Tesis

Terapi Medik Gizi pada Penyakit Ginjal Kronik yang Menjalani Hemodialisis dengan Anemia dan Asupan Rendah = Medical Nutrition Therapy in Chronic Kidney Disease Patients with Anemia and Low Nutritional Intake Undergoing Hemodialysis.

Latar belakang: Penyakit ginjal kronik (PGK) merupakan proses patologis dengan berbagai etiologi. Hal ini ditandai dengan penurunan fungsiginjal yang ireversibel, dan pada derajat akhir akan memerlukan dialisis. Peningkatan prevalensi PGK telah menjadi permasalahan kesehatan dunia. Pasien HD berisiko mengalami malnutrisi dan komplikasi lain seperti anemia. Pemberian terapi medik gizi yang sesuai diharapkan dapat mempertahankan dan memperbaiki status gizi pasien. Metode:Empat orang pasien usia 34-52 tahun dengan diagnosis PGK yang telah menjalani HD rutin sebanyak dua kali seminggu, serta memiliki etiologi terjadinya PGK yang berbeda. Dilakukan anamnesis, pemeriksaan fisik, dan pemeriksaan laboratorium kepada seluruh pasien. Riwayat asupan energi pasien dibawah kebutuhan basal, asupan protein kurang dari 1,2 g/kgBB, dengan penurunan berat badan lebih dari 10%. Pemeriksaan laboratorium didapatkan kadar Hb kurang dari 9g/dl dengan hipoalbuminemia pada pasien kedua dan empat. Berdasarkan hasil tersebut pasien dinyatakan berisiko malnutrisi, anemia, dan asupan tidak adekuat. Terapi medik gizi diberikan kepada pasien, sesuai dengan kebutuhan dan kondisi klinis pasien masingmasing. Pemberian kalori dilakukan secara bertahap, menyesuaikan dengan toleransi asupan dan kondisi klinis pasien. Protein diberikan berkisar antara 1,2 – 1,4 g/kgBB/ hari. Suplementasi mikronutrien yang diberikan berupa tiamin, riboflavin, piridoksin, kobalamin, dan folat Hasil:Asupan energi pasien telah di atas kebutuhan basal, dengan rata rata telah mencapai 90% KET. Asupan protein meningkat, dengan rentang antara 1–1,3 g/kgBB/hari. Peningkatan tersebut diikuti dengan perbaikan klinis dan parameter laboratorium, berupa hemoglobin dan albumin. Kesimpulan: Pemberian terapi medik gizi terbukti mampu memperbaiki kondisi klinis dan laboratorium pasien PGK yang menjalani hemodialisis, dengan mempertahankan status gizi, memperbaiki aktivitas fisik, perbaikan hemoglobin dan albumin.
Kata kunci : Penyakit Ginjal Kronik, Hemodialisis, Anemia, Asupan Rendah


Background: Chronic kidney disease (CKD) is defined by a pathological abnormality of the kidney from various etiologies. It is characterised by the irreversible gradual loss of kidney function, and it can progress to end-stage renal failure, which could establish the necessity for dialysis. The increasing CKD prevalence has become world’s medical problem. Hemodialysis patients have high risks of malnutrition and other complications such as anemia. By providing appropriate medical nutrition therapy, the patients are expected to have a maintained and improved nutritional status. Method: Four patients age 34-52 years old diagnosed with CKD had undergone routine HD twice a week and had different etiologies for their CKD. All patients had their medical history taken, physical examination, and laboratory test. History of patients' energy intake were below the basal requirement, while protein intake were less than 1.2 g /kg BW, with a weight loss of more than 10%. From the laboratory test, Hb levels were found less than 9g/dl with hypoalbuminemia in the second and fourth patients. These results indicates possible malnutrition, anemia, and inadequate intakes. Individualised specific nutrition therapy were given according to the needs and clinical conditions of each patient. Caloric intake were given in stages, adjusting to the intake tolerance, and protein ranges from 1.2 - 1.4 g / kg BW/ day. Micronutrient supplementation was given in the form of thiamine, riboflavin, pyridoxine, cobalamin, and folic acid. Results: The patients' energy intake were above the basal requirement, with an average of 90% of Total Energy Requirement. Protein intake increased to 1 - 1.3 g/ kg BW/ day. All of those were followed by improvements in clinical and laboratory parameters in hemoglobin and albumin. Conclusion: By maintaining nutritional status whilst improving physical activity along with rehabilitating hemoglobin and albumin, medical nutrition therapy plays a significant role in improving the clinical and laboratory results of CKD patients undergoing hemodialysis.
Key word : Chronic kidney disease, Hemodialysis, Anemia, Low Intake