CHARACTERISTIC OF CHRONIC KIDNEY DISEASE (CKD) PATIENTS
ROUTINELY TREATED WITH HEMODIALYSIS
IN DR TJITROWARDOJO LOCAL HOSPITAL, PURWOREJO,
CENTRAL JAVA, INDONESIA
Wiwit Sugiarti1, Sri Nabawiyati Nurul Makiyah2
1
Master of Nursing Program, Post Graduate University of Muhammadiyah Yogyakarta,
Yograkarta
2
Medical Study Program, Medical and Health Sciences Faculty,
University of Muhammadiyah Yogyakarta, Yogyakarta
Abstract: Chronic Kidney Disease (CKD) is the main cause of hemodialysis therapy. This research
aims to study the characteristic of the Chronic Kidney Disease patients who routinely undergo
hemodialysis (HD) therapy. Observational research with the cross-sectional design is conducted to the
chronic kidney disease patients routinely treated with hemodialysis in the Dr Tjitrowardojo Hospital in
Purworejo. The respondents’ characteristics include demography, vital sign, chronic kidney disease
causes, lifestyle, pain, and insomnia. Product Moment Pearson correlation test is used to test the data.
The research’s result shows that the majority of the respondents are men 22 people (61.1%), aged 40-55
years old 17 people (38,9%), High School graduate 18 people (50%), working 25 people (69,4%), and
are married 34 people (88,9%). The majority of the respondents do not smoke 33 people (91,7%), do not
drink coffee 25 people (69,4%), do not exercise 32 people (88,9%), and suffered CKD due to
hypertension 25 people (69,4%). The majority of the respondents, 24 people, have undergone HD for 1-5
years and every HD treatment hemodialysis.
Keywords: Characteristic, Chronic Kidney Disease, Hemodialysis, Pain, Insomnia
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Berkala Kedokteran, Vol. 14 No. 2, Sep 2018: 145-158 DOI: 10.20527/jbk.v14i2.5328
INTRODUCTION
Chronic Kidney Disease (CKD) is the main cause of hemodialysis (HD) therapy. HD is the main
alternative therapy replacing the kidney’s function of CKD patients due to the cost factor that
hemodialysis therapy is cheaper than other therapy. Also, it has a lower risk of bleeding
compared to the peritoneal dialysi.1
In Indonesia, the number of patients who routinely treated with hemodialysis from 2007 until
2014 is increasing. In 2007, the number of HD patient was 140.972 people, and in 2014, the
number of the increasing of HD patients reached 703.139 people.1 The total of new HD patient in
2010 is 9.649 people, and the active HD patients are 5.184 people. Based on the Dr
Tjitrowardojo Hospital, the increasing number of HD patients on each year are; 556 people in
2011, 836 people in 2012 and 918 people in 2013.
The patients treated with hemodialysis have some complication such as, tiredness, pruritus,
constipation, anorexia, pain, sleep disorder, anxiety, dyspnea, depression, nausea, and sleep
disorder affecting the life quality which can cause death.2,3,4 Insomnia disorder and
musculoskeletal pain, such as joint pain, back pain, and muscle cramp related to minerals and
bone disorders resulted by CKD which influences the high level of parathyroid hormone though
there are other factors such as demographic, lifestyle, biology, psychology, and dialysis.5 The
chronic pain felt by the HD patient will have an impact on the sleep disorder, namely, insomnia.
Patients treated with hemodialysis experience complication symptoms such as pain which affects
the quality of life, even can cause death.6,7,8 Musculoskeletal pain disorder is joint pain, back
pain, and muscle cramp related with minerals and bone disorder caused by the high of CKD
which influences the high parathyroid hormone though other factors are influencing such as
demographic, lifestyle, biology, psychology, and dialysis.9
This research aims to study the characteristic of Cronic Kidney Disease patients who routinely
undergo hemodialysis therapy in Hemodialysis Unit of Dr Tjitrowardojo Hospital Purworejo,
Central Java, Indonesia.
RESEARCH METHOD
This research is nonexperimental research with a cross-sectional design. The population of this
research is the patient who routinely undergoes the hemodialysis in Dr Tjitrowardojo Hospital,
Purworejo, as many as 70 people. The number of the sample is 36 respondents. The sampling of
this research is by quota sampling. The inclusion criteria are patients who routinely undergo HD
and are minimum age of 18 years (adult). Patients who at least have already undergone HD in 3
months routinely. Patients who undergo HD twice a week for 3 or 4 hours of each treatment and
did not experience any problem of AV fistula. The patients are conscious, cooperative and well
communicated, patients without femoral access, not the HD inpatients, and able to stand up for at
least 30 minutes without any help.
The exclusion criteria are HD patients with unstable hemodynamic, heart problem patients,
patients with the musculoskeletal disorder and fracture risk, patients with neurology disorder.
While the drop-out respondents are the patients, who deaths during the research period.
This research is conducted in Hemodialysis Unit of Dr Tjitrowadojo Hospital, Purworejo
Regency, Central Java Province. This research is conducted starting from June 2017 in
Hemodialysis Unit of Dr Tjitrowardojo Hospital Purworejo Regency, Central Java Province.
The research is conducted by determining the respondents who meet the
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criteria of inclusion and exclusion, asking the respondents to be the participants who have given
the research explanation, asking the respondents to sign the participant consent sheet. Collect the
data of characteristic respondents, including demographics, vital sign, the cause of chronic
kidney disease, lifestyle, pain, and insomnia. Visual Analog Scale (VAS) is used to measure the
pain score of the respondents. Insomnia Rating Scale from KSPBJ (Kelompok Studi Psikiatri
Biology Jakarta / Group Study of Psychiatry Biology Jakarta) is to measure the respondents’
insomnia score.
The data are examined their reliability with alfa-Cronbach. The data of respondents’
characteristic with kidney failure who routinely undergo the hemodialysis are analyzed
statistically by using univariate analysis. Their validity is tested by using Product Moment
Pearson correlation test.
RESULTS AND DISCUSSION
The result of data collecting on the second week of August 2006 in Hemodialysis Unit of DR.
Tjitrowardojo Hospital, Purworejo regency, the province of Central Java is that the number of
CKD patients who undergo hemodialysis therapy on the second week of August 2006 is as much
as 57 people. From those number of patients, the patients who meet the inclusion criteria are 34
patients. The research’s result includes the respondents’ characteristics, namely demographic,
vital sign, the cause of chronic kidney disease, lifestyle, pain and insomnia.
Respondents grouping according to demographics (gender, age, education, working status,
married status) can be seen in Table 1. Based on the gender, the majority of the respondents are
male with the number of 22 people ( 61,1 %) while the female is 14 people (38,9%). Data of
respondents age are the majority in the age range of 40-55 years old; they are 17 people (38, 9%)
and the
respondents aged above 55 years old are 12 people. That range age with the tendency of various
complications of kidney failure is compared to the respondents aged under 40 years old who are
seven people. Based on the educational background, the majority of the respondents have
graduated from high school; they are 18 people. Meanwhile, the majority of the respondents who
are working are 25 people (66, 7%). Furthermore, the majority of the respondents married is 34
people (88,9%) and those who are unmarried are two people (11,1 %).
Table 1. Respondents Distribution According to Demographic Condition.
Sugiarti W. et al. Characteristic of Chronic Kidney...
Demographic Condition 1. Gender:
Male Female Total
2. Age:
- <40 years
- 40-55 years - >55 years Total
3. Educational Background: - Basic (SD)
- Middle (SMP ,
- Higher (D3, S1) Total
4. Working Status - Worked
- Unemployed
Total
5. Marital Status
- Married
- Unmarried Total
F%
22 61,1 14 38,9 36 100
7 16,7 17 38,9 12 44,4 36 100
7 16,7 22 55,6 7 27,8 36 100
25 66,7 11 33,3 36 100
34 88,9 2 11,1 36 100
SMA)
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Berkala Kedokteran, Vol. 14 No. 2, Sep 2018: 145-158 DOI: 10.20527/jbk.v14i2.5328
The respondents grouping according to their lifestyle (smoking habit, coffee addict, exercises)
can be seen in Table 2. Based on the smoking habit, the majority of the respondents do not
smoke; they are 33 people (91, 7%). The majority of the respondents who don’t drink coffee are
25 people (69,4%). And the majority of the respondents who don’t have the exercise habit are 32
people (88,9%).
Table 2. Respondents Distribution According to Lifestyle.
disease, can be seen in table 3. The table shows that the majority of the respondents are having
chronic kidney disease caused by hypertension. They are 25 people (69, 4%).
Table 3. Respondents’ Distribution According to the Cause of Chronic Kidney Disease (CKD)
The cause of CKD
Hypertension
Urinary Stone
DM 25,6 Others 4 11,1 Total 36 100
The respondents grouping according to hemodialysis condition undergone by the respondents
(shift HD, how long undergoing HD, duration of each HD treatment) can be seen in table 4. All
the respondents undergo hemodialysis, both on morning shift and in evening shift, with the
number of each shift as many as 18 people. Majority of the respondents have undergone HD for
1-5 years. They are 24 people. For each HD treatment, the duration is 4,5 hours in maximum
with the number of the respondents are 21 people.
F % 25 69,4 5 13,9
Lifestyle
1. Smoking Habit
Yes No Total
2. Drinking Coffee Yes
No
Total
3. Exercise Habit
Yes No Total
F%
3 8,3 33 91,7 36 100
11 30,6 25 69,4 36 100
4 11,1 32 88,9 36 100
The respondents grouping according to biological conditions causing chronic kidney
Table 4. Respondents Distribution According to Hemodialysis Condition
Hemodialysis Condition
1. Shift HD
Morning Evening Total
2. how long undergoing < 1 year
1-5 years > 5 years Total
3. Duration of Each HD 4 hours
4,5 hours Total
F%
18 50 18 50 36 100
4 11,1 24 66,7 8 22,2 46 100
15 41,7 21 5,3 36 100
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Respondents grouping according to vital signs ( blood pressure, pulse, respiration, temperature)
can be seen in table 5. Majority of the respondents have hypertension (having high blood
pressure above 139/89 mmHg), they are 25 people. And those who have normal blood pressure
are 11 people. The respondents who have normal pulse, 60-100
times per minute, are 34. Majority of the respondents have the normal breathing rate
(respiration), 12-20 times per minute as many as 23 people. In addition, the majority of the
respondents who get hypothermia (having low temperature under 36, 5°C) are 28 people.
Table 5. Respondents Distribution According to Vital Signs Vital Signs
1. Blood Pressure
<90/60 MmHg (low/hypotension) 90/60 – 139/89 (normal)
>139/89 MmHg (high/hyphertension) Total
2. Pulse
<60 times/minute (slow) 60-100 times/minute (normal) >100 times/minute (fast) Total
3. Respiration
<12 times/minute (low) 12-20 times/minute (normal) >20 times/minute (fast) Total
4. Temperature
<36,5 oC (low/hypothermia) 36,5-37,5 oC (normal) >37,5oC (high)
Total
Respondents grouping according to used drugs (anti-hypertension, CaCO3, vitamin, EPO) can be
seen in Table 6. Table 6 is about the drugs used by the respondents as a hemodialysis patient in
Dr Tjitrowardojo Hospital, Purworejo. It can be seen that the majority of the respondents are
given the anti-hypertension drug. The respondents for the intervention group are 12 people
(66,7%), and the respondents of the control group are 16 people (88,9%). Also, Majority of the
respondents are given CaCO3 for the intervention group, the number of respondents is 12 people
(66,7%), and the
Sugiarti W. et al. Characteristic of Chronic Kidney...
- 11 25 36
- 34 2 36
- 23 13 36
28 8 - 36
number of respondents of
ten people (55,6%). Majority of the respondents, both of the intervention group and control
group, are given vitamin. For the intervention group, the number of the respondents are nine
people (50%) and for the control group are 11 people (61,1%). Majority of the respondents are
given Erythropoietin (EPO), for the intervention group, the number of the respondents are 16
people (88,9%), and the number of the respondents of the control group is 15 people (83,3%).
- 30,6 69,4 100
- 94,4 5,6 100
- 63,9 36,1 100
77,8 22,2 - 100
the control group is
