Pengaruh pemberian diet ekstra formula komersial dan diet ekstra filtrat ikan gabus terhadap kadar serum albumin dan kreatinin pasien dengan hemodialisis di RSU Dr. Saiful Anwar Malang

SULISTYOWATI, Etik, Prof.dr. Hamam Hadi, MS.,Sc.D

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Gizi dan Kesehatan)

Latar belakang. Penyakit ginjal kronis saat ini merupakan masalah kesehatan yang penting mengingat insidennya semakin meningkat, di Indonesia diperkirakan jumlahnya 100 penderita persatu juta penduduk setahun. Hemodialisis adalah salah satu cara untuk mempertahankan kelangsungan hidup penderita yang harus dilakukan berulang dan dalam jangka panjang. Tingginya angka malnutrisi pada pasien hemodialisis disamping karena penyakitnya juga tindakan dialisis menyebabkan hilangnya zat gizi. Sampai saat ini di rumah sakit di Indonesia terapi diet intradialisis yang ditujukan untuk mengganti zat gizi yang hilang terutama protein belum dilakukan sebagai bagian dari terapi diet. Untuk meningkatkan status gizi dan menurunkan angka mortalitas, maka terapi diet intradialisis secara oral dengan formula yang tepat sangat diperlukan. Tujuan. Mengkaji pengaruh pemberian diet ekstra formula komersial dan diet ekstra filtrat ikan gabus terhadap kadar serum albumin dan kreatinin pasien dengan hemodialisis Metode. Penelitian ini merupakan penelitian eksperimental dengan rancangan randomized control trial, yang dilakukan di Instalasi Dialisis RSU Dr. Saiful Anwar Malang terhadap 36 pasien hemodialisis yang terbagi menjadi 3 kelompok, yaitu kelompok yang mendapatkan diet standar, diet standar+formula komersial, dan diet standar+filtrat ikan gabus. Pengambilan data dilakukan dengan wawancara, pencatatan, dan pengukuran laboratorium, meliputi data karakteristik subyek, berat badan, tinggi badan, kadar serum albumin dan kreatinin, serta asupan makanan sehari sebelum, sesudah dan pada hari saat hemodialisis. Analisis data dilakukan secara deskriptif dan uji statistik Chi square, ANOVA dan Paired t test. Kesimpulan adanya perbedaan atau pengaruh yang signifikan secara statistik digunakan tingkat kemaknaan (α) 0,05 atau p<0,05. Hasil. Hasil penelitian menunjukkan tidak terdapat perbedaan yang signifikan terhadap karakteristik subyek pada awal penelitian, dengan rerata kadar serum albumin 3,61±0,48 g/dl dan serum kreatinin 9,04±2,73 mg/dl. Tidak terdapat perbedaan rerata asupan energi dan protein pada subyek. Pada akhir penelitian rerata kadar serum albumin 3,38±0,42 g/dl, serum kreatinin 8,34±3,6 mg/dl, dan terdapat perbedaan kadar serum albumin yang signifikan pada subyek (p=0,000), meskipun terdapat peningkatan kadar serum kreatinin pada kelompok yang mendapat diet ekstra filtrat ikan gabus namun secara statistik tidak signifikan. Kesimpulan. Terdapat pengaruh yang signifikan pemberian diet ekstra formula komersial dan filtrat ikan gabus terhadap peningkatan kadar serum albumin subyek dan tidak terdapat pengaruh yang signifikan pemberian diet ekstra terhadap kadar serum kreatinin, namun pemberian diet ekstra filtrat ikan gabus mampu mempertahankan kadar serum kreatinin

Background: Nowadays chronic kidney disease (CKD) is a serious health problem because of its increasing incidence. In Indonesia approximately there are 100 CKD patients per 1 million people a year. Hemodialysis is one of ways to prolong CKD patients life that should be done recurrently and for a long time. However, hemodialysis causes loss of nutrients leading to high prevalence of malnutrition among CKD patients. Until today intradialysis diet therapy which can replace loss of nutrients particularly protein has not been initiated as part of diet therapy in Indonesian hospitals. To improve nutrition status and minimize mortality rate oral intradialysis diet therapy with proper formula is needed. Objective: To study the effect of the supply of commercial formula and local catfish filtrate extra diet to albumin and creatinine serum level among hemodialysis patients. Method: The study was experimental with randomized control trial design carried out at Dialysis Installation of Dr. Saiful Anwar Hospital, Malang. There were as many as 36 hemodialysis patients divided into 3 groups; 1 group with standard diet, 1 group with commercial formula and standard diet, and 1 group with local catfish filtrate and standard diet. Data were obtained through interview, note taking and laboratory tests which consisted of subject characteristics in weight, height, albumin and creatinin serum level as well as food intake one day before, during and one day after hemodialysis. Data analysis was done descriptively and inferentially using Chi square, ANOVA and Paired t-test. The conclusion was based on significance level (α) 0.05 or p<0.05. Result: There was no significant difference in the characteristics of the subject at the beginning of the study with average albumin serum level 3.61 +0.48 g/dl and creatinine serum level 9.04 +2.73 mg/dl. There was no difference in average energy and protein intake of the subject. At the end of the study average albumin serum level was 3.38 +0.42 g/dl, creatinine serum level 8.34 +3.6 mg/dl, and there was significant difference in albumin serum level (p=0.000) of the subject. Although there was an increase of creatinine serum level in the group with local catfish filtrate extra diet, it was statistically insignificant. Conclusion: There was significant effect of the supply of commercial formula and local catfish filtrate extra diet to increase of albumin serum level of the subject and there was no significant effect of the supply of extra diet to creatinine serum level; however, the supply of local catfish filtrate extra diet could maintain creatinine serum level.

Kata Kunci : Penyakit Ginjal Kronis,Gizi,Terapi Diet Hemodialisis,hemodialysis, intradialysis diet therapy, commercial formula, local catfish filtrate, albumin serum, creatinine serum