease stage 5 is individualize and must be accompanied by daily nutrition education and motivation. With good nutrition governance, quality of life of CKD patients will be better, and it can also control variety of complications that may occur."

"Kepatuhan manajemen terapi hemodialisis terdiri dari empat aspek yaitu program hemodialisis, medikasi, pembatasan cairan, dan diet. Salah satu faktor penting dalam kepatuhan manajemen terapi hemodialisis adalah kualitas antara petugas kesehatan dengan pasien. Perawat merupakan petugas kesehatan yang sering bertatap muka dengan pasien sehingga memiliki peranan dalam meningkatkan kepatuhan. Tujuan penelitian adalah mengidentifikasi hubungan antara sikap caring perawat dan karakteristik responden. Jumlah responden penelitian ini sebanyak 97 orang pasien hemodialisis dengan desain penelitian cross sectional, yang didapat dengan purposive sampling. Hasil penelitian menggunakan uji Chi-Square menunjukkan bahwa tidak terdapat hubungan antara sikap caring perawat dengan kepatuhan manajemen terapi hemodialisis pada pasien gagal ginjal terminal dengan P value 0,418 >0,05 , namun ditemukan adanya hubungan pada variabel karakteristik responden yaitu dukungan keluarga dengan nilai P value 0,033.

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The adherence of hemodialysis therapy management consists of four aspects, they are hemodialysis program, medication, fluid restriction, and diet. One of important factor in adherence to hemodialysis therapy management is the quality between health care providers and patients. Nurses are health workers who often face to face with patients so that they have a role in improving compliance. The purpose of this study was to identify the association between caring nurse behavior and respondent characteristics. The number of respondents of this study were 97 hemodialysis patients with cross sectional study design, obtained with purposive sampling. The result of Chi Square test shows that there was no correlation between caring nurse attitude with hemodialysis therapy management adherence in end stage renal disease patients with p value 0,418 0,05, and found correlation to characteristic variable of respondent, that was family support with p value 0,033."

"Manajemen diri merupakan tata laksana multidisiplin terbaru yang memberdayakan pasien gagal ginjal terminal untuk aktif dalam mempertahankan status kesehatannya. Pelaksanaan manajemen diri masih tergolong rendah. Dukungan sosial dianggap sebagai salah satu faktor yang dapat mempengaruhi manajemen diri. Penelitian ini bertujuan untuk mengidentifikasi adanya hubungan antara dukungan sosial dengan manajemen diri pasien gagal ginjal terminal yang menjalani hemodialisis. Desain penelitian yang digunakan adalah cross sectional dengan jumlah sampel sebesar 107 responden dipilih dengan consecutive sampling. Data dikumpulkan secara daring dari 4 komunitas pemerhati pasien gagal ginjal di Indonesia menggunakan instrumen Medical Outcome Study Social Support Survey dan Hemodialysis Self-Management Instrument. Hasil penelitian dengan uji Chi square menunjukkan terdapat hubungan antara dukungan sosial dengan manajemen diri (p value <0,05). Penelitian ini merekomendasikan dukungan sosial sebagai bagian integral dari tatalaksana manajemen diri yang diberikan melalui kerja sama antara tenaga kesehatan, komunitas pemerhati pasien gagal ginjal, dan pendamping pasien.

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Self-management is the latest multidisciplinary intervention that empowers end-stage renal disease patients to be active in maintaining their health status. The implementation of self-management is still relatively low. Social support is considered as one of the factors that can affect self-management.

This study aims to identify the relationship between social support and self-management in end-stage renal disease patients undergoing hemodialysis. The design of the study is cross-sectional with a sample of 107 respondents selected by consecutive sampling. Data was collected online from 4 chronic kidney disease community in Indonesia using the Medical Outcome Study Social Support Survey and Hemodialysis Self-Management Instrument.

The result with the Chi-square test showed that there is a relationship between social support and self-management (p-value <0.05). This study recommends social support as a part of self-management intervention provided through cooperation between health workers, chronic kidney disease communities, and patient companions."