Hemodialysis Process Research Articles

Investigation of the acute effect of the synthetic hemodialysis membrane on the expression of XRCC1 and PARP1 in chronic hemodialysis patients.

The interaction between blood from end-stage renal failure patients undergoing hemodialysis treatment and the hemodialysis (HD) membranes used may lead to DNA damage, contingent upon the biocompatibility of the membranes. Given that this process could impact the disease's course, it is crucial to assess the efficacy of DNA repair mechanisms. In our study, we investigated the gene expression levels of XRCC1 and PARP1 enzymes, which are involved in the base excision repair (BER) repair mechanism crucial for repairing oxidative DNA damage, in 20 end-stage renal disease (ESRD) patients undergoing HD treatment both before and after dialysis sessions. Additionally, we compared our findings with those from 20 healthy controls. We assessed gene expression levels using real-time polymerase chain reaction (qRT-PCR). We observed that the HD process utilizing a polysulfone membrane did not impact the expression levels of genes. However, we noted a lower expression level of the PARP1 gene in ESRD patients undergoing HD compared to the control group (0.021 ± 0.005 vs 0.0019 ± 0.0013, p = 0.0001). Although our study findings indicate that HD membranes do not affect gene expression overall, the specific decrease in PARPI gene expression suggests that the effectiveness of the BER DNA repair mechanism is impaired in ESRD patients, which may play a significant role in the progression of the disease.

Zwitterion Modification in Desalination Membrane for Rejecting Salt and Salt Ions in Brackish Water – A Mini Review

ABSTRACTDesalination membrane using zwitterion modification provides a significant opportunity to enhance excellent properties for rejecting salt and salt ions. The outstanding properties are designed by positive and negative charges attached to the membrane surface, including water permeability, salt permeability, fouling, and hydrophilicity of the membrane surface. The hydrophilic membrane, which is mentioned as one of the types of desalination membrane, presents the ability to repel salt and salt ions and pass the water. The modification of hydrophilic membranes is also affected by several factors, including water permeability, salt permeability, fouling of membrane surfaces, crossflow velocity, transmembrane pressure, and temperature. Regarding membrane modification, zwitterion has been applied for several ranges, such as the hemodialysis process, live cell imaging, antibacterial surfaces, and wound dressing. However, using a zwitterion modification membrane for desalinating water containing salt content, including brackish water, has yet to be developed. In addition, literature reviews related to polymer membranes for brackish water desalination have never been comprehensively documented. Thus, this review article addresses the zwitterion modification for desalination membranes, which can reject salt and salt ions in brackish water. Furthermore, the mechanism of zwitterion modification for desalination membranes has been presented. Finally, the challenge of zwitterion modification for desalination membranes has been evaluated to inspire insight for future studies.

The effectiveness of live music in reducing anxiety and depression among patients undergoing haemodialysis. A randomised controlled pilot study.

Anxiety and depression are highly prevalent disorders among individuals undergoing chronic haemodialysis. For patients with kidney disease, the haemodialysis process often exacerbates these conditions. This study aims to investigate the effects of listening to live classical music on anxiety and depression scales during haemodialysis sessions. A randomised clinical trial was conducted with a group of patients who listened to live classical music during haemodialysis sessions, while the control group received treatment as usual. Anxiety and depression levels were assessed at baseline and after 4 weeks of listening to live music. The study comprised 90 patients. The results demonstrated a significant decrease in anxiety and depression among the intervention group, who listened to music, compared to the control group, who did not receive this intervention. Specifically, the intervention group, presented a decrease in score on the anxiety scale of -5.35 (p < 0.001) points on average and a decrease in score on the depression scale of -5.88 (p < 0.001) points on average, while in the control group the levels worsened with the progression of time. It is concluded that listening to live classical music during haemodialysis sessions reduces anxiety and depression levels in HD patients. This conclusion adds value to listening to live music in the hospital context, specifically in this case, in haemodialysis rooms.

PENGARUH DZIKIR TERHADAP KECEMASAN DAN KOPING RELIGIUS PASIEN HEMODIALISIS

Chronic Kidney Failure is a progressive and irreversible kidney function disorder where the body is unable to maintain fluid and electrolyte balance, resulting in uremia. In general, cases of chronic kidney failure undergoing hemodialysis are increasing every year, especially in developing countries. The anxiety and decreased coping experienced by patients suffering from chronic kidney failure undergoing hemodialysis is due to a lack of support and enthusiasm from the family, funding for treatment and costs to meet living needs.A literature search was carried out based on articles published between 2018-2023 according to the inclusion and exclusion criteria that had been determined using 1 data base, namely Google Schoolar. This literature search uses the PRISMA guideline in carrying out the screening process. From the search results, 200 articles were obtained. After carrying out the screening process, there were 8 articles that met the criteria and will be analyzed.Based on a study of 8 pieces of literature, it was found that the hemodialysis process affects clients' religious anxiety and coping.From the results of a literature review of 8 journals, it was found that dhikr was able to reduce anxiety levels because the client felt calmer Keywords: Dhikr, anxiety, religious coping

The lived experiences of fatigue among patients receiving haemodialysis in Oman: a qualitative exploration

BackgroundFatigue among patients with end-stage kidney disease (ESKD) receiving haemodialysis imposes a substantial burden on patients’ quality of life and expected treatment outcomes. This study explores the perspective on ESKD-related fatigue and contributing factors among Omani patients receiving haemodialysis.MethodsAn exploratory qualitative design was used. Participants (N = 25) were recruited from two Omani haemodialysis centres, and data were collected through semi-structured interviews, which were transcribed and analysed using a thematic analysis approach. NVivo 11 is used to manage qualitative data and create memos, nodes, and codes.ResultsFindings highlighted three themes: (i)“Inevitability of fatigue,” (ii)“Contributors to physical fatigue,” and (iii)“Contributors to mental fatigue.” Theme one alluded to the inevitability of fatigue and the unique experience encountered by patients. Theme two addressed the physical fatigue associated with ESKD-related factors, such as chronically low haemoglobin levels, and the exhausting impact caused by the frequency and travelling distance for treatment sessions. Theme three, mental fatigue, was notably driven by heightened emotional disturbance, encompassing frustration, guilt, anxiety, and distress, that in turn impacted family interactions, frequently triggering anger and remorse. Moreover, mental fatigue is a result of disturbances in expressing physical sexuality in marriage, as physical fatigue was found to be a significant contributor to unsatisfactory sexual experiences and, thus, straining the relationships between couples.ConclusionsThis study offers an explanation of fatigue among Omani patients with ESKD who are receiving haemodialysis. The study emphasises close links between physiological change, the haemodialysis process, and mental tiredness, together with their contribution to supporting the need for a holistic approach and care strategies in managing these patients and promoting patient and family well-being.

Comfort Level of Patients Undergoing Hemodialysis and Associated Factors in Turkey: A Cross-Sectional Study

Background: Hemodialysis is one of the treatment methods for chronic kidney disease, which is a common disease around the world. The problems that occur during the hemodialysis process may cause discomfort in patients. Therefore, it is important to regularly evaluate the concept of comfort in hemodialysis patients. Aim: To determine the comfort level of patients undergoing hemodialysis and the associated factors. Methods: This study was a descriptive cross-sectional study conducted among 95 patients who had been undergoing hemodialysis for at least 6 months. Data were collected using the sociodemographic characteristics form and the Hemodialysis Comfort Scale (HDCS). Results: The mean age of the participants was 58.37 ± 16.62 years. The median duration of hemodialysis was 5 (1–25) years. A total of 51% of the patients were male, 54.7% were married, 34.7% had completed primary school, and 85.3% had a comorbid chronic disease. The mean hemodialysis comfort score was 23.85 ± 6.93. The mean score was significantly higher in male patients (P = 0.041) and those without comorbid chronic disease (P = 0.013). There was a significant negative correlation between the age of hemodialysis patients and the mean hemodialysis comfort score (r = -0.260, P = 0.011). Conclusion: The comfort level was significantly better in hemodialysis patients who were male, those without comorbid disease, and those who were younger. There is a need to periodically assess the comfort level of hemodialysis patients and intervene when necessary in order to improve their quality of life.

Penerapan Senam Intradilitik Pada Pasien Yang Menjalani Hemodialisis Di RS PKU Muhammadiyah Gamping

Hemodialysis is a process of kidney replacement therapy. Decreased muscle strength in patients undergoing hemodialysis is a common problem caused by various factors related to chronic kidney disease and dialysis procedures. One way to treat decreased muscle strength is with intradialytic exercise therapy. Objective: To determine muscle strength after performing intradialytic exercises in hemodialysis patients. Method: The research uses a case study method, namely an individual-targeted nursing care approach. Results: After 3 intradialytic exercise interventions, an increase in muscle strength with handgrip dyanometer measurements of 7.80 and 3.50 was obtained. However, the results of measuring muscle strength using the Schawenker scale method did not show an increase, namely scale 4. Conclusion: Intradilytic exercise carried out in 3 meetings can increase hand muscle strength as measured using a handgrip dynanometer. Intradilytic exercise can be used as an alternative physical exercise during the hemodialysis process.

#655 Warm meal after a haemodialysis session saves the day (and lives?)

Abstract Background and Aims The haemodialysis (HD) process leads to chronic nutrient deficiency, particularly of proteins and amino acids. About 6-12 grams of amino acids loss and 7-8 grams of protein loss occurring during each dialysis session may contribute to hypoalbuminemia, a strong predictor of malnutrition and mortality [1]. Optimal dietary protein intake (DPI) may replenish low plasma amino acids, but DPI inadequacy is a common issue in HD patients, as well as malnutrition due to comorbidities. COVID-19 has made dramatic changes in dialysis centers’ procedures, including the transition from warm meals to cold sandwiches for patients to eat after the session. After the end of COVID-19 pandemic warm meals (meat dish included) were reintroduced. Our aim was to quantify the effect of one to three warm meals per week after the HD session (depending on the regime) on the patients’ protein status. Method Data of 68 patients (24 females and 44 males) on chronic HD were collected after signing the ICF consisting of total protein and albumin values measured two months apart. The first measurement was done while patients were on the long-term sandwich diet after every HD session. The second measurement was done 45 days after the warm meal diet was initiated after every session. Serum total protein and serum albumin were measured, with normal intervals for total serum protein and albumin being 66–81 g/L and 45–51 g/L respectively. The values were compared using Wilcoxon signed-rank test. Results The average albumin value with dry food was 35.9 g/L and for total protein 63.6 g/L, with just 6 patients having normal albumin levels (8.8%) and 21 patients having normal total protein levels (30.9%). The average albumin value after 45 days of HD with warm meals was 39.8 g/L and 66.6 g/L for total protein, with 28 patients having normal albumin levels (41.2%) and 36 patients having normal total protein levels (52.9%). This marks an increase of 4.7% in average value of total protein (3 g/L) and statistically significant increase in albumin value of 10.8% (3.9 g/L, p &amp;lt; 0.001). Greater number of patients had normal total protein and albumin values (4.7 times more patients had a normal albumin level after the initiation of warm meals, and 1.7 times more patients had normal total protein levels). There is a difference regarding male and female patients with a greater impact on males. Male patients had an average total proteins value increase of 5.3% (3.37 g/L) while female patients had 3.5% (2.29 g/L). There was a statistically significant increase in albumin value both for male (p &amp;lt; 0.001) and female patients (p = 0.002). In male patients the average increase was 12% (4.33 g/L), while in female patients it was 8.5% (3.04 g/L). After the introduction of warm meals, 50% of male patients had normal albumin values (vs. 9% before), while 25% of female patients reached normal albumin values (vs. 8.3% before). Conclusion Patients on chronic HD suffer from malnutrition which could lead to significantly higher mortality. Adequate nutrition is crucial for their wellbeing. This study has shown that having a warm meal (protein based) can lead to an increase of total plasma protein and albumin with a higher impact on male patients. In this way we could increase DPI of HD patients, reduce the chance of malnutrition and reduce the cardiovascular risk and mortality.

#705 Survival of expanded hemodialysis and high-flux hemodialysis patients in Colombia: a cohort's study

Abstract Background and Aims Survival is a core outcome of hemodialysis (HD) therapy. Progressive improvement in the permeability and biocompatibility of membranes for HD, dialysis techniques and clinical processes around these therapies have been developed. Recently, expanded hemodialysis (HDx) enabled by the medium cut-off membrane Theranova® has demonstrated encouraging efficacy outcomes in terms of better clearance of medium molecules and better outcomes reported by patients when compared to high-flux hemodialysis membranes (HF HD). The objective of the present study is to compare survival in an HDx cohort versus an HF HD cohort at a 48-month follow-up. Method Cohort study, one group with expanded haemodialysis (HDx) enabled by Theranova® and the other with HF HD, adult prevalent HD patients (&amp;gt; 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. The sociodemographic and clinical characteristics of all patients were summarized descriptively. A Fine-Gray regression model was performed to evaluate the factors associated with time to death from causes other than COVID-19, death attributable to COVID-19 cause is a competing risk. A sensitivity analysis was performed using different statistical methods, such as extended Cox regression and Cox regression, after adjusting for imbalance between the cohorts with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 1092 patients, 533 in HF-HD vs 559 in HDx; the mean age 61 years; 42% had diabetes, and 19% had cardiovascular disease. All patients' sociodemographic and clinical characteristics are summarized descriptively by cohort arm (Table 1). A multivariate analysis was performed to evaluate the effect of demographic, clinical, and laboratory variables on the risk of death, adjusting for the competing risk of death from COVID-19 during four years of follow-up. Our results indicate that the Theranova dialyzer has a protective effect on mortality risk when controlling for confounding variables SHR = 0.75 [95% CI: 0.58 to 0.95, p-value = 0.019] (Table 2). The different sensitivity analyses report a statistically significant beneficial effect of Theranova versus HF dialyzer. See Table 3. Fig. 1 shows a difference in the survival functions according to the type of dialyzer. Conclusion HDx enabled by Theranova dialyzer was associated with an approximately 25% reduction in mortality risk compared to HF HD patients followed for up to 4 years; this effect was consistently observed using different survival analysis methods.

Perbedaan Adekuasi Hemodialisis pada Pasien Akses AV Shunt dan AV Femoral

Adequacy of hemodialysis is the adequacy of the number of hemodialysis processes which is characterized by patients feeling better and comfortable. Hemodialysis access can be done with an Arterio-Venous (AV) shunt will increase blood flow rapidly. Another access to get central venous access can use the femoral AV. The use of hemodialysis access can affect adequacy. The purpose of this study was to determine differences in the adequacy of hemodialysis in patients with AV shunt and AV Femoral access. This research uses quantitative research with comparative descriptive method. Time approach using cross sectional. A sample of 32 people were divided into 2 groups, namely the AV shunt access group and the AV femoral access group. The sampling technique used a purposive sampling technique in accordance with the inclusion and exclusion criteria. Data analysis used independent t-test. The average urea level in hemodialysis patients with AV shunt access was 74.72% and AV femoral access was 67.05%.There was a significant difference in the adequacy of hemodialysis in patients with AV shunt and AV femoral access (pv = 0.013). Cilacap General Hospital is advised to improve its services by opening an AV shunt installation facility and providing education to Chronic Renal Failure (CRF) patients so that patients are motivated to install an AV shunt.

Pengaruh Kombinasi Terapi Foot Massage dan Murottal Alquran terhadap Tingkat Kelelahan Pasien yang Menjalani Hemodialisa

Chronic kidney failure occurs due to a decrease in kidney function, causing an imbalance in the body's metabolism, fluids and electrolytes which can result in uremia. Patients with chronic renal failure must undergo routine hemodialysis therapy. Hemodialysis therapy can cause nursing problems, namely fatigue. Fatigue can be caused by a lack of hemoglobin levels in patients or the length of the hemodialysis process. The research method used in this research is a case report by evaluating the implementation of a combination intervention of foot massage and murottal therapy Surat Ar Rahman. The instrument for measuring fatigue levels uses the FACIT-fatigue scale questionnaire. The results of this study showed that the patient experienced high fatigue with a score of 10.5 and after being given a combination of relaxation intervention of foot massage and murottal Al-Quran therapy, the patient's fatigue level score became 18.2 or moderate fatigue. From these results, it can be concluded that there is an effect of providing a combination of relaxing foot massage and murottal therapy on reducing the level of fatigue in chronic kidney failure patients undergoing hemodialysis.

Subjectivity study on health conservation of elderly hemodialysis patients

BackgroundHealth conservation enables elderly hemodialysis patients to maintain a positive state of well-being while undergoing treatment and maintenance of disease. This study was to identify the type of perceptions on health conservation of elderly hemodialysis patients and compare the characteristics of perceptions.MethodsThis study used an exploratory study design applying Q methodology, which is designed to research subjectivity. The study determined a population of subjective statements, the concourse, based on the preceding literature and interviews with twenty-five elderly patients over 65 years of age with hemodialysis. We chose a total of 50 statements considered to be representative of the concourse for the Q-sample. The study selected 50 elderly patients over 65 years of age with hemodialysis as the P-set. The participants provided their internal viewpoints by sorting the Q-sample items into a grid. The researchers performed an analysis using PC-QUANL program. Data were collected from June to November, 2019.ResultsType I, ‘support system-based effort’ focused on one’s own effort, positive and proactive attitude, family support, medical instructions, information, and medications. Type II, ‘skeptical life maintaining’ expressed a pessimistic future without hope, strongly negative perception on preserving health, and thus minimal effort and motivation to continue life. Type III, ‘treatment process interest’ is based on an interest in the hemodialysis process; for them, it is important to follow medical staff’s instructions, take regular medications precisely, pay attention to the results of regular monthly blood tests, and control their health. Type IV, ‘positive effort’ accepts hemodialysis positively, lives with hemodialysis, and carries out all daily life activities.ConclusionIn nursing practice, nurses need to pay attention to the perceptions on health conservation of elderly hemodialysis patients. This study can be implied as the evidence of nursing practice based on the perception on health conservation of elderly hemodialysis patients.

Quality of Life of Chronic Renal Failure Patients Undergoing Hemodialysis During Post Covid 19 Pandemic

Chronic Kidney Disease (CKD) is one of the most involved diseases of the urinary system, which is becoming a serious public health problem among the world's population characterized by high prevalence, mortality, and health costs. CKD is defined as a progressive abnormality of kidney structure and/or function for more than three months followed by health implications. It can be determined using the glomerular filtration rate, which is used to classify the severity of the disease. The majority of patients with stage 4 and all stage 5 require renal replacement therapy to maintain their quality of life, including hemodialysis (HD). Hemodialysis (HD) is a procedure in which a dialysis machine and a special filter called an artificial kidney, or dialyzer are used to clean the patient's blood, which can improve the patient's quality of life. Basically, the hemodialysis process carried out by CKD patients is able to increase serum creatinine, albumin, and pre-albumin, then also able to normalize the catabolic rate of protein and increase the food intake of CKD patients. However, most previous studies have found that the hemodialysis process can increase the prevalence of malnutrition and reduce the quality of life of patients. This study aims to determine the picture of the quality of life of CKD patients undergoing hemodialysis during the post-COVID 19 pandemic period. Data collection of this study was carried out in the Hemodialysis room of Arifin Achmad Hospital Pekanbaru, with a total of 65 samples with the criteria of patients undergoing regular HD at least 2 times a week. Data analysis in this study using univariate for demographic data and quality of life picture of chronic kidney failure patients. The results showed that the majority of respondents were male as many as 37 people (56.9%), almost all of them were married as many as 62 respondents (95.4%), the majority had high school education as many as 41 respondents (63.1%), almost half were not working, namely as many as 29 respondents (44.6%), and the majority aged 51-60 years as many as 30 respondents (46.2%). While the picture of quality of life 2 shows that the majority of respondents have a good quality of life, namely 33 respondents (50.8%). Based on the results of this study, it is hoped that families can play an important role in providing support and motivation during hemodialysis therapy so as to increase expectations and higher quality of life for patients

Gambaran Kepatuhan Pasien dengan Penyakit Ginjal Kronis dalam Menjalani Hemodialisis di RSUD Prof.Dr.W.Z. Johanes

Hemodialysis is a tool that patients with chronic kidney disease (CKD) need to replace damaged kidney function. Compliance with hemodialysis plays an important role in the patient's health condition. Since 2021, the number of hemodialysis patients at RSUD Prof.DR.W.Z. Johanes, from 108 patients to around 85 patients remaining in 2022. This study aims to provide an overview of CKD patients' compliance in undergoing hemodialysis at RSUD Prof.DR.W.Z. John. This type of research is qualitative with a case study approach. Eight key informants and two supporting informants using purposive sampling. The research results showed that generally, hemodialysis compliance among informants was good. Predisposing factors, knowledge about hemodialysis and its risks, motivation to comply with hemodialysis such as the hope of health, not wanting to give up, want to work, and also the desire to still live with the family as well as belief in the benefits of hemodialysis encouraging informants to be more compliant. Supporting factors such as completeness of facilities and affordability of access to services encourage more optimal hemodialysis. Reinforcing factors such as emotional, instrumental, and information support provided by family and health workers increase informants' compliance with hemodialysis. Hemodialysis units can improve and maintain the quality of hemodialysis facilities and services. Existing health workers can increase patient knowledge and motivation by maintaining positive communication during the hemodialysis process. The family can be a positive companion for the fulfillment of hemodialysis patients. Hemodialysis patients must maintain and improve their physical and mental condition.

Investigation of APE1 and OGG1 expression in chronic hemodialysis patients.

The role of DNA repair mechanisms is of significant importance in diseases characterized by elevated oxidative DNA damage, such as chronic kidney disease. It is imperative to thoroughly understand the functions of molecules associated with DNA repair mechanisms, not only for assessing susceptibility to diseases but also for monitoring disease progression. In this research, we investigated the APE1 and OGG1 gene expression levels, both of which are involved in the base excision repair (BER) mechanism in chronic hemodialysis patients with malignancy (HPM; n = 8) and without malignancy (HP; n = 36) in pre- and post-dialysis period and 37 healty persons. We also assessed how these values correlate with the clinical profiles of the patients. We conducted gene expression analysis using real-time polymerase chain reaction (qRT-PCR). No significant differences in APE1 gene expression levels were observed in pre-dialysis when comparing the HP and HPM groups to the control group. The expression levels of the OGG1 gene were significantly lower in both the HP and HPM groups in pre- and post-dialysis periods compared to the control group. Dialysis procedures led to a reduction in APE1 and OGG1 gene expression levels in both HP and HPM groups. The findings of our study elucidate the impact of alterations in the base excision repair (BER) mechanism, including the hemodialysis process, in end-stage renal disease (ESRD).

Arduino microcontroller based real-time monitoring of haemodialysis process for patients with kidney disease

The efficient and precise monitoring of the haemodialysis process is critical for the well-being of patients suffering from end-stage renal disease (ESRD). In this work, a comprehensive study on the utilization of Arduino microcontroller-based systems for real-time monitoring, data acquisition and control of the haemodialysis process is presented. Arduino instrumentation unit was developed for an in vitro Haemodialysis (HD) system using Atmega 328 and Arduino nano microcontrollers. Haemodialysis process was conducted using in vitro haemodialysis system. Temperature probes (model DS18B20), conductivity probes (model EC-PPM-TDS) and weight sensor (load cell type HX711, 10 kg max stain gauge type) were used for real-time measuring and monitoring blood and dialysate temperatures, conductivities, and blood weight respectively. Simulink interface embedded in MATLAB software R.2019 was used as microcontroller software interface. In vitro HD result of the real-time monitoring indicated that initial and final measurement for blood temperatures gave 32.8 – 36.5 °C at set dialysate temperature 37 °C respectively, blood and dialysate conductivity 2 - 3.5 mS/cm and intradialytic blood weight 187.5 g – 147.5 g. This paper offers valuable insights into the implementation of Arduino microcontrollers for real-time monitoring of the haemodialysis process, with a strong emphasis on patient safety, data generation and data security. The research presented contributes to the advancement of technology in the field of nephrology and has the potential to significantly impact the quality of life for ESRD patients undergoing haemodialysis.

The Haemodialysis Session Effect on the Choroidal Thickness and Retinal and Choroidal Microcirculation-A Literature Review.

Haemodialysis (HD) is currently the most commonly used method of renal replacement therapy. The process of dialysis involves numerous changes that affect many systems, including the eye. The changes occurring in the course of HD may affect the ocular parameters, such as intraocular pressure, central corneal thickness, retinal thickness, retinal nerve fibre layer thickness, and choroidal thickness (CT). The choroid, being one of the most vascularized tissues, is characterized by the highest ratio of blood flow to tissue volume in the entire body, may be particularly susceptible to changes occurring during HD, and at the same time reflect the microcirculatory status and its response to HD. Patients with end-stage renal disease subjected to dialysis are highly susceptible to systemic microvascular dysfunction. Moreover, it is considered that the process of HD itself contributes to vascular dysfunction. Nowadays, thanks to the development of imaging techniques, the widely available optical coherence tomography (OCT) tests allow for the assessment of CT, while OCT-angiography allows for a quick, non-invasive, and repeatable assessment of the condition of retinal and choroidal microcirculation, which significantly expands our knowledge regarding the reaction of ocular microcirculation due to HD. The assessment of both retinal and choroidal circulation is even more attractive because retinal circulation is autoregulated, while choroidal circulation is mainly controlled by extrinsic autonomic innervation. Thus, assessment of the choroidal response to an HD session may provide the possibility to indirectly evaluate the functions of the autonomic system in patients subjected to HD. At a time when the importance of microcirculation in systemic and renal diseases is becoming increasingly evident, the assessment of ocular microcirculation appears to be a potential biomarker for assessing the condition of systemic microcirculation. In this work, we present a review of the literature on the effect of the HD session on CT and the retinal and choroidal microcirculation.

ASUHAN KEPERAWATAN PADA PASIEN GAGAL GINJAL KRONIK DENGAN HEMODIALISA MELALUI TINDAKAN KOMPRES DINGIN PADA AV SHUNT

Hemodialysis is an intervention designed to assist patients in managing fluid and electrolyte metabolism. The hemodialysis process involves puncturing the arteriovenous (AV) shunt area to facilitate dialysis. The repeated punctures in this area can result in pain. Research Objective: To provide an overview of nursing care for chronic kidney failure patients undergoing hemodialysis through the use of cold compresses on the AV shunt site. Method: This study is a case study with a medical-surgical nursing care approach. The research was conducted from February to March 2023 on two chronic kidney failure patients undergoing hemodialysis. Results and Discussion: After the intervention of applying cold compresses to patients I and II, a reduction in pain scale was observed. For patient I, the pain scale decreased from 6 (0-10) before the intervention to 3 (0-10) after the intervention. For patient II, the pain scale decreased from 5 (0-10) to 3 (0-10) after the intervention. Conclusion and Recommendations: Cold compresses can effectively reduce pain at the AV shunt puncture site in hemodialysis patients. Therefore, it is recommended to incorporate cold compress interventions for patients undergoing hemodialysis.

Gambaran Kecemasan Pasien Gagal Ginjal Kronik yang Menjalani Hemodialisa di Rumah Sakit Santa Elisabeth Medan Tahun 2023

Background: Chronic renal failure is the presence of progressive kidney damage in the human body characterized by uremia (urea in other wastes circulating in the blood and its complications. Hemodialysis is a high-tech substitute for removing metabolic waste from human blood circulation such as water, sodium, potassium, hydrogen, urea, creatinine, uric acid, and other substances through a semi-membrane Permeable as a separator of blood and dialysate fluid in artificial kidneys where diffusion, osmosis and ultra filtration processes occur. Proses hemodialysis 1-3 times a week and each time takes 2-5 hours, this activity will continue 3-4 hours per therapy. Anxiety in hemodialysis patients arises because during the hemodialysis process they see tubes that are fed by blood entering the body, they also have to pay costs when undergoing hemodialysis, and uncertainty about recovery. Objective: To find out the anxiety picture of chronic kidney failure patients undergoing hemodialysis at Santa Elisabeth Medan Hospital 2023. Methods: To find out the anxiety picture of chronic kidney failure patients undergoing hemodialysis at Santa Elisabeth Medan Hospital 2023. Method: This study is a descriptive research. Sampling using Total Sampling technique amounting to 40 respondents. The research instrument uses Zung Self Rating Scale (ZSAS) questionnaire. Results: The results of this study found that the anxiety of chronic kidney failure patients undergoing hemodialysis at the Santa Elisabeth Hospital in Medan in 2023 mostly experienced mild anxiety as much as 50.0%, moderate anxiety as much as 40.0% and severe anxiety as much as 7.5% and panic as much as 2.5%. Conclusion: This researcher illustrates that the anxiety level of patients with chronic kidney failure undergoing hemodialysis is influenced by characteristics such as age, type of health, and education.

Analysis of Energy and Protein Intake with Nutritional Status of Chronic Kidney Failure Patients with Hemodialysis at Harapan and Doa Regional Hospital, Bengkulu City

Background:Chronic kidney disease is a global public health priority that continues to grow and is associated with high morbidity rates and is the third fastest growing cause of death in the world and the fifth leading cause of death. Malnutrition often occurs in end-stage renal disease patients undergoing hemodialysis (HD). Malnutrition is caused by catabolic events during the hemodialysis process. Objective: The aim of the study was to analyze energy intake, protein and nutritional status of chronic kidney failure patients on hemodialysis at Harapan and Doa Regional Hospital, Bengkulu City. Materials/Methods: Explanatory research type, with a cross sectional approach. The study population was all chronic kidney failure sufferers who underwent hemodialysis at Harapan and Doa Hospital, Bengkulu City in June-July 2023. Data were collected by interviews and anthropometric measurements, 3x24 hour recall forms and SGA forms and from patient medical records. Data processing was carried out using univariate tests. Result:This study shows that 98% of respondents' energy intake before hemodialysis had insufficient energy intake (&lt; 80%) and 2% had sufficient energy intake (80), protein intake before hemodialysis 92% protein intake is less (&lt; 80%) during hemodialysis and after hemodialysis 85% with less protein intake (&lt; 80%), nutritional status of chronic kidney failure patients with hemodialysis good nutritional status (SGA score A), namely (54%) lack of protein intake, poor/moderate nutritional status (SGA B score), namely (43%), poor nutritional status (SGA C score), namely (3%). Conclusion:The conclusion of this study is that energy intake, protein and nutritional status in chronic kidney failure patients on hemodialysis are still lacking. Therefore, increasing intake needs to be done by paying attention to the patient's nutritional status