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"Pendahuluan: PGK merupakan penyakit yang sering memiliki beberapa komorbid sehingga perlu menggunakan berbagai terapi kombinasi obat. Oleh sebab itu, polifarmasi sering dilakukan dan salah satu konsekuensinya adalah terjadinya potensi interaksi obat (PIO). PIO dianggap sebagai masalah pengobatan yang dapat dicegah, namun dalam praktik klinis dapat mengakibatkan efek samping obat (ESO) atau reaksi obat yang merugikan. Hal tersebut tentu akan mempengaruhi klinis dan keberhasilan pengobatan serta keamanan penggunaan obat pada pasien PGK. Penelitian ini bertujuan untuk mengetahui pola peresepan pasien PGK dan pengaruhnya terhadap potensi interaksi dan efek samping obat yang dicurigai akibat interaksi obat. Metode: Penelitian ini merupakan penelitian non eksperimental dan pengambilan data dilakukan secara potong lintang pada pasien PGK rawat jalan stadium 3-5 pre-dialisis di rumah sakit Cipto Mangunkusumo (RSCM) dalam periode Januari 2019 sampai dengan Desember 2020. Data diambil dari electronic health record dan pusat rekam medis RSCM. Rujukan potensi interaksi obat menggunakan software Micromedex. Hasil: Terdapat 106 pasien yang memenuhi persyaratan dan diambil menjadi subjek penelitian. Hasil penelitian menunjukkan bahwa pada pasien PGK rawat jalan stadium 3- 5 pre-dialisis di RSCM tahun 2019-2020, terdapat 111 jenis obat yang diresepkan dan obat yang paling sering diresepkan adalah bisoprolol (36,5%). Proporsi pasien yang mendapatkan pengobatan dengan potensi interaksi obat adalah 76% (81 pasien), sedangkan proporsi pasien yang mengalami ESO yang dicurigai akibat interaksi obat adalah 28% (23 pasien) dari 81 pasien dengan PIO. ESO tersebut berupa hiperglikemi (17 pasien), hipertensi (1 pasien), hiperkalemi (1 pasien) dan hipotensi (1 pasien). Terdapat hubungan yang bermakna secara statistik antara variabel perancu yaitu, jumlah obat > 10, komorbid jantung dan DM dengan ESO yang dicurigai akibat interaksi obat (p<0.05). Hasil multivariat mendapatkan hanya komorbid jantung (gagal jantung dan penyakit jantung koroner) yang memiliki hubungan yang bermakna secara statistik dengan ESO yang dicurigai akibat interaksi obat (p = 0,03). Kesimpulan: Pada penelitian ini, sebanyak 76% pasien mendapatkan pengobatan dengan PIO. Sedangkan 28% pasien dari 81 pasien dengan PIO mengalami ESO yang dicurigai akibat interaksi obat. ESO yang paling banyak dialami adalah hiperglikemi. Komorbid jantung merupakan faktor risiko terjadinya ESO yang dicurigai akibat interaksi obat.

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Introduction: CKD often has several comorbidities so it is necessary to use various drug combination therapies. Therefore, it can lead to polypharmacy and one of its consequences is the occurrence of potential drug-drug interactions (DDI). DDI is considered a problem that can be prevented, but in clinical practice it can result in adverse drug reactions (ADR). This will certainly affect the clinical and treatment success as well as the safety of the drug use in CKD patients. This study was aimed to determine the prescribing pattern and its effect on potential DDI and ADR that are suspected due to DDI.

Methods: This was a non-experimental cross-sectional study, conducted on CKD outpatients stage 3-5 pre-dialysis at Cipto Mangunkusumo Hospital in the period January 2019 to December 2020. Data were taken from electronic health records and the hospital’s medical record. The Micromedex software was used as a reference for potential drug interactions.

Results: There were 106 patients who met the requirements and were taken as research subjects. The results showed that in CKD out-patients stage 3-5 pre-dialysis at RSCM in 2019-2020, there were 111 types of drugs prescribed and the most frequently prescribed drug was bisoprolol (36.5%). The proportion of patients who received treatment with a potential DDI was 76% (81 patients), while the proportion of patients who experienced ADR suspected due to DDI was 28% (23 patients) from 81 patients with suspected DDI. The ADRs were hyperglycemia (17 patients), hypertension (1 patient), hyperkalemia (1 patient) and hypotension (1 patient). There was a statistically significant association between the confounding variables, namely, number of drugs, cardiovascular disease and DM with ADR suspected due to DDI (p<0.05). Multivariate analysis found that only cardiovascular disease (congestive heart failure and coronary artery disease) had a statistically significant relationship with ADR suspected due to DDI (p = 0.03).

Conclusion: In this study, 76% of patients received treatment with potential DDI. Meanwhile, 23% from 81 patients patients with DDI experienced ADR suspected due to drug interactions. The most often occuring ADR is hyperglycemia. It was found that cardivascular comorbidity is a risk factor for having an ADR suspected cause by DDI."

"Latar Belakang: Prevalensi penyakit ginjal kronik (PGK) stadium akhir di Indonesia mengalami kenaikan setiap tahunnya dan biasanya mempunyai banyak komorbid seperti hipertensi, diabetes mellitus (DM) dan penyakit kardiovaskular. Selain itu pasien PGK juga berisiko mengalami komplikasi jangka panjang seperti anemia, gangguan mineral dan tulang, sehingga memerlukan pengobatan dengan beberapa jenis obat (polifarmasi). Obat-obatan pada pasien PGK digunakan dalam waktu jangka panjang sehingga berpotensi terjadi interaksi antar obat. Semakin banyaknya interaksi obat maka akan meningkatkan risiko efek samping obat (ESO). Pasien PGK juga sangat rentan mengalami peningkatan risiko akumulasi obat dan efek samping karena adanya perubahan parameter farmakokinetik dan farmakodinamik. Selain itu pada pasien PGK stadium 5 dengan hemodialisis (HD) terdapat beberapa obat yang terdialisis dalam proses HD sehingga dapat mengurangi efektivitas pengobatan. Tujuan dari penelitian ini adalah untuk mengetahui pola peresepan pada pasien PGK stadium 5 yang menjalani HD rutin serta kaitannya dengan potensi interaksi obat (PIO) dan kemungkinan ESO yang dapat diakibatkan oleh interaksi antar obat tersebut.Metode: Penelitian ini merupakan penelitian observasional dengan desain potong lintang pada pasien PGK stadium 5 dengan HD rutin di Rumah Sakit Cipto Mangunkusumo dalam periode Januari 2020 sampai dengan Juli 2021. Data diambil dari rekam medis unit HD, rekam medis pusat, electronic health record (EHR) dan hospital information system (HIS). Untuk mengetahui PIO dilakukan penilaian berdasarkan perangkat lunak Lexicomp dan penilaian kausalitas ESO dengan menggunakan algoritma Naranjo.Hasil: Didapatkan 147 pasien yang memenuhi kriteria inklusi dan terdapat 101 jenis obat dengan 2767 kali peresepan dalam waktu 3 bulan. Proporsi pasien yang mengalami potensi interaksi antar obat sebanyak 89% pasien. Proporsi pasien yang mengalami potensi interaksi kategori mayor sebanyak 14% pasien, kategori moderat sebanyak 88% pasien, dan kategori minor sebanyak 37% pasien. Proporsi pasien yang dicurigai mengalami ESO akibat interaksi obat sebanyak 50% (66 pasien) dari 131 pasien yang mengalami PIO. Pada hasil multivariat, hanya komorbid DM yang memiliki hubungan yang bermakna secara statistik dengan ESO yang dicurigai akibat interaksi obat.Kesimpulan: Sebanyak 89% pasien PGK stadium 5 dengan HD mengalami potensi interaksi obat dan hipertensi merupakan efek samping terbanyak yang dicurigai akibat interaksi obat. Komorbid DM mempunyai peran yang cukup penting untuk terjadinya efek samping yang dicurigai akibat interaksi obat pada pasien PGK stadium 5 dengan HD

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Background: The prevalence of end-stage renal disease in Indonesia has increased every year and usually has many comorbidities such as hypertension, diabetes mellitus (DM) and cardiovascular disease. In addition, there is also a risk of long-term complications, thus requiring treatment with several types of drugs (polypharmacy). The higher the frequency of drug interactions, the higher the risk of adverse drug reaction (ADR). Chronic kidney disease (CKD) patients are also very susceptible to an increased risk of drug accumulation and ADR due to changes in pharmacokinetic and pharmacodynamic parameters. In addition, CKD stage 5 patients with hemodialysis (HD) have several drugs that are dialyzed in the HD process so that it can reduce the effectiveness of treatment. The purpose of this study was to determine the prescribing pattern in stage 5 CKD patients on routine HD and its relationship to DDI and the possibility of ADR that could be caused by interactions between these drugs.

Methods: This was an observational study with a cross-sectional design in CKD stage 5 patients on routine HD at Cipto Mangunkusumo Hospital in the period January 2020 to July 2021. Data were taken from HD unit medical records. To determine the DDI, an assessment was carried out based on the Lexicomp software and ADR causality assessment using the Naranjo algorithm.

Results: A total of 147 patients met the inclusion criteria and there were 101 types of drugs with 2767 prescriptions within 3 months. The proportion of patients who received treatment with potential DDI is 89% of patients. The proportion of patients who received DDI in the major category was 14%, the moderate category was 88%, and the minor category was 37%. From 131 patients with DDI, the proportion of patients suspected having ADR cause by DDI is 50% (66 patients). Multivariate analysis found that only DM had statistically significant relationship with ADR that are suspected due to DDI.

Conclusion: In this study, 89% of patients received treatment with potential DDI and hypertension is the most suspected ADR due to drug interactions. Comorbid DM has an important role in the occurrence of ADR due to DDI in stage 5 CKD patients on HD."

"ABSTRAKTujuan penelitian ini adalah untuk mengembangkan model perilaku adaptasi pasien penyakit ginjal kronis pre dialisis serta mengidentifikasi efektifitas model terhadap respon adaptasi fisiologi, perilaku adaptasi psikologi, pengetahuan dan sikap. Penelitian ini merupakan riset development yang dilakukan dalam dua tahap. Tahap satu mengidentifikasi masalah melalui penelitian kualitatif dengan pendekatan fenomenologi deskriptif tentang pengalaman hidup pasien dengan penyakit ginjal kronis pre dialisis, dilanjutkan membuat solusi dengan mengembangkan model perilaku adaptasi pasien penyakit ginjal kronis pre dialisis. Penelitian tahap dua quasi eksperimen dengan desain pre-test-post-test with control group untuk melihat efektifitas model pada 70 pasien penyakit ginjal kronis pre dialisis 38 orang kelompok intervensi dan 32 orang kelompok kontrol . Hasil penelitian tahap satu berupa buku model dan panduan implementasi, materi pembelajaran perilaku adaptasi untuk perawat pelaksana, serta booklet perilaku adaptasi untuk pasien penyakit ginjal kronis pre dialisis. Hasil penelitian tahap dua membuktikan kelompok intervensi memiliki respon adaptasi fisiologi, perilaku adaptasi psikologi, serta pengetahuan dan sikap yang lebih baik dibanding kelompok kontrol. Kesimpulan hasil penelitian ini adalah model perilaku adaptasi pasien penyakit ginjal kronis pre dialisis efektif terhadap respon adaptasi fisiologi, perilaku adaptasi psikologi, pengetahuan dan sikap. Saran melakukan sosialisasi model, advokasi ke unit terkait, aplikasi dalam asuhan keperawatan pada pasien penyakit ginjal kronis pre dialisis. Kata kunci: model perilaku adaptasi, respon adaptasi fisiologi, perilaku adaptasi psikologi, penyakit ginjal kronis pre dialisis

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ABSTRACTThe purpose of this study is to develop a model of adaptation behaviors for patients with chronic kidney disease pre dialysis and identify the effectiveness of the model towards physiological adaptation response, psychological adaptation behavior, knowledge and attitude of the patients. The study is a development research done in two stages. Stage one is identification of the issues through qualitative study according to descriptive phenomenology approach related to patients rsquo life experiences with chronic kidney disease pre dialysis, continued by the development of a model of adaptation behaviors for patients with chronic kidney disease pre dialysis as a solution to the issue. Stage two is a quasi experiment according to pre test post test with control group design to observe the effectiveness of the model in 70 patients with chronic kidney disease pre dialysis 38 subjects in the intervention group and 32 subjects in control group . The result of stage one study is a model book and implementation guideline, adaptation behaviors learning material for caregiver nurse and basic adaptation behaviors booklet for patients with chronic kidney disease pre dialysis. The result of stage two study proved that the intervention group has a physiological adaptation response, psychological adaptation behavior, knowledge and attitude better than the control group. In conclusion, the constructed model of adaptation behaviors for patients with chronic kidney disease pre dialysis is effective towards physiological adaptation response, psychological adaptation behavior, knowledge and attitude of the patients. Suggestions for model dissemination, advocacy to related units, application in nursing care in patients with chronic kidney disease pre dialysis. Keywords Model of adaptation behaviors, physiological adaptation response, psychological adaptation behavior, chronic kidney disease pre dialysis"

"Latar Belakang: Penyakit ginjal kronik (PGK) merupakan terminologi baru yang dikeluarkan oleh the National Kidney Foundation’s Kidney Disease and Outcome Quality Initiative (NKF KDOQI) pada tahun 2002 untuk pasien yang mengalami kerusakan ginjal paling sedikit selama tiga bulan dengan atau tanpa penurunan LFG atau pasien yang memiliki LFG < 60 mL/menit/1,73 m2 lebih dari tiga bulan dengan atau tanpa kerusakan ginjal. Progresivitas PGK ditentukan oleh beberapa faktor risiko seperti hipertensi, proteinuria, anemia, genetik, ras, usia dan jenis kelamin. Terminologi PGK belum banyak digunakan di Indonesia, sehingga karakteristik dan kesintasan PGK stadium 3 dan 4 pada anak belum banyak diteliti.Tujuan: Mendapatkan karakteristik dan kesintasan PGK stadium 3 dan 4 pada anak yang berobat di Departemen Ilmu Kesehatan Anak FKUI-RSCMMetode: Desain penelitian ini adalah kohort prospektif historikal yang diambil dari rekam medis di Departemen Ilmu Kesehatan Anak FKUI-RSCM sejak Januari 2004 hingga 30 November 2012, kemudian diamati luaran akhirnya sampai penelitian dinyatakan selesai. Kriteria pemilihan subjek meliputi usia 2-18 tahun dan memenuhi kriteria PGK stadium 3 dan 4 menurut NKF KDOQI. Data ditabulasi untuk melihat karakteristik subjek. Kesintasan dianalisis dengan menggunakan Kaplan Meier dengan event yang dinilai adalah PGK stadium 5 atau kematian.Hasil: Dalam kurun waktu 8 tahun ditemukan 50 rekam medis yang masuk dalam analisis, terdiri atas 36 subjek PGK stadium 3 dan 14 subjek PGK stadium 4. Median usia adalah 7,9 (2-15) tahun dengan jenis kelamin perempuan (58 %) sedikit lebih banyak dari pada lelaki (42 %). Etiologi terbanyak adalah glomerulonefritis (56 %) dengan sindrom nefrotik memiliki proporsi terbesar. Gambaran klinis yang ditemukan adalah hipertensi (42 %), gizi kurang (40 %), anemia (70 %), gangguan elektrolit (78 %), asidosis (34 %), proteinuria (72 %), perawakan pendek (56 %), osteodistrofi renal (2 %), dan kardiomiopati dilatasi (14 %). Median kesintasan keseluruhan adalah 57,13 bulan (IK 95 % 11,18 sampai 103,09).Simpulan: PGK stadium 3 dan 4 sedikit lebih banyak terjadi pada perempuan (58 %) dengan etiologi terbanyak adalah glomerulonefritis (56 %). Komplikasi PGK di Departemen Ilmu Kesehatan Anak FKUI-RSCM yang paling sering adalah gangguan elektrolit (78 %), anemia (70 %), perawakan pendek (56 %), gizi kurang (46 %), dan hipertensi (42 %). Median kesintasan keseluruhan adalah 57,13 bulan (IK 95 % 11,18 sampai 103,09).

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Background: Chronic kidney disease (CKD) is a new terminology in 2002, defined by the National Kidney Foundation Kidney Disease and Outcome Quality Initiative (NKF KDOQI) Group to classify any patient who has kidney damage lasting for at least 3 months with or without a decreased GFR or any patient who has a GFR of less than 60 mL/min per 1.73 m2 lasting for 3 months with or without kidney damage. The progression of established CKD is influenced by several risk factors, such as hypertension, proteinuria, anemia, genetic, race, age, and sex. In Indonesia, the term of CKD is not widely used so that its characteristic and renal survival remains sparse.

Objective: To find the characteristic and renal survival of pediatric chronic kidney disease in Cipto Mangunkusumo Hospital.

Methods: A historical prospective cohort study was conducted from medical record in Department of Child Health CMH from January 2004 to November 2012. The outcome was followed up until the end of the study. The inclusion criteria were 2-18 years old children with chronic kidney disease stage 3 and 4 according to NKF KDOQI classification. Renal survival was analyzed by using Kaplan Meier survival function. The event was progression to CKD stage 5 or death.

Results: A total of 50 medical records were included in the analysis. Of those, 36 patients had CKD stage 3 and 14 patients had CKD stage 4. The median age at admission was 7.9 (2 to 15) years and 58 % were female. The most common etiology was glomerulonephritis (56 %) where nephrotic syndrome was the most frequent cause. The common clinical manifestations were hypertension (42 %), malnourished (40 %), anemia (70 %), electrolyte disturbance (78 %), acidosis (34 %), proteinuria (72 %), short stature (56 %), renal osteodystrophy (2 %), and dilated cardiomyopathy (14 %). Overall renal survival was 57.13 months (CI 95 % 11.18 to 103.09).

Conclusion: CKD stage 3 and 4 are more common in female (58 %) with glomerulonephritis (56 %) is the most common etiology. The most frequent complications are electrolyte disturbance (78 %), anemia (70 %), short stature (56 %), malnourished (46 %), and hypertension (42 %). Overall renal survival is 57.13 months (CI 95 % 11.18 to 103.09).

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"[ABSTRAKPola sirkadian tekanan darah (TD) adalah gambaran TD 24 jam berupa kurva TD yang meningkat pada pagi hari, menurun pada siang / sore hari dan terendah pada malam hari / waktu tidur. 24 hours Ambulatory Blood Pressure Monitoring (24 hrs ABPM) merupakan alat pengukur TD yang lebih akurat dan dapat memperlihatkan pola sirkadian TD 24 jam. Turunnya TD 10 - 20% pada malam hari disebut dipper, jika turun < 10% disebut nondipper. Meningkatnya TD 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Faktor utama penyebab hipertensi pada PGK 5D adalah menurunnya Laju Filtrasi Glomerulus (LFG) dan meningkatnya cairan ekstraselular. Transplantasi ginjal akan memperbaiki TD dan nondipper dengan membaiknya LFG, meningkatnya produksi urin dan menurunnya cairan ekstraseluler. Namun demikian satu bulan Pasca Transplantasi Ginjal kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD.Tujuan : Mengetahui perbedaan pola sirkadian TD, data dipper / nondipper dan rerata TD 24 jam pada pasien PGK Pra dan satu bulan Pasca Transplantasi Ginjal. Metode Penelitian : Studi Pre experimental dengan before and after design. Subjek penelitian pasien PGK 5D / Pra Transplantasi Ginjal berusia 18 ? 60 tahun, dilakukan di RSCM pada bulan Oktober sampai dengan Desember 2014. Jumlah subjek sebanyak 15 orang. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG, pengukuran TD 24 jam dengan 24 hrs ABPM, Pra dan satu bulan Pasca Transplantasi Ginjal. Analisis statistik dengan uji McNemar dan uji t dependen.Hasil : Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan Pasca Transplantasi Ginjal seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan Pasca Transplantasi Ginjal nondipper (homogen). Terdapat penurunan rerata TD sistolik 24 jam pasien PGK satu bulan Pasca Transplantasi Ginjal yang tidak signifikan (p > 0,05) dan penurunan rerata TD diastolik 24 jam yang signifikan (p < 0,05).Simpulan : Belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal. Terdapat penurunan rerata TD sistolik 24 jam yang tidak signifikan dan penurunan rerata TD diastolik 24 jam yang signifikan pada pasien satu bulan Pasca Transplantasi Ginjal.

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ABSTRACTThe circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.;Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation., Background: The circadian pattern of blood pressure (BP) is a 24 hours bloodpressure (24hrs BP) curve which increases in the morning, decreases in theafternoon/evening and the lowest state is at night/bedtime. 24 hrs AmbulatoryBlood Pressure Monitoring (ABPM) is a BP measuring device that isaccurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20%at night is called as a dipper, while less than 10% is called as a nondipper. Theincreasing of 24 hrs BP and nondipper are the risk factor forcardiovascular morbidity and mortality. The prevalence ofhypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis(CKD 5D) are still very high. The main factors causing hypertension in CKD 5Dare decreased Glomerular Filtration Rate (GFR) and increased extracellularfluid. Kidney transplantation will improve BP and nondipperby GFR improvement, increases urine production and decreases extracellularfluid. However, one month after kidney transplantation, the doseof immunosuppressant drugs is relatively high, which is an obstacle to decreaseBP.Aim: To determine differences in the circadian pattern of BP, the dataof dipper and nondipper, and the mean of 24 hrs BP in CKD before, and onemonth after kidney transplantation.Methods: Design of the study is before and after design. Subjects of the studywere patients with CKD 5D before kidney transplantation, aged 18-60 years,were conducted in Cipto Mangunkusumo Hospital during October toDecember 2014. 15 subjects were included in the study. 24 hrs urinecollection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in allsubjects, before and one month after kidney transplantation. McNemar test and tdependent test were used in statistical analysis.Results: Before kidney transplantation, 12 of 15 subjects were nondippers whilethe others 3 subjects were dippers. After kidney transplantation, all subjects (15patients) were nondippers. McNemar test can not be used because all subjects onemonth after kidney transplantation were nondippers (homogeneous). Thedecreasing of the mean of 24 hrs systolic BP was found in all CKD onemonth after kidney transplantation, but statistically not significant (p>0.05),while decreasing of the mean of 24 hrs diastolic BP was statistically significant(p<0.05).Conclusion: There were still no improvement in nondipper patientsone month after kidney transplantation. There were a decrease in the mean of 24hrs systolic BP but statistically not significant and a decrease in the mean of 24hrs diastolic BP which is statistically significant in patients one month afterkidney􀀃transplantation.]"

"Latar Belakang: Penyakit ginjal kronik pada anak memerlukan perhatian khusus, terutama dalam pemasangan catheter double lumen (CDL) untuk hemodialisis. Studi tentang faktor risiko disfungsi kateter pada anak dengan penyakit ginjal kronik yang menjalani hemodialisis bertujuan mengevaluasi hubungan antara parameter laboratorium, seperti kadar platelet dan albumin serum, dengan disfungsi kateter. Penelitian ini diharapkan dapat meningkatkan pemahaman mengenai faktor risiko disfungsi kateter pada anak dengan penyakit ginjal kronik.

Metode: Studi ini memiliki desain studi potong lintang yang dilakukan dengan menggunakan sampel data rekam medik dari pasien-pasien anak yang sudah menggunakan catheter double lumen (CDL) tunnel mulai bulan September hingga Oktober 2023.

Hasil: Sebanyak 59 pasien memenuhi kriteria pada penelitian ini yang sebagian besar memiliki jenis kelamin perempuan (50,8%) dan berusia >10 tahun (69,5%). Kadar platelet yang tinggi berhubungan signifikan terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo (p=0,001). Kadar APTT tidak memiliki hubungan signifikan terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo (p=0,810). Kadar albumin serum yang rendah atau hipoalbuminemia berhubungan signifikan terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo (p=0,001). Faktor yang paling berpengaruh terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo adalah kadar albumin serum.

Kesimpulan: Kadar albumin dan platelet berhubungan signifikan terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo. Faktor yang paling berpengaruh terhadap kejadian disfungsi kateter pada pasien anak dengan penyakit ginjal tahap akhir di RSUPN Dr. Cipto Mangunkusumo adalah kadar albumin serum.

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Background: Chronic kidney disease in children requires special attention, particularly in the placement of double-lumen catheters (DLC) for hemodialysis. A study on the risk factors for catheter dysfunction in children with chronic kidney disease undergoing hemodialysis aimed to evaluate the relationship between laboratory parameters, such as platelet levels and serum albumin, and catheter dysfunction. This research is expected to enhance understanding of the risk factors for catheter dysfunction in children with chronic kidney disease.

Methods: This study employed a cross-sectional study design using medical record data samples from pediatric patients who had undergone double-lumen catheter (DLC) tunnel placement from September to October 2023.

Results: A total of 59 patients met the criteria for this study, the majority of whom were female (50.8%) and aged over 10 years (69.5%). High platelet levels were significantly associated with catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo (p=0.001). APTT levels did not have a significant association with catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo (p=0.810). Low serum albumin levels or hypoalbuminemia were significantly associated with catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo (p=0.001). The most influential factor for catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo was serum albumin level.

Conclusion: Albumin levels and platelet are significantly associated with catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo. The most influential factor for catheter dysfunction in pediatric patients with end-stage kidney disease at RSUPN Dr. Cipto Mangunkusumo was serum albumin level."

"Dislipidemia merupakan faktor risiko terjadinya penyakit kardiovaskular dengan statin sebagai lini pertama pengobatannya. Keadaan dislipidemia biasanya diikuti oleh penyakit lain sehingga untuk terapinya diperlukan kombinasi obat. Penggunaan kombinasi obat akan meningkatkan risiko dari interaksi obat. Tujuan dari penelitian ini adalah menganalisis interaksi obat golongan statin pada resep pasien rawat inap di RSPAD Gatot Soebroto periode Februari-April 2017. Penelitian ini bersifat deskriptif analitik dengan pengambilan data secara prospektif. Penapisan interaksi menggunakan Micromedex dan Medscape Drug Interaction Checker. Hasil analisis didapatkan 558 kasus interaksi dari 490 jumlah resep yang memenuhi kriteria inklusi. Interaksi obat terbanyak memiliki tingkat keparahan moderat 88 diikuti dengan tingkat keparahan mayor 11 , dan minor 1 . Kombinasi statin dan klopidogrel merupakan kombinasi obat yang paling banyak mengalami interaksi. Mekanisme interaksi yang paling banyak terjadi pada penelitian ini adalah interaksi farmakokinetik. Hasil analisis bivariat menggunakan SPSS dengan uji Chi square menunjukkan terdapat hubungan yang signifikan antara jumlah obat tiap resep dan interaksi p= 0,000.

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Dyslipidemia is a risk factor for cardiovascular disease with statins as the first line treatment. Dyslipidemia is usually followed by other diseases that lead to the need of drugs combination therapy. Drugs combination will increase the risk of drug interactions. The purpose of this study was to analyze statin drug interactions in prescription of hospitalized patients at Gatot Soebroto Army Center Hospital in period of February April 2017. This study was analytical descriptive with prospective data collection. Drug interaction screening used Micromedex and Medscape Drug Interaction Checker. The analysis results obtained 558 cases of interactions of 490 prescriptions that complied the inclusion criteria. The most common drug interaction contained moderate severity of 88 followed by major severity of 11 , and minor 1 . Statin and clopidogrel were the most frequent combination that lead to interactions. The most frequent interaction mechanism in this study was pharmacokinetic interactions. The result of bivariate analysis which used SPSS with Chi square test showed that there was a significant correlation between the number of drug each prescription and the interaction p 0,000."

"Tuberkulosis merupakan salah satu penyakit infeksi pernapasan. Terdapat peningkatan kasus tuberkulosis dari tahun ke tahun, sehingga perlu upaya untuk meningkatkan keberhasilan terapi tuberkulosis, salah satunya manajemen interaksi obat. Penelitian ini bertujuan untuk menganalisis potensi interaksi obat pada pasien tuberkulosis di Rumah Sakit Universitas Indonesia periode 2022 - 2023. Penelitian ini menggunakan desain studi cross-sectional, jenis data restrospektif dari rekam medis pasien TBSO dan TBRO mulai usia anak hingga lansia. Analisis interaksi menggunakan Lexi-Interact®. Pasien tuberkulosis paru di Rumah Sakit Universitas Indonesia mayoritas berjenis kelamin laki-laki (51,8%), berusia dewasa (38,2%), memiliki jenis tuberkulosis sensitif obat (56,4%), dan mayoritas pasien memiliki komorbid (81,8%). Hasil analisis menunjukkan dari 110 pasien tercatat sebanyak 256 jenis interaksi obat, berdasarkan kategori risiko sebanyak 14,8% interaksi tergolong kategori B (No action needed), 66.4% interaksi kategori C (Monitor therapy), 15,6% interaksi kategori D (Consider modification therapy), dan 3,1% interaksi kategori X (Avoid combination). Berdasarkan mekanisme, tercatat 33,2% interaksi memiliki mekanisme farmakokinetik, 50,4% mekanisme farmakodinamik, 1,9% mekanisme farmakokinetik dan farmakodinamik, dan 14,5% mekanisme tidak diketahui. Berdasarkan tingkat keparahan 24,2% termasuk kelompok minor, 62,9% kelompok moderate, dan 12,9% kelompok major. Berdasarkan tingkat reliabilitas hanya 0,8% dari 256 jenis interaksi termasuk poor, selain itu 62,1% termasuk fair, 31,6% termasuk good, dan 5,5% termasuk excellent. Hasil uji korelasi Spearman’s rho menunjukkan adanya korelasi antara jumlah potensi interaksi obat dengan jumlah obat (p<0,05). Selain itu, hasil uji beda rerata menunjukkan adanya perbedaan rerata interaksi obat pada variabel komorbid, kategori tuberkulosis, dan usia (p<0,05). Dapat disimpulkan terdapat berbagai macam interaksi obat yang berpotensi terjadi pada pasien tuberkulosis di Rumah Sakit Universitas Indonesia, sehingga tenaga kesehatan perlu mempertimbangkan adanya modifikasi terapi dan pemantauan lanjutan terhadap efek samping yang mungkin timbul dari adanya interaksi obat.

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Tuberculosis is a respiratory infectious diseases. There is an increase in tuberculosis cases, so drug interaction management is needed to improve the therapy. This study aimed to analyze the potential drug interactions in tuberculosis patients at Universitas Indonesia Hospital for the period 2022 - 2023. The design is cross-sectional study, using retrospective data from all of pulmonary TB patients in age children until elderly. Interaction analysis using Lexi-Interact®. The majority of pulmonary tuberculosis patients at Universitas Indonesia Hospital were male (51.8%), aged adults (38.2%), had drug-sensitive tuberculosis (56.4%), and the majority of patients had comorbidities (81.8%). The results showed from 110 patients, 256 types of drug interactions were recorded. Based on the risk category, 14.8% category B (No action needed), 66.4% category C (Monitor therapy), 15.6% category D (Consider modification therapy), and 3.1% category X (Avoid combination). Based on mechanism, 33.2% of interactions had pharmacokinetic mechanism, 50.4% pharmacodynamic mechanism, 1.9% dual mechanism, and 14.5% unknown mechanism. Based on severity, 24.2% in the minor group, 62.9% in the moderate group, and 12.9% in the major group. Based on the level of reliability, only 0.8% from 256 types of interactions were poor, 62.1% were fair, 31.6% were good, and 5.5% were excellent. Spearman's rho correlation test results showed a correlation between the number of potential drug interactions with the number of drugs (p<0.05). Besides that, the mean difference test results showed a difference in the mean of drug interactions between variable comorbidities, tuberculosis categories, and age (p<0.05). The conclusion is there are various types of drug interactions in tuberculosis patients at Universitas Indonesia Hospital, so health workers should consider modifying therapy and monitoring of side effects that may arise from drug interactions."

"Latar Belakang: Penyakit ginjal kronik (PGK) dilaporkan berhubungan dengan peningkatan risiko kejadian ulkus pedis dan amputasi pada diabetes melitus (DM). Namun, data mengenai hal tersebut masih terbatas termasuk di Indonesia. Tujuan penelitian ini adalah untuk mengetahui pengaruh PGK terhadap kejadian ulkus pedis dan amputasi ekstremitas bawah dalam 3 tahun.Metode: Penelitian ini merupakan studi kohort retrospektif pada DM berusia >18 tahun dengan menggunakan data sekunder di RSUP Fatmawati pada periode Januari – Desember 2016. Kesintasan terhadap ulkus pedis dan amputasi ekstremitas bawah berdasarkan LFG dihitung dan dianalisis melalui kurva Kaplan Meier. Adjusted hazard ratio (aHR) dinilai dengan menggunakan analisis multivariate Cox proportional hazards. Hasil: Dari 204 subjek penelitian, 108 orang (52,9%) memiliki LFG > 60, 54 orang (26,5%) memiliki LFG 30-59, dan 42 orang (20,6%) memiliki LFG <30 ml/menit/1,73 m2. Kesintasan ulkus pedis dalam 3 tahun adalah 75,7% untuk LFG <30; 86,4% untuk LFG 30-59; dan 94,1% untuk LFG > 60 ml/menit/1,73 m2. Laju insidens ulkus pedis per 1000 orang per bulan adalah 7,98 untuk LFG <30; 4,08 untuk LFG 30-59; dan 1,61 untuk LFG >60 ml/menit/1,73m2. Pasien dengan LFG 30-59 dan LFG <30 ml/menit/1,73 m2 memiliki adjusted HR 1,36 (IK 95% 0,39-4,66) dan 4,39 (IK 95% 1,18-16,4) terhadap ulkus pedis dibandingkan dengan LFG > 60 ml/menit/1,73 m2. Tidak dilakukan analisis lebih lanjut pada luaran amputasi ekstremitas bawah karena tidak ada pasien yang mengalami luaran pada kelompok LFG >60 ml/menit/1,73 m2Kesimpulan: PGK mempengaruhi kejadian ulkus pedis dalam 3 tahun pada pasien DM dan risiko ulkus pedis dalam 3 tahun semakin meningkat seiring dengan semakin berat derajat PGK. Pengaruh PGK terhadap kejadian amputasi ekstremitas bawah masih belum dapat disimpulkan pada penelitian ini.

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Background: Chronic kidney disease (CKD) has been reported associated with poor prognoses in foot ulcers and lower extremity amputation (LEA) in patients with diabetes melitus (DM). However, the study is still limited and never been done in Indonesia. The objective of this study is to evaluate the impact of CKD on foot ulcers and LEA in patients with diabetes.

Methods: This was a retrospective cohort study in Internal Medicine out-patient clinic in Fatmawati General Hospital. All subjects were enrolled between January-December 2016 who had history of DM, age >18 years old and had a history of DM. Foot ulcer-free and amputation-free survival for estimated glomerular filtration rate (eGFR) >60, 30-59, and <30 ml/min/1,73 m2 were calculated and analyzed by Kaplan-Meier curves. Adjusted hazard ratio (HR) was analalyzed using multivariate Cox proportional hazards. multivariate model.

Results: A total of 204 individuals were included: 108 (52,9%) in eGFR >60, 54 in eGFR 30-59, and 42 in eGFR <30 ml/min/1,73 m2. Foot ulcer free survival for patient with eGFR <30, 30-59, >60 ml/min/1.73 m2 were 75,7%; 86,4%; and 94,1% respectively. Unadjusted foot ulcer incidence rates per 1000 patients per month were 7,98 for eGFR <30; 4,08 for eGFR 30-59; and 1,61 for eGFR >60 ml/menit/1.73m2. For the development of foot ulcer compared with eGFR > 60 ml/min/ 1.73 m2, adjusted HR for patient with eGFR 30-59 ml/min/1.73 m2 was 1,36 (CI 95% 0,39-4,66) and for eGFR < 30 ml/min/1.73 m2 was 4,39 (CI 95% 1,18-16,4). HR for LEA could not be analyzed because there were no patient who had been amputated after 3 years follow up in group eGFR >60 ml/min/1.73 m2.

Conclusion: CKD increased the risk of foot ulcer in 3 years among DM patients. The risk was increased concomitant with the severity of CKD. The impact of CKD on LEA could not be concluded in this study."

"Penyakit Ginjal Kronis (PGK) menjadi masalah kesehatan global yang sampai saat ini terus meningkat dengan prognosis yang buruk dan biaya yang tinggi. Meningkatnya angka kejadian PGK menjadi urgensi besar bagi masyarakat untuk melakukan pencegahan terhadap penyakit tersebut. Hipertensi sebagai salah satu penyebab utama PGK juga menjadi masalah kesehatan yang terus meningkat di berbagai daerah, termasuk di Puskesmas Puring. Dukungan keluarga diyakini mempunyai peranan penting dalam pembentukan perilaku kesehatan anggota keluarganya. Tujuan dari penelitian ini yaitu untuk mengetahui adanya hubungan dukungan keluarga dengan perilaku pencegahan PGK pada pasien hipertensi di Puskesmas Puring Kabupaten Kebumen. Penelitian ini menggunakan desain penelitian deskriptif analitik menggunakan pendekatan cross sectional dengan teknik sampling consecutive sampling. Instrumen yang digunakan adalah Perceived Social Support From Family (PSS-Fa) dan CDK Screening Index yang telah dimodifikasi. Responden penelitian berjumlah 104 responden yang tersebar di wilayah Kecamatan Puring, Kabupaten Kebumen. Hasil penelitian menunjukkan bahwa mayoritas responden yaitu perempuan, berusia >56 tahun, tingkat pendidikan Sekolah Dasar, tidak bekerja, dan tidak memiliki riwayat keluarga PGK, memiliki dukungan keluarga yang baik, dan juga memiliki perilaku pencegahan PGK yang baik. Hasil uji hubungan dalam penelitian ini didapatkan terdapat hubungan antara dukungan keluarga dengan perilaku pencegahan PGK. Penelitian ini merekomendasikan kepada keluarga penderita hipertensi untuk tetap meningkatkan dukungannya kepada anggota keluarga yang menderita hipertensi untuk meningkatkan perilaku terhadap pencegahan PGK.

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Chronic Kidney Disease (CKD) is a global health problem that continues to increase, with a poor prognosis and high costs. The increasing number of cases of CKD is a big urgency for the community to prevent this disease. Hypertension, one of the main cause of CKD, is also being a health problem that increase at various regions, including the Puring Health Center. Family support is believed to have an important role in shaping the health behavior of family members. The purpose of this study was to determine the relationship between family support and CKD prevention behavior in hypertensive patients at the Puring Health Center, Kebumen Regency. This study used a descriptive analytic research design using a cross sectional approach with consecutive sampling techniques. The instruments used were Perceived Social Support From Family (PSS-Fa) and the modified CDK Screening Index. The research respondents totaled 104 respondents spread across the Puring District, Kebumen Regency. The results showed that the majority of respondents were women, aged >56 years, elementary school education level, not working, and had no family history of CKD, had good family support, and also had good CKD prevention behavior. The results of the relationship test in this study found that there was a relationship between family support and CKD prevention behavior. This study recommends that families with hypertension continue to increase their support for family members who is suffering from hypertension to improve behavior towards CKD prevention."