KARYA TULIS AKHIR

Hubungan Lamanya Menjalani Hemodialisis terhadap Kualitas Hidup

Pasien Chronic Kidney Disease (CKD)

Oleh:

YESSI KARTIKA HAPSARI

201310330311087

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG

2017

HASIL PENELITIAN

Hubungan Lamanya Menjalani Hemodialisis terhadap Kualitas Hidup

Pasien Chronic Kidney Disease (CKD)

KARYA TULIS AKHIR

Diajukan kepada

Universitas Muhammadiyah Malang

Untuk Memenuhi Salah Satu Persyaratan

Dalam Menyelesaikan Program Sarjana

Fakultas Kedokteran

Oleh :

Yessi Kartika Hapsari

201310330311087

UNIVERSITAS MUHAMMADIYAH MALANG

FAKULTAS KEDOKTERAN

2017

LEMBAR PENGESAHAN

KARYA TULIS AKHIR

Telah disetujui sebagai usulan penelitian untuk memenuhi persyaratan Pendidikan Sarjana

Fakultas Kedokteran Universitas Muhammadiyah Malang

Tanggal : 7 Juni 2017

Pembimbing I

dr. Isbandiyah, Sp.PD

NIP. 11305010423

Pembimbing II

dr.Rubayat Indradi, M.OH

NIP.11314100546

Mengetahui,

Fakultas Kedokteran Universitas Muhammadiyah Malang

Dekan,

dr. Irma Suswati, M.Kes

NIP.11395010320

PERNYATAAN ORISINALITAS

Karya tulis akhir ini adalah karya saya sendiri, dan semua sumber baik yang dikutip maupun

dirujuk telah saya nyatakan dengan benar.

Nama : Yessi Kartika Hapsari

NIM : 201310330311087

Tanda tangan :

Tanggal : 7 Juni 2017

LEMBAR PENGUJIAN

Karya Tulis Akhir oleh Yessi Kartika Hapsari ini telah diuji dan dipertahankan di depan Tim

Penguji pada tanggal : 7 Juni 2017

Tim Penguji

dr. Isbandiyah, Sp.PD , Ketua

dr. Rubayat Indradi, M.OH , Anggota

dr. Iwan Sys Indrawanto, Sp.KJ , Anggota

KATA PENGANTAR

Puji syukur ke hadirat Tuhan Yang Maha Esa yang telah melimpahkan hidayah dan

karunianya. Sehingga penulis dapat menyelesaikan laporan usulan penelitian yang berjudul

“Hubungan Lamanya Menjalani Hemodialisis terhadap Kualitas Hidup Pasien Chronic

Kidney Disease (CKD)”

Penulisan usulan penelitian ini bertujuan untuk memenuhi Salah satu syarat untuk

mencapai gelar sarjana Fakultas Kedokteran Jurusan Pendidikan Kedokteran Universitas

Muhammadiyah Malang. Penulis menyadari bahwa tanpa bantuan dan bimbingan dari

berbagai pihak, dari masa perkuliahan sampai penyusunan penelitian ini sangatlah tidak

mudah. Oleh karena itu penulis ingin mengucapkan terimakasih kepada :

1. Ayahanda Joko Supriadi dan Ibunda Sri Budiyanti selaku orangtua penulis dan

Saudara Mas dr. Erdilian Jodi dan Mbak dr. Nidya Ayomi, Tante Andayani, Atik,

Mamik Indarti serta keluaga lainnya yang telah memberikan dorongan dan motivasi

serta kasih sayang, sehingga penulis bisa menyelesaikan karya tulis ini.

2. dr. Isbandiyah, Sp.PD selaku pembimbing I atas segala dukungan, masukan dan saran

yang sangat luar biasa dalam penyusunan karya tulis ini.

3. dr.Rubayat Indradi, M.OH selaku pembimbing II atas segala bimbingan dan koreksi

serta motivasi yang diberikan demi kesempurnaan karya tulis ini

4. dr. Iwan Sys Indrawanto, Sp.KJ selaku dosen penguji yang telah meluangkan waktu

untuk menguji penelitian saya.

5. dr.Irma Suswati selaku dekan Fakultas kedokteran Universitas Muhammadiyah

Malang.

6. Seluruh staf tata usaha Fakultas kedokteran Universitas Muhammadiyah Malang atas

segala dukungan yang telah diberikan.

7. Staf unit Hemodialisis Rumkit Tk.II Soepraoen, Bu Nurul, Mbak Marieta Puspita

serta staf unit HD lainnya yang telah membantu saya selama melakukan penelitian ini.

8. Sahabat penulis, Zanty Rakhmania Putri, Karina Puspaseruni, Ajeng Karima, Ken

Ratri, Laura Putri, Kirana Lazuardi, Lee Dong Wook, Rara, Ina, Asti, Ana, Adli,

Gagas, Nada, Agha, Alvin, Iik dan seluruh rekan di fakultas kedokteran angkatan

2013 yang telah banyak membantu dan memberikan motivasi serta doanya dalam

penyusunan laporan penelitian.

9. Semua pihak yang tidak dapat disebutkan namanya satu persatu, yang telah

memeberikan dukungan dan motivasi dalam penyelesaian laporan penelitian ini.

Penelitian ini masih jauh dari kesempurnaan. Dengan kerendahan hati penulis memohon

maaf yang sebesar-besarnya dan mengharapkan saran dan kritik yang membangun. Semoga

penelitian ini dapat menambah wawasan dan bermanfaat bagi semua pihak.

Malang , 28 Mei 2017

Penulis

ABSTRAK

Hapsari, Y.K. 2017. Hubungan Lamanya Menjalani Hemodialisis Terhadap Kualitas Hidup

Pasien Chronic Kidney Disease (CKD). Tugas Akhir, Fakultas Kedokteran

Universitas Muhammadiyah Malang. Pembimbing: (I) Isbandiyah. (*), Pembimbing

(II) Rubayat Indradi (**)

Latar belakang: Chronic Kidney Disease (CKD) adalah suatu problem yang serius di

masyarakat umum. Terapi CKD berupa terapi pengganti ginjal yang terdiri dari dialisis dan

transplantasi ginjal. Dialisis yang umum dilakukan di Indonesia adalah hemodialisis.

Hemodialisis dapat menggantikan kerja ginjal, oleh karena itu hemodialisis dapat

mempengaruhi kualitas hidup. Kualitas hidup dilihat dari kesehatan fisik, psikologi,

hubungan sosial, dan lingkungan sekitar pasien.

Tujuan: Mengetahui hubungan lamanya menjalani hemodialisis terhadap kualitas hidup

pasien CKD

Metode: Analytical observation dengan pendekatan cross sectional yang dilakukan di

Rumkit tingkat II dr. Soepraoen Malang. Teknik pengambilan sampel menggunakan

purposive random sampling dengan jumlah sampel 57 responden. Data dianalisis dengan uji

Chi-Square dan Mann-Whitney.

Hasil penelitian dan diskusi: Hasil uji Chi-Square pada domain 3 kualitas hidup (hubungan

sosial) p=0,360, Hasil uji Mann-Whitney pada domain 1 (kesehatan fisik) p=0,668, domain 2

(psikologi) p=0,780, dan domain 4 (lingkungan) p=0334. Seluruh variabel tidak memiliki

perbedaan yang signifikan (>0,05)

Kesimpulan: Tidak terdapat hubungan antara lama menjalani hemodialisis terhadap empat

faktor kualitas hidup, yaitu kesehatan fisik, psikologi, hubungan sosial dan lingkungan.

Kata kunci: Chronic kidney disease, lama hemodialisis, kualitas hidup

(*) Staff Pengajar Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Muhammadiyah

Malang

(**) Staff Pengajar Kedokteran Okupasi Fakultas Kedokteran Universitas Muhammadiyah

Malang

ABSTRACT

Hapsari, Y.K. 2017. Correlation of Hemodialysis Duration and Quality of Life of Chronic

Kidney Disease (CKD) Patients. Advisors: (I) Isbandiyah (*), (II) Rubayat Indradi

(**)

Background: Chronic Kidney Disease (CKD) is a serious problem in the general population.

CKD therapy consist of dialysis and renal transplantation. Hemodialysis is the most common

therapy in Indonesia. It can takes over kidney’s work, therefore hemodialysis can affect

quality of life. Quality of life can be observed from the physical health, psychology, social

relationships, and the environment around the patient.

Objective: To find out the relationship between the duration of hemodialysis and quality of

life of CKD patient

Methods: Analytical observation with cross sectional approach. The research was held at

Rumkit tk. II dr. Soepraoen Malang. The sampling technique used purposive random

sampling with total sample 57 respondents. Data were analyzed by Chi-Square and Mann-

Whitney test.

Results: Chi-Square test result on domain 3 quality of life (social relation) p = 0,360, Mann-

Whitney test result on domain 1 (physical health) p = 0,668, domain 3 (psychology) p =

0,780, and domain 4 (environment) p = 0,334. All the variables had no significant difference

(> 0,05)

Conclusions: There was no relationship between duration of hemodialysis and four factors of

quality of life i.e. physical health, psychology, social relations and environment.

Keywords: Chronic kidney disease, duration of hemodialysis, quality of life

(*) Lecturer of Internal Medicine of Medical Faculty Of Muhammadiyah Malang University

(**) Lecturer of Occupational Medicine of Medical faculty of Muhammadiyah Malang

University

DAFTAR ISI

Halaman

HALAMAN JUDUL ............................................................................ i

LEMBAR PENGESAHAN .................................................................. iii

LEMBAR PERNYATAAN ORISINALITAS ...................................... iv

LEMBAR PENGUJIAN ...................................................................... v

KATA PENGANTAR.......................................................................... vi

ABSTRAK........................................................................................... viii

DAFTAR ISI ....................................................................................... x

DAFTAR TABEL ................................................................................ xiv

DAFTAR GAMBAR ........................................................................... xv

DAFTAR SINGKATAN ...................................................................... xvi

DAFTAR LAMPIRAN ........................................................................ xvi

BAB 1 PENDAHULUAN

1.1 Latar Belakang .................................................................................. 1

1.2 Rumusan Masalah ............................................................................. 4

1.3 Tujuan Penelitian

1.3.1 Tujuan Umum ........................................................................... 4

1.3.2 Tujuan Khusus .......................................................................... 4

1.4 Manfaat Penelitian ............................................................................. 4

BAB 2 TINJAUAN PUSTAKA

2.1 Chronic Kidney Disease (CKD)

2.1.1 Definisi ..................................................................................... 5

2.1.2 Klasifikasi ................................................................................ 5

2.1.3 Epidemiologi ............................................................................ 6

2.1.4 Etiologi ..................................................................................... 7

2.1.5 Patofisiologi .............................................................................. 7

2.1.6 Penatalaksanaan ......................................................................... 9

2.1.7 Komplikasi .............................................................................. 12

2.2 Terapi Pengganti Ginjal

2.2.1 Dialisis Peritoneal .................................................................... 14

2.2.1.2 Definisi ........................................................................ 14

2.2.1.3 Cara Kerja .................................................................... 14

2.2.1.4 Perbedaan DP dan HD .................................................. 14

2.2.2 Hemodialisis

2.2.2.1 Definisi ........................................................................ 15

2.2.2.2 Epidemiologi ................................................................ 15

2.2.2.3 Indikasi ........................................................................ 16

2.2.2.4 Cara Kerja .................................................................... 17

2.2.2.5 Komplikasi ................................................................... 19

2.2.2.5.1 Komplikasi akut ............................................. 20

2.2.2.5.2 Komplikasi kronis .......................................... 20

2.2.2.6 Faktor-faktor yang Mempengaruhi Keberhasilan HD.... 20

2.2.2.6.1 Adekuasi Hemodialisis ................................... 21

2.2.2.6.2 Kepatuhan Pasien ........................................... 22

2.2.2.7 Outcome HD ................................................................ 23

2.3.2 Transplantasi Ginjal ................................................................. 23

2.3.2.1 Definisi ........................................................................ 23

2.3.2.2 Keuntungan Transplantasi Ginjal .................................. 23

2.4 Kualitas Hidup

2.4.1 Definisi .................................................................................... 25

2.4.2 Faktor-faktor Kualitas Hidup .................................................... 26

2.5 Penelitian yang Sejenis .................................................................... 27

BAB 3 KERANGKA KONSEPTUAL DAN HIPOTESIS PENELITIAN

3.1 Kerangka Konsep ............................................................................ 29

3.2 Hipotesis Penelitian ......................................................................... 30

BAB 4 METODE PENELITIAN

4.1 Jenis Penelitian ................................................................................ 31

4.2 Lokasi dan Waktu Penelitian ........................................................... 31

4.3 Populasi dan Sampel

4.3.1 Populasi ................................................................................... 31

4.3.2 Sampel .................................................................................... 31

4.3.3 Besar Sampel .......................................................................... 31

4.3.4 Teknik Pengambilan Sampel .................................................... 32

4.3.5 Karakteristik Sampel Penelitian

4.3.5.1 Kriteria Inklusi ............................................................. 32

4.3.5.2 Kriteria Eksklusi........................................................... 32

4.3.6 Variabel Penelitian

4.3.6.1 Variabel Terikat .......................................................... 32

4.3.6.2 Variabel Bebas ............................................................. 33

4.3.5 Definisi Operasional Variabel ................................................. 33

4.4 Alat dan Bahan Penelitian ................................................................ 34

4.5 Alur Penelitian ................................................................................. 35

4.6 Analisis Data ................................................................................... 35

BAB 5 HASIL PENELITIAN DAN ANALISIS DATA

5.1 Hasil Penelitian ................................................................................ 36

5.1.2 Karakteristik Responden .......................................................... 36

5.1.2.1 Jenis Kelamin .............................................................. 37

5.1.2.2 Usia ............................................................................. 37

5.1.2.3 Kualitas Hidup ............................................................ 38

5.1.2.4 Lama Menjalani Hemodialisis ..................................... 40

5.2 Hasil Analisis Bivariat ..................................................................... 41

BAB 6 PEMBAHASAN

6.1 Jenis Kelamin ................................................................................... 43

6.2 Usia .................................................................................................. 44

6.1 Jenis Kelamin ................................................................................... 44

6.3 Kualitas Hidup

6.3.1 Kesehatan Fisik (Domain 1) ..................................................... 45

6.3.2 Psikologi (Domain 2) ............................................................... 47

6.3.3 Hubungan Sosial (Domain 3) ................................................... 50

6.3.4 Lingkungan (Domain 4) ........................................................... 51

6.4 Pembahasan Analisis Data Bivariat .................................................. 52

6.5 Keterbatasan Penelitian .................................................................... 55

BAB 7 KESIMPULAN DAN SARAN

7.1 Kesimpulan ..................................................................................... 57

7.2 Saran ............................................................................................... 57

DAFTAR PUSTAKA ........................................................................................ 59

LAMPIRAN ...................................................................................................... 64

DAFTAR TABEL

Tabel Halaman

2.1 Kriteria CKD ................................................................................................ 5

2.2 Klasifikasi CKD berdasarkan Derajat Penyakit ............................................. 6

2.3 Rencana Tatalaksana CKD sesuai dengan Derajatnya .................................. 9

2.4 Pembatasan Asupan Protein dan Fosfat pada CKD ..................................... 11

2.5 Komplikasi CKD ........................................................................................ 13

2.6 Keuntungan Transplantasi Ginjal dibandingkan dengan HD Kronik ........... 24

5.1 Karakteristik Responden Penelitian............................................................... 36

5.2 Data Hasil Uji Chi-Square dan Mann-Whitney............................................. 41

DAFTAR GAMBAR

Gambar Halaman

2.1 Etiologi gagal ginjal dari pasien yang HD di Indonesia pada tahun 2011......7

2.2 Ultrafiltrasi ............................................................................................... 17

2.3 Bagan Hemodialisis .................................................................................. 18

2.4 Hemodialisis ............................................................................................ 19

3.1 Kerangka Konsep ..................................................................................... 29

5.1 Distribusi Responden Berdasarkan Jenis Kelamin………………………...37

5.2 Distribusi Responden Berdasarkan Usia................…………………...…...37

5.3 Distribusi Responden Berdasarkan Domain 1………………………..........38

5.4 Distribusi Responden Berdasarkan Domain 2.......………………………...38

5.5 Distribusi Responden Berdasarkan Domain 3.......………………………...39

5.6 Distribusi Responden Berdasarkan Domain 4.......………………………...40

5.7 Distribusi Responden Berdasarkan Lama Menjalani HD.......…...………...40

DAFTAR SINGKATAN

CKD : Chronic Kidney Disease (Penyakit ginjal kronis)

HD : Hemodialisis

TGF- β : Transforming Growth Factor β

GFR : Glomerulus Filtration Rate

EPO : Eritropoietin

DP : Dialisis peritoneal

K : Kalium

BUN : Blood Urea Nitrogen

Na : Natrium

RRU : Rasio Reduksi Ureum

NO : Nitric Oxide

NHANES : National Health and Nutrition Examination Survey

MCV : Mean Corpuscular Volume

NIDDK : National Institute of Diabetes and Digestive and Kidney Diseases

USRDS : Uinited States Renal Data System

DAFTAR LAMPIRAN

Lampiran Halaman

1 Surat kelaikan etik ...................................................................................... 60

2 Surat Ijin Penelitian .................................................................................... 61

3 Kuesioner WHOQOL-BREF dan Inform Consent ...................................... 62

4 Langkah Skoring Kuesioner WHOQOL-BREF .......................................... 71

5 Data Hasil Penelitian ................................................................................... 73

6 Analisis Data .............................................................................................. 79

7 Dokumentasi Penelitian .............................................................................. 83

59

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