Tesis

Faktor-faktor Prediktor Post Dialysis Fatigue Sedang pada Pasien yang Menjalani Hemodialisis Reguler = Predicting Factors of Moderate Post Dialysis Fatigue in Patients Undergoing Regular Hemodialysis.

Latar Belakang: Fatigue sering dialami oleh pasien PGK-HD. Fatigue merupakan prediktor mortalitas dan target potensial dalam suatu rencana terapi. Post Dialysis Fatigue (PDF) dapat menyebabkan penurunan kualitas hidup, peningkatan angka morbiditas dan mortalitas. Tujuan: Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang dapat berperan sebagai prediktor PDF sedang pada pasien yang menjalani hemodialisis reguler. Metode: Penelitian ini menggunakan desain kohort retrospektif pada pasien Penyakit Ginjal Kronik yang menjalani Hemodialisis (PGK-HD) yang menjalani HD di RSUP Fatmawati selama periode November-Desember 2024. Data sekunder berupa Variabilitas Tekanan Darah (VTD), hasil laboratorium, IDWG, ultrafiltrasi, lama (vintage) dialisis dan komorbid selama satu bulan terakhir didapat dari rekam medis. Data primer menggunakan Post Dialysis Fatigue Scale, Malnutrition Inflammation Scale dan Beck Depression Inventory II yang dilakukan pada sesi HD ke delapan. Analisis bivariat menggunakan uji Chi-square, kecuali variabel status depresi karena tidak memenuhi syarat dan dilakukan analisis dengan uji Fisher. Variabel-variabel yang memiliki p < 0,250 pada analisis bivariat dilanjutkan ke model regresi logistik yaitu malnutrisi inflamasi, depresi dan lama (vintage) HD sampai didapatkan di model akhir p < 0,05. Hasil: Sebanyak 135 subjek penelitian diikutsertakan dalam penelitian ini. Hasil uji bivariat menunjukkan malnutrisi inflamasi, status depresi, dan lama (vintage) dialisis memiliki hubungan signifikan dengan status fatigue (p < 0,05). Analisis multivariat mengunakan regresi logistik menunjukkan malnutrisi inflamasi RR 2,165, (IK 95 % 1,542-3,039), p < 0,001, depresi RR 1,851, (IK 95 % : 1,208-2,834), p = 0,005, dan lama HD RR 1,580, (IK 95 % 1,017-2,455), p=0,042. berhubungan signifikan dengan PDF. Simpulan: Proporsi PDF sedang adalah 39,3 %. Malnutrisi inflamasi berat, depresi ringan sedang dan lama (vintage) HD lebih dari 12 bulan berperan sebagai faktor prediktor PDF sedang pada pasien yang menjalani HD reguler.
Kata kunci: faktor-faktor prediktor, hemodialisis, penyakit ginjal kronik, post dialysis fatigue sedang


Background: Fatigue is often experienced by CKD-HD patients. Fatigue is a predictor of mortality and a potential target in a treatment plan. Post Dialysis Fatigue (PDF) can lead to decreased quality of life, increased morbidity and mortality rates. Objective: The aim of this study was to determine the factors that can act as predictors of moderate PDF in patients undergoing regular hemodialysis. Method: A retrospective cohort study in CKD-HD patients during the period November-December 2024. Secondary data were result in the form of Blood Pressure Variability (BPV), laboratory results, IDWG, ultrafiltration, dialysis vintage and comorbidities during the last month were obtained from medical records. Primary data using Post Dialysis Fatigue Scale, Malnutrition Inflammation Scale and Beck Depression Inventory II were collected at the eighth HD session. Chi-square test was used for bivariate analysis, except for the depression status variable because it did not meet the requirements and was analyzed by Fisher's test. Variables that had p < 0.250 in the bivariate analysis were continued to the logistic regression model, malnutrition inflammation, depression and vintage dialysis until the final model obtained p < 0.05. Results: A total of 135 research subjects were included in this study. Bivariate test results showed inflammatory malnutrition, depression status, and dialysis vintage had a significant relationship with fatigue status (p < 0.05). Multivariate analysis using logistic regression showed inflammatory malnutrition RR 2.165, (95% CI 1.542-3.039), p < 0.001, depression RR 1.851, (95% CI: 1.208-2.834), p=0.005, and length of HD RR 1.580, (95% CI 1.017-2.455), p=0.042. significantly associated with PDF. The logistic regression model shows a significant relationship between moderate PDF and severe malnutrition inflammation score, mild to moderate depression, and dialysis vintage exceeding 12 months. Conclusion: The proportion of moderate PDF is 39,3 %. Severe malnutrition inflammation, mild-moderate depression and dialysis vintage > 12 months act as predictors of moderate PDF in patients undergoing regular HD.
Key words: chronic kidney disease, hemodialysis, moderate post dialysis fatigue, predictor factors.