Analisis Survival Pasien Hemodialisis dengan Hipertensi di Lampung Tahun 2016-2018
Survival Analysis of Hemodialysis Patients with Hypertension in Lampung Year 2016-2018
Abstract
Abstract
Chronic Kidney Disease (CKD) is now a serious health problem and millions die every year because they do not have access to treatment. One of the main risk factors for this catastrophic disease is hypertension. The purpose of this study was to determine survival rates in the hypertension and nonhypertension groups and to see the relationship between blood pressure, sex and age on the death status of CKD patients. The study used a retrospective cohort study design. The research data came from the medical records of patients in the hemodialysis room of Abdul Moeloek Hospital during 2016-2018, was 396 respondents. Data analysis used Kaplan Meier and Cox regression. The analysis showed the hypertensive groups were 320 (80.2 percent) and nonhipertensive groups were 76 (19.8 percent) with the proportion of hypertensive groups who died totaled 184 (57.5 percent) people. The average survival rate of the hypertension group was 33 months, whereas the nonhypertensive group was 44 months. The log rank test results show a p-value of 0.007 which indicates a lower survival rate between the hypertension and nonhypertension groups. The results of the multivariate cox regression test showed that the nonhypertensive group had a 1.6 times longer survival risk compared to the hypertensive group (p.value 0.006, 95 percent Confident Interval 1.2-2.3) after being controlled by sex. While the age variable was not significantly related to the death status of CKD patients (p.value 0.067). The conclusion is the average life span of CKD patients from the hypertension group is shorter than the nonhypertension group. The hypertension group had a shorter survival risk than the nonhypertensive group of CKD patients undergoing hemodialysis. In addition, female sex has a risk of survival longer after being controlled by blood pressure. Early detection of hypertension is highly recommended. This can be done by controlling blood pressure routines by utilizing the postbindu program at the health center. In addition, optimizing Germas (community movement healthy life) socialization was especially for young teenagers to be aware of the importance of health and to control routine blood pressure since the age of 15 years at risk.
Abstrak
Penyakit Ginjal Kronis (PGK) saat ini menjadi masalah kesehatan serius dan jutaan meninggal setiap tahun karena tidak mempunyai akses untuk pengobatan. Salah faktor risiko utama penyakit katastropik ini adalah hipertensi. Tujuan penelitian untuk diketahui angka ketahanan hidup pada kelompok hipertensi dan nonhipertensi serta melihat hubungan antara tekanan darah, jenis kelamin dan usia terhadap status kematian pasien PGK. Penelitian menggunakan desain studi kohort retrospektif. Data penelitian berasal dari rekam medis pasien di ruang hemodialisis RS Abdul Moeloek selama tahun 2016-2018 sebanyak 396 responden. Analisis data menggunakan kaplan meier dan regresi cox. Hasil analisis menunjukkan kelompok hipertensi sebanyak 320 (80.2 persen) dan nonhipertensi sebanyak 76 (19.8 persen) dengan proporsi kelompok hipertensi yang meninggal berjumlah 184 (57.5 persen) orang. Rata-rata ketahanan hidup kelompok hipertensi adalah 33 bulan, sedangkan pada kelompok nonhipertensi adalah 44 bulan. Hasil uji log rank menunjukkan nilai p-value sebesar 0.007 yang menunjukkan perbedaan survival rate lebih rendah antara kelompok hipertensi dan nonhipertensi. Hasil uji regresi cox multivariat menunjukkan kelompok nonhipertensi memiliki risiko ketahanan hidup 1.6 kali lebih lama dibandingkan dengan kelompok hipertensi (p.value 0.006, 95 persen Interval Kepercayaan 1.2-2.3) setelah dikontrol oleh jenis kelamin. Sedangkan variabel umur tidak berhubungan signifikan terhadap status kematian pasien PGK (p.value 0.067). Kesimpulan adalah rata-rata lama hidup pasien PGK dari kelompok hipertensi lebih pendek dibandingkan kelompok nonhipertensi. Kelompok hipertensi memiliki risiko ketahanan hidup lebih pendek dibandingkan kelompok nonhipertensi terhadap pasien PGK yang menjalani hemodialisis. Selain itu, jenis kelamin perempuan memiliki risiko ketahanan hidup lebih lama setelah dikontrol oleh tekanan darah. Deteksi dini hipertensi sangat dianjurkan. Hal ini dapat dilakukan dengan mengontrol rutin tekanan darah dengan memanfaatkan program posbindu yang ada di puskemas. Selain itu, optimalisasi sosialisasi Germas terutama untuk para remaja muda agar sadar tentang pentingnya kesehatan dan mengontrol tekanan darah rutin sejak usia berisiko 15 tahun.
References
Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1923–94.
Moeloek NF. Air Bagi Kesehatan : Upaya Peningkatan Promotif Preventif bagi Kesehatan Ginjal di Indonesia [Internet]. Jakarta; 2018 [cited 2018 Aug 31]. Available from: https://www.persi.or.id/images/2018/data/materi_menkes.pdf
Badan Penelitian dan Pengembangan Kesehatan. Riset Kesehatan Dasar (RISKESDAS) 2013. Laporan Nasional 2013. Jakarta; 2013.
Lydia A, Nugroho P. Kondisi Kesehatan Ginjal Masyarakat Indonesia dan Perkembangannya [Internet]. 2018 [cited 2018 Aug 31]. Available from: https://www.persi.or.id/images/2018/data/aida_lydia.pdf
Indonesian Renal Registry Team. 8 th Report Of Indonesian Renal Registry 2015 [Internet]. 2015 [cited 2018 Aug 30]. Available from: https://www.indonesianrenalregistry.org/data/INDONESIAN RENAL REGISTRY 2015.pdf
Indonesia Renal Registry Team. 9 th Report Of Indonesian Renal Registry 2016 [Internet]. 2016 [cited 2018 Aug 31]. Available from: https://www.indonesianrenalregistry.org/data/INDONESIAN RENAL REGISTRY 2016.pdf
Indonesian Renal Registry Team. 10 th Report Of Indonesian Renal Registry 2017 [Internet]. 2017. Available from: https://www.indonesianrenalregistry.org/data/IRR 2017 .pdf
Indonesian Renal Rgistry Team. 11 th Report Of Indonesian Renal Registry 2018 [Internet]. 2018. Available from: https://www.indonesianrenalregistry.org/data/IRR 2018.pdf
Yulianto D, Basuki H, Widodo. Analisis Ketahanan Hidup Pasien Penyakit Ginjal Kronis Dengan Hemodialisis Di RSUD Dr. Soetomo Surabaya. J Manaj Kesehat Yayasan RSDr Soetomo [Internet]. 2017;3(1):96. Available from: https://media.neliti.com/media/publications/258424-analisis-ketahanan-hidup-pasien-penyakit-a82c8244.pdf
Hidayati T, Kushadiwijaya H, Suhardi. Hubungan antara Hipertensi, Merokok dan Minuman Suplemen Energi dan Kejadian Penyakit Ginjal Kronik. Ber Kedokt Masy [Internet]. 2008;24(2):90–102. Available from: https://journal.ugm.ac.id/bkm/article/view/3600
Fitrianto H, Azmi S, Kadri H. Penggunaan Obat Antihipertensi pada Pasien Hipertensi Esensial di Poliklinik Ginjal Hipertensi RSUP DR. M. Djamil Tahun 2011. J Kesehat Andalas [Internet]. 2014;3(1):45–8. Available from: Penggunaan Obat Antihipertensi pada Pasien Hipertensi Esensial di Poliklinik Ginjal Hipertensi RSUP DR. M. Djamil Tahun 2011
Ogston SA, Lemeshow S, Hosmer DW, Klar J, Lwanga SK. Adequacy of Sample Size in Health Studies. Biometrics. 1991;47(1):347.
Ding C, Yang Z, Wang S, Sun F, Zhan S. The associations of metabolic syndrome with incident hypertension, type 2 diabetes mellitus and chronic kidney disease: a cohort study. Endocrine [Internet]. 2018;60(2):282–91. Available from: http://dx.doi.org/10.1007/s12020-018-1552-1
Ruang Hemodialisa RSUD Dr. H. Abdul Muluk. Laporan Bulanan Frekuensi Tindakan Hemodialisa Tahun 2016. Bandar Lampung; 2016.
Ruang Hemodialisa RSUD Dr. H. Abdul Muluk. Laporan Bulanan Frekuensi Tindakan Hemodialisa Tahun 2017. 2017.
Ruang Hemodialisa RSUD Dr. H. Abdul Muluk. Laporan Bulanan Frekuensi Tindakan Hemodialisa Tahun 2018. 2018.
KDIGO. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl [Internet]. 2013 [cited 2018 Sep 1];3(1):1–150. Available from: http://www.kidney-international.org
Badan Penelitian dan Pengembangan Kesehatan. Hasil Utama Riskesdas 2018. Kementerian Kesehatan. 2018.
Nurcahyati S. Faktor-Faktor yang Berhubungan dengan Kualitas Hidup Pasien Hemodialisis di Rumah Sakit Islam Fatimah Cilacap dan Rumah Sakit Umum Daerah Banyumas [Internet]. Indonesia; 2011. Available from: http://lib.ui.ac.id/file?file=digital/20282431-T Sofiana Nurchayati.pdf
Delima D, Tjitra E, Tana L, Halim FS, Ghani L, Siswoyo H, et al. Faktor Risiko Penyakit Ginjal Kronik : Studi Kasus Kontrol di Empat Rumah Sakit di Jakarta Tahun 2014. Bul Penelit Kesehat [Internet]. 2017;45(1):17–26. Available from: http://ejournal.litbang.kemkes.go.id/index.php/BPK/article/download/7328/5123
Pongsibidang GS. Risk Factor Hypertension, Diabetes and Consuming Herbal Medicine of Chronic Kidney Disease In Dr. Wahidin Sudirohusodo Hospitals Makassar 2015. J Wiyata [Internet]. 2016;3(2):162–7. Available from: https://ojs.iik.ac.id/index.php/wiyata/article/view/87
Ebad M. Survival analysis of chronic dialysis patients [Internet]. University of Waterloo; 2018 [cited 2018 Aug 31]. Available from: http://hdl.handle.net/10012/13584
Sulistiowati E, Idaiani S. Risk Factors of Chronic Kidney Disease Based on Cross- Sectional Analysis Baseline Cohort Study Non-Communicable Diseases At Population 25-65 Years Old In Kebon Kelapa, Bogor 2011. Bul Penelit Kesehat [Internet]. 2015;43(3):163–72. Available from: http://ejournal.litbang.kemkes.go.id/index.php/BPK/article/view/4344/4000
Pranandari R, Supadmi W. Risk factors cronic renal failure on hemodialysis unit in RSUD Wates Kulon Progo. Maj Farm [Internet]. 2015;22(2):316–20. Available from: https://jurnal.ugm.ac.id/majalahfarmaseutik/article/view/24120/15776
Chang PY, Chien LN, Lin YF, Wu MS, Chiu WT, Chiou HY. Risk factors of gender for renal progression in patients with early chronic kidney disease. Med (United States) [Internet]. 2016;95(30). Available from: https://journals.lww.com/md-journal/fulltext/2016/07260/risk_factors_of_gender_for_renal_progression_in.26.aspx
