Jurnal Farmasi Indonesia: Volume 12 Nomor 2 (2020)

Assessment of Health-Related Quality of Life with Patient

Chronic Kidney Disease
Fajriansyah1*, Mujriah1, Zulfahmidah2
Abstract: Measuring the quality of life can be used as a reference for the success
Artikel of an action or therapy as well as initial data in formulating the right action for
the patient. This study aims to provide an overview of the quality of life of patients
Penelitian with chronic renal failure who seek treatment at the Hasanuddin University
hospital. The research design used was an observational cross-sectional design
with data collection carried out by filling out a questionnaire prospectively. The
subjects of the study were chronic renal failure patients undergoing hemodialysis
1Sekolah Tinggi ilmu Farmasi, who met the inclusion criteria and were selected using a non-random sampling
Makassar, Sulawesi Selatan technique by means of total sampling. The patient's quality of life was measured
2Fakultas Kedokteran
using the Kidney Disease Quality of Life Short Form (KDQOL-SF™) Indonesian
Universitas Muslim Indonesia, version 1.3 questionnaire. A total of 30 patients were willing to participate in this
Makassar, Sulawesi Selatan study. The results of the study on 30 patients with chronic renal failure, there were
7 out of 19 scale/item having a not good, namely burden of kidney disease, work
status, sleep, physical functioning, role-physical, pain, and general health. The
Korespondensi: average value of 19 scale/item shows an average score of> 59.37, which is 63.86
which belongs to the good quality of life category.
Fajriansyah
[Link]@[Link] Keywords: health related quality of life, chronic kidney disease, KDQoL

Introduction (HD) is a kidney replacement therapy that uses a

special tool with the aim of removing uremic
The prevalence of Chronic Kidney Disease
toxins and regulating body electrolyte fluids
(CKD) is increasing globally, though regional
(KEMENKES RI, 2010). In Indonesia,
disparities exist. It is increasing worldwide at an
hemodialysis is performed 3 times a week with a
annual growth rate of 8% [1]. Epidemiologic
duration of 4-5 hours of dialysis. [3]. Another
studies have shown that the incidence of kidney
problem that a patient has to deal with is like a
diseases is higher in the developing countries
problem financial problems, difficulty keeping a
than in the developed world. Based on the results
job, missing sexual mistakes, depression, and fear
of the Basic Health Research (RISKESDAS) of the
of death. A planned lifestyle relates to therapeutic
Ministry of Health of the Republic of Indonesia in
hemodialysis therapy (eg implementation of
2013, the prevalence of chronic kidney failure
hemodialysis therapy 2-3 times a week for 3-4
based on a doctor's diagnosis in Indonesia is hours) and keeps the fluid of the fluid taking the
0.2%. The highest prevalence was in Central
spirit alive patient. This will affect the quality of
Sulawesi at 0.5%, followed by Aceh, Gorontalo,
life of CKD patients [4].
and North Sulawesi with 0.4% each. Meanwhile
East Nusa Tenggara, South Sulawesi, Lampung, Quality of life becomes an important measure
West Java, Central Java, DI Yogyakarta, and East after patients undergo renal replacement therapy
Java each had 0.3%. North Sumatra Province at such as hemodialysis or a kidney transplant. The
0.2% [2]. quality of life of patients undergoing hemodialysis
is decreasing because the patient not only faces
Chronic kidney disease (CKD) causes sufferers
health problems associated with chronic kidney
to be unable to get rid of body fluids and results
disease but is also associated with lifelong
from the rest of the body's metabolism. If CKD is
therapy, as a result, the quality of life for patients
too severe, then the patient must undergo
undergoing hemodialysis is lower than the
hemodialysis therapy (dialysis) at least twice a average individual. HD therapy will also affect the
week (Suhardjono et al., 2001). Hemodialysis
patient's psychological state. Patients will
Fajriansyah et al “Assesment of Health-Related Quality ………………” 203
 Jurnal Farmasi Indonesia: Volume 12 Nomor 2 (2020)

experience disturbances in thinking and 2-3 times a week, aged 20-64 years, willing to
concentration processes as well as disturbances participate in the study by signing an informed
in social relations. All of these conditions will consent form. The exclusion criteria in this study
cause a decrease in the quality of life of CKD were that the patient control schedule was not
patients who undergo HD therapy [5]. In fixed, the patient's medical record data was
particular, patients will experience physical incomplete and the patient was unconscious.
suffering, limitations in daily activities [5].
Materials and data sources used in this study
In addition, quality of life measurement can are primary data obtained by filling out
also be a reference for an action/intervention or questionnaires by patients and secondary data
therapy. In addition, data on quality of life can also obtained from patient medical records. The data
be preliminary data for consideration of collection process was carried out by
formulating appropriate interventions/actions interviewing patients and using a tool in the form
for patients [6]. There are several questionnaires of a questionnaire filled out by patients who were
used to measure the quality of life, one of which is willing to become respondents. The research
the Kidney Disease Quality of Life Short Form tools used were the informed consent sheet, the
(KDQOL-SF™) questionnaire which has been patient's personal datasheet, and Kidney Disease
recognized for its benefits in the medical world. Quality of Life Short Form (KDQOL-SF™)
KDQOL SF is a measure of the overall quality of life Indonesian version 1.3 questionnaire. The
of patients with renal failure both physically, collected data is processed by checking the
mentally, and socially [7]. completeness of the data, then the analysis of the
answers to the questionnaire consisting of 24
Hasanuddin University Hospital, which is one
questions is given a score, then the score is
of the health service facilities as a place of referral
converted into numbers 0-100. Assessment of
for chronic kidney failure patients and provides
quality of life, in general, is an average of all
hemodialysis services. Based on the results of the
aspects and is interpreted according to a scale:
initial survey conducted at the Hasanuddin
Quality of life is good (mean score of 19 scale
University Hospital, it was stated that the number
KDQOL-SF 1.3> 59.37), and quality of life is poor
of patients undergoing hemodialysis in October
(mean score of 19 scale KDQOL -SF 1.3 ≤ 59.37).
2017 was 48 patients. This study aims to see an
overview of the quality of life of patients with Result and Discussion
kidney failure who seek treatment at Hasanuddin
A total of 30 patients who met the inclusion
University Hospital using a kidney disease-
criteria were willing to participate in this study.
specific tool (Kidney Disease Quality of Life
Patient sociodemographic data can be seen in
(KDQOL-SF™).
Table 1.
Methods
Gender was suggested as a non-modifiable
The design of this study was an observational predictor of the risk of initiation and progression
cross-sectional design with data collection of chronic kidney disease. The incidence of
carried out by filling out a questionnaire terminal renal failure has been reported to be
prospectively. This research has been submitted greater in men. Female gender was associated
to the Health Research Ethics Committee of the with slower progression of chronic kidney
Faculty of Medicine, Muslim University of disease, better kidney protection, and better
Indonesia, and has been approved with the ethical patient clinical outcome [8]. Increasing a person's
approval recommendation number 996 / KEPK- age has an impact on decreasing body functions
UMI / XI / 2017. so that they are more susceptible to disease.
Increasing patient age is also related to the
The subjects in this study were chronic renal
prognosis of a disease and life expectancy.
failure patients undergoing hemodialysis who
Patients over 55 years of age are more likely to
met the inclusion criteria and were selected using
develop complications that can aggravate kidney
nonrandom sampling techniques by means of
function to work compared to patients under 40
total sampling. The inclusion criteria in this study
years of age.
were: patients undergoing routine hemodialysis

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 Jurnal Farmasi Indonesia: Volume 12 Nomor 2 (2020)

Table 1. Sociodemographic characteristics

Characteristics n Percentage (%) (%)
Gender
Female 10 33,33
Male 20 66,67
Age
18 – 44 years 14 46,67
45 – 64 years 16 53,33
Level of last education
Elementary school 2 6,67
Junior and high school 13 43,33
University 15 50
Occupation
Not working/retired 13 43,33
Working 17 56,67
Long suffered
≤8 months 5 16,67
>8 months 25 83,33

This is in accordance with research conducted score of 7 scale (item) indicates that the category
by Gweon et all (2019) which shows that the not good quality of life. 7 scale (item) show poor
majority of respondents are from college, the quality categories, namely burden of kidney
higher the level of education of a person, the disease, work status, sleep, physical functioning,
awareness of the importance of health and role-physical, pain, and general health.
treatment of the health problems they face will
Category not good quality of life was also
also be more likely to think positively [9]. The
shown in sleep quality and sexual dysfunction.
latest education status also affects the economic
CKD patients in this study experienced sleep
and social resources achieved, so that a paradigm
disturbances at night. Changes in the fulfillment of
appears that a low level of education results in an
needs for rest and sleep experienced by
individual having low knowledge of their own
hemodialysis patients. Sleep cannot be fulfilled
health and increases the risk of chronic kidney
due to a reason, namely, discomfort, restlessness
disease [7]. Patient characteristics based on the
during sleep and not knowing what feelings cause
length of time undergoing hemodialysis were
him to not sleep. Sexual dysfunction as a result of
classified as less than 8 months and 8 months or
conditions that are not possible for strength and
more, which refers to the study of Anees, et al
body condition is not healthy. In hemodialysis
(2011) [10]. The results of the long-suffering
patients who experience sexual dysfunction
characteristics> 8 months were 25 patients
disorders, sexual dysfunction occurs in end-stage
(83.33%) and <8 months were 5 patients
renal failure patients with hemodialysis, these
(16.67%). The results of measuring the quality of
patients generally receive antidepressant
life in this study can be seen in Table 2.
therapy, where these drugs can have the effect of
Our study shows a clear decrement in quality reducing libido and ejaculation in men [14].
of life associated with CKD. The finding is
According to Gonçalves et all (2015), the scale
consistent with previous studies that focused on
(item) of not good quality of life is also shown in
those with established disease regardless of the
the role / emotional limitations, in addition to
instruments used to measure quality of life [11-
being anxious because of the amount of time
13]. In Table 2 it shows the total mean final score
being reduced, shortening the time for work and
of 12 scale (item) of quality of life for CKD patients
activities, also not being as careful/thorough in
in Hasanuddin University hospital showing that
completing their work as before [15].
the category of good quality of life and the final

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 Jurnal Farmasi Indonesia: Volume 12 Nomor 2 (2020)

Table 2. Quality of life measurement results

Scale (item) Average±SD Category

Symptoms 71,78 ± 10,17 Good
Effects of kidney disease 68,33 ± 10,24 Good
Burden of kidney disease 59,21 ±17,53 Not good
Work status 59,21 ± 28,33 Not good
Cognitive function 73,56 ± 17,55 Good
Quality of social interaction 78,39 ±10,45 Good
Sexual function 62,00 ± 25,37 Good
Sleep 59,36 ± 12,00 Not good
Social support 66,67 ± 10,72 Good
Dialysis staff encouragement 82,92 ± 10,63 Good
Patient satisfaction 80,56 ± 12,44 Good
Physical functioning 58,00 ±18,32 Not good
Role-physical 27,50 ± 25,72 Not good
Pain 57,92 ± 15,33 Not good
General health 52,40 ± 10,93 Not good
Emotional well-being 61,11 ± 24,89 Good
Role-emotional 72,27 ± 8,72 Good
Social function 71,33 ± 20,51 Good
Energy/fatigue 61,67 ± 10,93 Good
Average 63,86

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