Tesis

Faktor-Faktor Yang Berhubungan Dengan Kualitas Hidup Pasien Geriatri Yang Menjalani Hemodialisis Kronik = Associated Factors on Geriatric Patients undergoing Chronic Hemodialysis.

Latar Belakang Lebih dari 30% pasien hemodialisis (HD) di Indonesia adalah geriatri. Beberapa studi di Indonesia telah menunjukkan penurunan kualitas hidup pada pasien HD. Namun, hingga saat ini, masih sedikit penelitian yang secara khusus mengevaluasi kualitas hidup pasien HD berusia lanjut serta faktor-faktor yang berhubungan dengan penurunan tersebut. Tujuan Penelitian ini dilakukan untuk mengetahui gambaran kualitas hidup pasien geriatri yang menjalani HD serta hubungan komorbiditas, status fungsional, frailty, sarkopenia, status nutrisi, depresi, kadar hemoglobin, lama (vintage) HD, akses vaskular, dan adekuasi HD dengan kualitas hidup. Metode Penelitian ini menggunakan desain potong lintang dengan metode consecutive sampling. Penelitian dilaksanakan di Unit HD RSUPN Dr. Cipto Mangunkusumo (RSCM), RSUP Persahabatan (RSP), dan RSUP Fatmawati (RSF). Kriteria inklusi adalah pasien berusia 60 tahun ke atas yang menjalani hemodialisis. Kualitas hidup diukur menggunakan instrumen EQ-5D-5L. Data riwayat penyakit dan hasil pemeriksaan laboratorium diperoleh dari rekam medis rumah sakit. Analisis bivariat dilakukan menggunakan uji Mann-Whitney untuk variabel komorbiditas, sarkopenia, depresi, kadar hemoglobin, akses vaskular, dan adekuasi HD; uji Kruskal-Wallis untuk variabel frailty, status fungsional, dan status nutrisi; serta uji korelasi Spearman untuk variabel lama HD. Analisis multivariat menggunakan regresi linier untuk mengidentifikasi faktor yang berhubungan dengan penurunan kualitas hidup. Hasil Sebanyak 124 subjek (rerata usia 67 tahun) diikutsertakan dalam studi ini. Rerata skor indeks EQ-5D-5L tercatat sebesar 0,76 (RIK 0,63–1,00), sementara rerata skor VAS adalah 70. Mayoritas subjek (75%) tidak mengalami kesulitan dalam perawatan diri maupun aktivitas sehari-hari. Analisis menunjukkan bahwa status fungsional (p < 0,0001) dan depresi (p < 0,002) merupakan faktor yang berhubungan signifikan dengan kualitas hidup pasien geriatri yang menjalani hemodialisis, dengan nilai adjusted R² sebesar 0,642. Kesimpulan Pasien geriatri yang menjalani HD di RSCM, RSP, dan RSF memiliki rerata skor indeks EQ-5D-5L 0,76 (dari 1,000) dan 75% pasien tidak memiliki masalah pada perawatan diri dan aktifitas sehari-hari. Status fungsional dan depresi terbukti berperan penting dalam menentukan kualitas hidup mereka.
Kata kunci: faktor, kualitas hidup, geriatric, penyakit ginjal tahap akhir, hemodialisis


Background More than 30% of hemodialysis (HD) patients in Indonesia are geriatrics. Several studies in Indonesia have reported a decline in the quality of life among HD patients. However, to date, there is still limited research specifically evaluating the quality of life of elderly HD patients and the factors associated with this decline. Objective This study aims to describe the quality of life of geriatric patients undergoing HD and to examine the associations between comorbidities, functional status, frailty, sarcopenia, nutritional status, depression, hemoglobin levels, HD vintage, vascular access, and HD adequacy with quality of life. Methods This study employed a cross-sectional design with consecutive sampling method. The study was carried out in the hemodialysis units of Dr. Cipto Mangunkusumo National General Hospital (RSCM), Persahabatan National General Hospital (RSP), and Fatmawati National General Hospital (RSF). The inclusion criteria were patients aged 60 years or older undergoing hemodialysis. Quality of life was measured using the EQ-5D- 5L instrument. Data on medical history and laboratory results were obtained from hospital medical records. Bivariate analysis was performed using the Mann-Whitney test for variables such as comorbidities, sarcopenia, depression, hemoglobin levels, vascular access, and HD adequacy; the Kruskal-Wallis test for variables such as frailty, functional status, and nutritional status; and Spearman correlation for the duration of HD. Multivariate analysis was conducted using linear regression to identify factors associated with a decline in quality of life. Results A total of 124 subjects (mean age 67 years) were included in this study. The mean EQ- 5D-5L index score was 0.76 (IQR 0.63–1.00), while the mean VAS score was 70. The majority of subjects (75%) reported no difficulties in self-care or daily activities. Analysis revealed that functional status (p < 0.0001) and depression (p < 0.002) were significantly associated with the quality of life in geriatric patients undergoing hemodialysis, with an adjusted R² value of 0.642. Conclusion Geriatric patients undergoing HD at RSCM, RSP, and RSF had an average EQ-5D-5L index score of 0.76 (out of 1.000), and 75% of the patients reported no issues with selfcare and daily activities. Functional status and depression have been proven to play a significant role in determining their quality of life.
Keywords: factors, quality of life, geriatric, end-stage renal disease, hemodialysis