"Faktor Risiko yang Berhubungan dengan Kematian Pasien Penyakit Ginjal " by Joue Abraham Trixie Latupeirissa, Mondastri Korib Sudaryo et al.
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Abstract

Introduction. Although mortality among adult chronic kidney disease (CKD) patients on regular hemodialysis remains infrequent within the first three months, it is still a potential outcome. Given that hemodialysis is required for life, identifying risk factors for mortality is critical. This study aims to examine risk factors associated with mortality in adult CKD patients undergoing regular hemodialysis.

Methods. A case-control study, without matching, was conducted using medical record data from adult CKD patients (≥18 years) receiving regular hemodialysis between 2022 and 2024 at three hospitals (types A, B, and C) in Lampung Province. The case group consisted of patients who experienced mortality, while the control group consisted of similar patients who survived. Patients with autoimmune-related CKD were excluded. Subjects were selected using convenience sampling with a 1:2 case-to-control ratio. Risk factors assessed included sociodemographics, dialysis duration, comorbidities, and nutritional status. Logistic regression analysis was performed.

Results. A total of 114 cases and 228 controls were included, with the longest dialysis duration in both groups being 72 months. The oldest patient starting dialysis was 77 years in the case group and 75 years in the control group. Logistic regression analysis revealed that the following factors were associated with increased mortality: history of heart failure (OR = 2.3; 95% CI = 1.2–4.4; p = 0.009), history of post-renal obstruction (OR = 3.5; 95% CI = 1.6–7.6; p = 0.002), random blood glucose ≥140 mg/dL (OR = 2.1; 95% CI = 1.2–3.6; p = 0.011), acute kidney injury (OR = 6.5; 95% CI = 3.8–11.1; p < 0.001), and BMI

Conclusion. History of heart failure, post-renal obstruction, elevated blood glucose, acute kidney injury, and low BMI are significant predictors of mortality in adult CKD patients undergoing regular hemodialysis in Lampung Province.

Bahasa Abstract

Pendahuluan. Meskipun kematian pasien penyakit ginjal kronik (PGK) pada usia dewasa yang menjalani hemodialisis setelah tiga bulan masih jarang, namun berpotensi untuk terjadi. Padahal, layanan hemodialisis dibutuhkan seumur hidup. Tujuan studi ini adalah untuk mengetahui faktor – faktor risiko yang berhubungan dengan kematian pasien PGK usia dewasa yang menjalankan hemodialisis reguler.

Metode. Studi kasus kontrol tanpa pencocokan dilakukan menggunakan data rekam medis pasian PGK usia ≥18 tahun yang menjalani hemodialisis reguler pada periode 2022 – 2024 di tiga rumah sakit (tipe A, B, dan C) di Provinsi Lampung. Kelompok kasus adalah pasien PGK usia ≥18 tahun yang menjalani hemodialisis reguler dan mengalami kematian, sedangkan kelompok kontrol adalah pasien dengan karakter serupa namun tidak mengalami kematian. Pasien yang mengalami PGK akibat autoimun dieksklusi dari kedua kelompok. Subjek dipilih secara convenience sampling dengan perbandingan kasus dan kontrol 1:2. Faktor risiko yang dinilai terdiri atas empat kelompok, yaitu sosiodemografi, lama hemodialisis, komorbid, dan status gizi. Selanjutnya, dilakukan uji menggunakan regresi logistik.

Hasil. Dari tiga rumah sakit lokasi studi, secara keseluruhan didapatkan 114 kasus dan 228 kontrol dengan lama hemodialisis terpanjang pada kedua kelompok adalah 72 bulan. Usia paling tua pada kelompok kasus saat memulai hemodialisis adalah 77 tahun, sedangkan pada kelompok kontrol 75 tahun. Hasil analisis menunjukkan faktor risiko yang berhubungan terhadap kematian adalah riwayat gagal jantung (OR = 2,3; IK 95% = 1,2 – 4,4; nilai p = 0,009), riwayat obstruksi pasca ginjal (OR = 3,5; IK 95% = 1,6 – 7,6; nilai p = 0,002), glukosa sewaktu ≥140 mg/dl (OR = 2,1; IK 95% = 1,2 – 3,6; nilai p = 0,011), gagal ginjal akut (OR = 6,5; IK 95% = 3,8 – 11,1; nilai p

Kesimpulan. Riwayat gagal jantung, riwayat obstruksi pasca ginjal, kadar glukosa sewaktu, dan gagal ginjal akut adalah prediktor terhadap kematian pada pasien PGK usia dewasa yang menjalani hemodialisis reguler di Provinsi Lampung.

Kata Kunci: faktor risiko, hemodialisis, kematian, penyakit ginjal kronik

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