Jurnal Ilmiah Farmako Bahari

Journal Homepage : https://journal.uniga.ac.id/index.php/JFB

HEALTH RELATED QUALITY OF LIFE (HRQoL) IN CHRONIC

KIDNEY FAILURE PATIENTS AT ARIFIN AHMAD REGIONAL
GENERAL HOSPITAL RIAU PROVINCE

Rickha Octavia, Seftika Sari*, Fitriatun Nisa

Sekolah Tinggi Ilmu Farmasi Riau, Jl. Kamboja, Simpang Baru, Kec. Tampan,
Kota Pekanbaru, Riau 28289, Indonesia
*Corresponding author: Seftika Sari (seftikasari@stifar-riau.ac.id)

ARTICLE HISTORY
Received: 30 October 2023 Revised: 8 January 2024 Accepted: 19 January 2024

Abstract
After tuberculosis, the illness with the highest death rate is chronic kidney failure. Renal
function declines in patients with chronic kidney failure until, eventually, they are unable
to filter and eliminate the body's electrolytes at all. Metrics about quality of life are
necessary because the patient's health will suffer if medical therapy fails. This research
aims to determine the description of health-related quality of life (HRQoL) in chronic
kidney failure patients at the Arifin Achmad Regional General Hospital, Riau Province.
The samples used in this study were chronic kidney failure patients who underwent
treatment at the Arifin Achmad Regional General Hospital, Riau Province, in the period
January-December 2022 and met the inclusion and exclusion criteria. This study is
observational and descriptive. Non-probability sampling was employed to select 74
participants for the study. Based on the results of research that has been carried out
regarding the description of health-related quality of life (HRQoL) in patients with chronic
kidney failure at the Arifin Achmad Regional General Hospital, Riau Province, it was
found that chronic kidney failure has an impact on the quality of life in health with an
average utility value of EQ-5D -5L and VAS namely 0.6235 and 0.7177. Anxiety or
depression (40.5%) and pain or discomfort (52.7%) were the most commonly reported
health issues.

Keywords: chronic kidney failure,EQ-5D-5L, EQ-VAS,health-related quality of life

Introduction
The illness known as chronic kidney failure causes the kidneys to lose all function
until they are incapable of producing urine, maintaining the proper balance of bodily
chemicals and fluids in the blood, or filtering and excreting the body's electrolytes. These
complications occur in the chronic kidney failure phase and require medical therapy.
Patients with chronic kidney failure must be heavily dependent on therapy for the
remainder of their lives, as not doing so could seriously harm their health and possibly
result in death.1
According to data from Basic Health Research, 31.7% of Indonesians had chronic
kidney failure in 2018. The highest prevalence of chronic kidney failure occurred in North
Kalimantan Province, reaching 0.64%, followed by North Maluku Province, reaching
0.56%, and third place was occupied by North Sumatra Province, reaching 0.53%. In
Riau Province, chronic kidney failure reached 0.26%.2

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The illness known as chronic kidney failure causes the kidneys to function less and
less until they are completely incapable of filtering blood and producing urine. These
issues arise during the stage of chronic kidney failure and call for medical intervention.
Patients with chronic kidney failure must be heavily dependent on therapy for the
remainder of their lives, as not doing so could seriously harm their health and possibly
result in death.1
In chronic kidney failure, one of the therapies needed is kidney replacement
therapy. The impact of decreased kidney function means that urine cannot be produced
and excreted, toxins will accumulate, blood pressure cannot be controlled, and fluid
balance is disturbed, which can cause the body to become swollen, short of breath, and
experience anemia. Kidney replacement therapy that can be performed on patients with
chronic kidney failure is hemodialysis therapy, peritoneal dialysis, and kidney
transplantation. The therapy most often chosen by patients is hemodialysis therapy
because the cost is relatively more affordable than others. Hemodialysis therapy is only
limited to maintaining patient survival but not to cure chronic kidney failure. This can have
an impact on the patient's quality of life.3
Health-Related Quality of Life (HRQoL) is defined as a person's perception
regarding their health, which concerns physical, spiritual, and social function and their
role in society. An individual who can carry out their functions and roles in daily life well
is someone with a good quality of life.4
Based on the research results of measuring the quality of life of patients using the
WHOQOL-BREF questionnaire scores obtained from several variables, namely, in the
age variable, the majority of patients are aged 46-65 (62.2%), and the majority are male.5
As many as (62.2%), with the majority of hemodialysis duration <12 months (42.2%).
The description of the quality of life of patients is that (37.8%) have poor quality of life in
the health domain, (13.3%) have poor quality of life in the psychological domain, (31.1%)
have poor quality of life in the social relations domain and (13.3%) had poor quality of
life in the environmental domain.
The results of research conducted by Siwi6 with the percentage of quality of life of
chronic kidney failure patients with good and bad scores, seen in terms of the physical
health dimension, namely patients who experience poor physical health 56.1% and those
who experience good physical health 43.9%. The psychological health dimension of
patients in poor condition was 58.5%, while in good condition, it was 41.5%. The social
relationship dimension of patients in poor condition was 48.8%, while in good condition,
it was 51.2%. The quality of life dimension of patients in poor condition was 61%, while
in good condition, it was 39%.
EuroQOL-5 Dimension (EQ-5D) is a simple, generic method. It has been validated
in various countries such as Nice (United Kingdom) and Hitap (Thailand) as a method
for measuring health status.7 This study uses the EQ-5D-5L questionnaire, which is used
as a method to measure patient quality of life. The EQ-5D-5L questionnaire is a valid
instrument and has an Indonesian value set.8
Several studies on quality of life in health (HRQoL) in patients with chronic kidney
failure have been carried out in Indonesia. The score obtained for each EQ-5D-5L utility
was 0.673, and that for EQ-VAS was 71.4. The most frequently reported problem in
patients with chronic renal failure is pain or discomfort (38%), followed by activities that
can be done (29%), and then anxiety or depression (22%). This proves that chronic
kidney failure has a significant impact on reducing the patient's quality of life.9
The characteristics of each influence the differences in quality of life. One
characteristic that influences quality of life is age. Research conducted by Firmansyah10
Chronic kidney failure cases often occurs at the age of 41-50 years with several 30%.
This is following research conducted by Badariah et al.11 where the most cases of chronic
kidney failure occur in the 41-50 year age range with 30%.

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This research was conducted at the Arifin Achmad Regional General Hospital
(RSUD), Riau Province. In Riau Province, especially at Arifin Achmad Regional Hospital,
quality of life measurements have never been carried out using the EQ-5D questionnaire,
which consists of the EQ-5D-5L and EQ-VAS. In initial observations, chronic kidney
failure is the 7th most common inpatient disease and the 6th most common outpatient
disease in 2022 at the Arifin Achmad Regional General Hospital. In 2022, data was
obtained from January to December for 280 patients with chronic kidney failure. Thus,
based on this description, researchers at the Arifin Achmad Regional General Hospital
in the Province of Riau were interested in studying the health-related quality of life
(HRQoL) of patients with chronic kidney failure.

Materials
The population in this study were patients with chronic kidney failure who
underwent treatment at the Arifin Ahmad Regional General Hospital, Riau Province, from
January to December 2022. The sample chosen for this study was patients with chronic
kidney failure at the Arifin Achmad Regional General Hospital Riau Province period from
January to December 2022 with a sampling method, non-probability sampling using a
purposive sampling technique, and a sample of 74 respondents was obtained. The
inclusion criteria in this study were respondents willing to be research subjects,
respondents who were at least 18 years old, and respondents who could read and write.
The exclusion criteria in this study were respondents whose medical record data was
incomplete and respondents whose questionnaire data was incomplete. Data collection
in this research was through primary and secondary data. Primary data in this research
is obtained from research questionnaires, while secondary data is medical record data.
Primary data collection was carried out using a questionnaire given directly to
respondents. The instruments used in this research were the consent form to become a
respondent and the Indonesian version of the EQ-5D-5L and EQ-VAS questionnaires,
measured using the value set of Purba, and this questionnaire has been validated
throughout Indonesia.8 In the EQ-5D-5L questionnaire, there are five domains, namely,
ability to walk or move, self-care, usual activities, pain or discomfort, and anxiety or
depression. Each of these dimensions has a question: a value or score. There are five
categories of response levels in each domain, namely: no problem, a little problem, quite
problematic, very problematic, and very, very problematic.8

Methods
This research is descriptive observational research. Data analysis uses univariate
analysis, which aims to explain or describe the characteristics of each research variable.
The variables whose descriptions will be looked at in this research are age, gender,
education level, employment status, and length of suffering.
Result

Respondent Characteristics

Table 1. Distribution of Research Respondent Characteristics

No Respondent Characteristics n = 74 %
Early Adulthood (18-40 years) 19 25,7
1. Age Middle Adult (41-60 years) 43 58,1
Older Adults (>60 years) 12 16,2
2. Gender Male 40 54,1

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Table 1. (Extension)
No Respondent Characteristics n = 74 %
Female 34 45,9
Lower Education (Primary School and 29 39,2
Level
3. Middle School)
Education
Higher Education (High School and College) 45 60,8
Doesn't work 40 54,1
4. Job-status
Work 34 45,9
Long < 1 year 22 29,7
5.
Suffering > 1 year 52 70,3

Health-Related Quality of Life (HRQoL) in Chronic Kidney Failure Patients

Table 2. Frequency of Respondents in Each EQ-5D-5L Domain

Levels Dimensi n = 74 %
Walking Ability
1 No problems with walking ability 45 60,8
2 Slight problems with walking ability 17 23
3 Quite problematic in the ability to walk 7 9,4
4 Very problematic in the ability to walk 2 2,7
5 Very, very problematic in the ability to walk 3 4,1
Self-care
1 No problems with self-care 51 68,9
2 Some problems with self-care 14 18,9
3 Quite problematic in self-care 4 5,4
4 Very problematic in self-care 2 2,7
5 Very very problematic in self-care 3 4,1
Commonly Performed Activities
1 No problems with usual activities 26 35,1
2 Slight problems in usual activities 29 39,2
3 Quite problematic in usual activities 11 14,9
4 Very problematic in usual activities 4 5,4
5 Very very problematic in normal activities 4 5,4
Done
Pain or discomfort
1 No problems with pain or discomfort 16 21,6
2 Slight problems with pain or discomfort 39 52,7
3 Quite problematic in terms of pain or discomfort 15 20,3
4 Very problematic in pain or discomfort 2 2,7
5 It matters whether you feel pain or not 2 2,7
comfortable
Anxiety or Depression
1 No problems with anxiety or depression 26 35,1
2 Slight problems with anxiety or depression 30 40,5
3 Quite problematic to feel anxious or depressed 10 13,5
4 Very problematic in feeling anxious or depressed 6 8,2
5 Very problematic feelings of anxiety or depression 2 2,7

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Utility Value in Chronic Renal Failure Patients

Table 3. Utility Value in Patients with Chronic Renal Failure

Utilitas Mean Standard Median Minimum-Maksimum
Deviasi
EQ-5D-5L 0,6235 0,3870 0,745 -0,865-1
EQ-VAS 0,7177 0,1601 0,715 0,3-0,99

Discussion

Respondent Characteristics

Analysis Based on Age Range

In terms of age characteristics, the middle adult group (41-60 years) is the largest
age group that experiences chronic kidney failure with a total of 43 patients (58.1%),
followed by early adults (18-40 years) with a total of 19 patients (25.7 %), then the elderly
group (>60 years) with a total of 12 patients (16.2%). These results are supported by
research at the same location, namely Arifin Achmad Regional Hospital. Based on
Sambiring, where the highest frequency of chronic kidney failure patients was aged 45-
60 years, at 74%.12
Based on the description above, it is known that chronic kidney failure often occurs
in the 41-60-year age group. This can be caused by the aging process, which causes
changes in kidney structure with a decrease in overall kidney mass due to changes in
kidney structure. Microscopically, changes occur due to a decrease in the Glomerular
Filtration Rate (GFR) by 50% from normal, as well as a decrease in the glomerular
filtration rate of the nephron.13 Furthermore, a decline in kidney function may worsen the
kidneys' condition. As a result, the ability of the kidney tubules to reabsorb and
concentrate urine decreases, and metabolic syndromes such as hypertension,
hyperglycemia, and hyperuricemia are experienced.14
The second highest incidence of chronic kidney failure occurs in the early adult
age group (18-40 years). This is due to an unhealthy lifestyle, so at a young age, many
people suffer from chronic kidney failure. The main factors in the occurrence of chronic
kidney failure at a young age are a lack of maintaining a healthy diet such as consuming
fruit and vegetables, rarely exercising, and bad habits of smoking and alcohol.15
Based on age level, the age group (>60 years) is more susceptible to chronic
kidney failure than the age group (41-60 years). However, many patients aged (>60
years) have died due to low life expectancy. They can no longer carry out physical
activities that provide extra energy for daily activities, improve sleep quality, strengthen
muscles, reduce stress, and improve mental health. Chronic kidney failure patients also
depend on medical therapy. In patients who undergo kidney transplantation, kidney
health, and life expectancy will improve better than patients who survive with therapy.16

Analysis Based on Gender

In terms of gender characteristics, it was found that the group of patients most
affected by chronic kidney failure was a group of male patients, 40 patients (54.1%), but
not much different from female patients, namely 34 patients (45.9%). Tiar supports the
results of this research,17 most patients with chronic kidney failure were found to be male
patients, with 28 patients (68.3%) out of a total of 41 patients at Ambarawa Regional
Hospital, Semarang. The same results were obtained at RSUD Dr. Saiful Anwar Malang
obtained 22 male patients (59.5%) from a total of 37 patients.18
The data above shows that men are predominantly affected by chronic kidney
failure because men pay less focus on their health and uphold a healthy way of living

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compared to women. This is proven by the results of physical activity behavior, which is
more common in women (52.1%) compared to men (47.1%).19 The percentage of men
is greater than women because men have a smoking habit. In contrast, active smokers
are seven times more likely to suffer from chronic kidney failure when compared to non-
smokers. This is also because women have the hormone estrogen, which functions to
balance calcium levels and can stop oxalate from being absorbed, as this can lead to
kidney stones and chronic kidney failure, so the risk for men to experience chronic kidney
failure can be greater than that of women 5

Analysis Based on Education Level

The education level categories in this study were divided into low education
(Primary School and Junior High School) and high education (High School and College).
In terms of educational level characteristics, the largest group of chronic kidney failure
patients was the higher education group, with 45 patients (60.8%), and the low education
group of chronic kidney failure patients (Primary School and Junior High School) with 29
patients (39.2%).
In terms of educational level characteristics, it was found that the group of patients
most affected by chronic kidney failure was the higher education group with 45 patients
(60.8%), where the most chronic kidney failure patients were high school graduates
(SMA) with 26 patients and university graduates. (PT) as many as 19 patients. The
results of this research are supported by Edriyan20 the majority of chronic kidney failure
patients were high school graduates, 16 patients (53.3%) out of a total of 30 patients at
RSU Royal Prima Medan. The same results were obtained Anasulfalah21 where
individuals suffering from long-term renal failure at RSUD Dr. Moewardi Surakarta is
dominated by a high school education level of 21 patients (47%).
Education is an effort by society to behave or adopt behavior using appeals and
invitations, as well as providing information and awareness. Education also influences a
person's level of knowledge about the disease they are suffering from.22 A person's level
of education will certainly shape a person's character to become a more critical person
in dealing with various problems. A person's perspective is wider, and they can adopt
Clean and Healthy Living Behaviors the more educated they are.23
However, not all highly educated people think the same way. For someone who is
highly educated and has a lot of wealth who can buy and do everything, without being
accompanied by a willingness to learn and a high curiosity for his health, it does not
guarantee that someone has a good level of knowledge on the contrary, other people
are willing to learn and increase their knowledge. With information, even though their
educational background is low, they can have better knowledge.24

Analysis Based on Employment Status

Regarding the characteristics of work status, the majority of patients suffering from
chronic kidney failure are 40 patients (54.1%) not working and 34 patients (45.9%) who
are working, whereas respondents who do not work stay at home due to poor physical
health. Able to work. Research result Tiar18 at Dr. Hospital. Saiful Anwar Malang, where
31 patients did not work (83.8%) and six patients worked (16.2%). The research results
were similar Anasulfalah21, carried out at Moewardi Hospital on patients with chronic
kidney failure, where 18 were in the non-working category (43%).
All types of work, both formal and informal, cause work fatigue. Individuals who
feel worn out at work experience symptoms such as feeling lethargic, yawning,
drowsiness, dizziness, difficulty thinking, lack of concentration, lack of alertness, poor
and slow perception, stiffness and awkwardness in movement, lack of passion for work,
unbalanced standing, tremors in the limbs, inability to control posture, and a decline in
both spiritual and physical performance.25

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Work problems: Some patients used to work but had to stop working because of
their illness. According to Abdelghany26 this is attributed to the patient retiring, not being
suitable for work, or having physical limitations in carrying out work, so the patient
chooses not to work. Patients also experience limitations in working because they have
to undergo hemodialysis treatment, which is carried out twice a week by patients so that
patients are more comfortable not working. This is supported Firmansyah27 that some
patients cannot return to their previous jobs because of chronic kidney failure. Other
research explains that patients with jobs become more independent and can meet their
needs independently, making them more confident and secure. This is the opposite if the
patient does not work.28

Suffering for a long time

In terms of long-suffering characteristics, 22 patients (29.7%) had chronic kidney
failure for less than one year and more than one year, namely 52 patients (70.3%). This
long-suffering has been observed since a doctor first diagnosed it. Research conducted
by Suparti29 states that the survival time of patients with chronic kidney failure decreases
with increasing time and only depends on the treatment they are undergoing.
Based on the research location, namely the Arifin Achmad Regional General
Hospital, Riau Province, which is a government hospital and is the referral center for all
district and city hospitals in Riau Province, in this study, many chronic kidney failure
patients were found who had suffered for >1 year. Because the patient was referred to
Arifin Achmad Regional Hospital when he had been sick for > one year, his illness had
to be treated in a hospital with better quality treatment.30

Health-Related Quality Of Life (HRQoL) In Chronic Kidney Failure Patients

In Table 2, the frequency of respondents in each EQ-5D-5L domain is obtained.
The results of each dimension in the question showed that chronic kidney failure patients
had problems in each dimension and level. In the dimension of walking ability, it was
found that 60.8% of respondents had no difficulty walking, 23% had little difficulty, 9.4%
had moderate difficulty, 2.7% had very difficulty, and 4% had very, very difficulty in
walking ability 1%.
These results show that most respondents tend not to have difficulty in the
dimension of walking ability. The results of this research follow research conducted by
Amaliyah31 it was found that some respondents did not experience difficulties in mobility
or walking ability, amounting to 73 respondents out of a total of 100 respondents with a
percentage of 73%. Apart from that, research conducted at Bulelang Hospital, Bali,
showed that (69.7%) of respondents did not experience difficulty walking.32
The ability to walk influences the treatment therapy the patient undergoes.
Dependence on therapy, medication, and medical assistance describes the level of the
patient's ability to walk.17 Most patients do not experience difficulty in walking. This is due
to the successful therapy, which is quite effective, and the drugs the patient uses to
support the therapy the patient is undergoing.33 Based on the description above, it can
be concluded that the majority of respondents do not have difficulty walking, but there
are a small number of respondents who have little to very little difficulty in their ability to
walk, so they need the help of other people, sticks, and wheelchairs to walk, and can
even only lie in bed.32
The second dimension of this research is self-care in bathing and dressing oneself.
It was found that 68.9% of respondents had no difficulty in self-care, 18.9% had a little
difficulty, 5.4% had quite difficulty and had very difficulty, and 2.7 % were unable to self-
care by 4.1%. Based on these results, it can be seen from the dimensions of self-care in
the form of bathing and dressing oneself, showing that most respondents tend to have
no problems. The results of this research following research conducted by Amaliyah31

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the results showed that some respondents did not experience difficulties in self-care,
amounting to 82 respondents out of a total of 100 respondents with a percentage of 82%,
supported by research conducted by Yuliawati32 The same results were obtained,
namely that the majority of 70.8% of respondents did not have problems in caring for
themselves. Likewise, the results of research conducted by Hartini34 showed that the
majority of respondents, 66%, did not experience difficulties in self-care.
Self-care is an activity and initiative carried out by patients to fulfill their life needs.
Self-care is a dimension that aims to avoid having to ask for help.35 This statement is
based on the research results obtained, where most respondents said they had no
trouble taking care of themselves.36 Patients who experience difficulty carrying out self-
care, such as bathing and dressing themselves, are mostly patients who have problems
in the dimension of walking ability and, therefore, require help from the family. This often
happens in elderly patients because patients have experienced serious complications
due to medical therapy, so caring for themselves, such as bathing and dressing, requires
the help of other people for some patients.37
The third dimension in this research is the usual activities in the form of work,
studying, doing household work, family activities, relaxing, and recreation. It was found
that respondents who had no difficulty in carrying out their usual activities were 35.1%,
with little difficulty at 39.2%, moderate difficulty at 14.9%, very difficulty at 5.4%, and
unable to carry out usual activities at 5.4%. Based on these results, it can be seen that
in the dimensions of activities they usually carry out, respondents tend to have a little
difficulty in these dimensions.
These results show that most respondents have little difficulty in the dimensions of
activities that are usually carried out. The results of this research were conducted by
Maulida38 At the Cibabat Regional Hospital, and the results showed that the majority of
respondents, 77.4%, experienced little difficulty carrying out their usual activities.
However, other research found that most respondents did not experience
challenges in performing their daily tasks. Research conducted by Yuliawati32 it was
found that some respondents with chronic kidney failure did not experience difficulties in
carrying out their usual activities, amounting to 70.8%. Research conducted by
Amaliyah31 the findings indicated that most of the participants had chronic kidney failure,
65 respondents out of a total of 100 respondents with a percentage of 65% of
respondents not experiencing difficulties in their usual activities.
The usual activities are daily activities carried out by the patient and have become
the patient's habits. However, these activities change due to the patient's illness.37 Based
on the description above, it was found that most respondents had some difficulty carrying
out their usual activities such as working, studying, doing household chores, family
activities, relaxing, and recreating. This was caused by the decline in the health condition
of patients who could no longer complete their usual activities.31
The results of interviews with respondents showed that respondents had carried
out activities that they usually did before suffering from chronic kidney failure, and these
activities continued to be carried out repeatedly. Still, only some respondents
experienced problems carrying out their usual activities because they had to be
hospitalized at Arifin Achmad Regional Hospital with shortness of breath. There has been
a conflict with the disease, and there is a lack of appetite, so he needs an infusion. Apart
from that, family activities such as relaxation or recreation are activities where the patient
gets support from the family. Family support is really needed by chronic kidney failure
patients in facing life after a diagnosis of chronic kidney failure and its treatment so that
it can improve the patient's quality of life.39
The fourth dimension in this study, namely pain or discomfort, was found by
respondents who did not feel pain or discomfort at 21.6%, felt a little pain or discomfort
at 52.7%, felt quite painful or uncomfortable at 20.3%, felt very painful or uncomfortable

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was 2.7%, and felt very painful or uncomfortable was 2.7%. Based on these results, it
can be seen in the dimension of pain or discomfort, showing that most respondents tend
to feel a little pain or discomfort in this dimension.
The results of this research are by research conducted by Amaliyah31 it was found
that some respondents felt a little pain or discomfort, amounting to 59 respondents out
of a total of 100 respondents with a percentage of 59% of respondents. Similar results
were obtained in other research carried out at RSBSA Bandung and RSD Cimahi by
Hartini34 the results showed that most respondents felt a little problematic in the
dimension of pain or discomfort, with a percentage of 40%.
It can be concluded that most respondents felt a little pain or discomfort. The
majority of patients complain of pain caused by high uric acid levels in the serum due to
kidney damage. As is known, gout is a condition resulting from the final metabolism of
purines, which can result in joint swelling, excruciating pain, and a burning feeling.37
Other causes of pain in chronic kidney failure patients are usually a factor in the patient's
medical therapy, such as hemodialysis. This is due to the theory that chronic kidney
failure patients will experience discomfort, such as muscle pain or cramps during
hemodialysis or complications during hemodialysis access, which will have an impact on
their quality of life.38
The fifth dimension in this study, namely feeling anxious or depressed or sad, was
found by respondents who did not feel anxious or depressed or sad at 35.1%, felt slightly
anxious or depressed or sad at 40.5%, felt quite anxious or depressed or sad 13. 5%,
feeling anxious or depressed or sad at 8.2%, and feeling very anxious or depressed or
sad at 2.7%. Based on these results, it can be seen in the dimensions of feeling anxious
or, depressed or sad showing that most respondents tend to feel a little anxious or
depressed or sad in these dimensions.
The results of this research are under research conducted by Amaliyah31 that some
respondents with chronic kidney failure felt a little anxious or depressed, amounting to
52 respondents out of a total of 100 respondents with a percentage of 52%. The results
of the research are in line with those carried out by Yuliawati32 the results showed that
41.8% of respondents experienced slight anxiety or depression. However, other research
states that the majority of respondents do not feel anxious or depressed. Research
conducted by Maulida38 found that most respondents did not feel anxious or depressed,
with a percentage of 82.3%. Likewise, research conducted at RSUD Dr. Aloei Saboi
Gorontalo, the results showed that the majority of respondents, 67%, did not feel anxious
or sad.37
Based on the description above, it can be concluded that most respondents feel a
little anxious or depressed. This is because chronic kidney failure patients have thoughts
about the suffering they will experience throughout their life, which gives rise to feelings
of anxiety in them.37 This has a big influence on the physical and psychological changes
in chronic kidney failure patients, which have the potential to cause psychological
disorders in sufferers, which can be manifested in the form of complaints of depression,
anxiety, nervousness, and feelings of uselessness, with family support which is
manifested in the form of attention to chronic kidney failure sufferers. And always
accompanying you in the treatment process will help the sufferer's health recovery.39
Utility Value in Chronic Renal Failure Patients
In the results of this research, the utility values of the EQ-5D-5L and EQ-VAS can
be seen in Table 3, where the mean value for each EQ-5D-5L utility value is 0.6235, and
the EQ-VAS value is 0.7177. This can be caused by the emergence of the effects of
treatment therapy carried out by the patient, thereby affecting the patient's health status.
The results of this research are supported by research by Madania,37 which showed that

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the respective utility values of the EQ-5D-5L and EQ-VAS were 0.673 and 71.4,
respectively.
However, different results were obtained by Rahmani,40 which states the utility
value of the EQ-5D-3L and the VAS value is 0.65 and 62.29, respectively. The use of
different questionnaires could cause this difference in utility values. The EQ-5D-5L
questionnaire is more sensitive and precise than the EQ-5D-3L because the EQ-5D-5L
has five levels in the assessment of each domain.8
In this study, the results of the EQ-5D-5L utility value for one of the patients were
(-0.787) and EQ-VAS (0.4), where these results indicated that the patient's health
condition was approaching death, caused by the patient's kidney function having
decreased by 10 % of normal. The Glomerular Filtration Rate (GFR) decreased to <15
of normal. The patient's health is also decreasing due to the conflict between chronic
kidney failure and the patient's comorbidities. The condition of the kidneys, which are no
longer able to remove and filter the body's electrolytes, results in the condition getting
worse so that the patient can only lie down and cannot carry out activities that could
improve the patient's condition.37
The EQ-5D-5L and EQ-VAS have differences in assessment. Namely, the EQ-5D-
5L consists of 5 dimensions with five levels of answers, ranging from no problems to very
serious problems. The EQ-5D-5L utility index range is between 0 (very poor health
condition equivalent to death) and 1 (very good health condition).8 Furthermore, the
Visual Analog Scale (EQ-VAS) can be used to assess the health status of respondents
using a 20 cm vertical scale. The EQ-VAS assessment is based on respondents'
answers regarding their health condition with a score range of 0 (worst health or
equivalent to death) to 100 (best health condition).41 There is no difference in the average
EQ-5D-5L and EQ-VAS scores in this study, where the EQ-5D-5L and EQ-VAS quality
of life scores should be the same.
Conclusion
Based on research conducted on Health-Related Quality of Life (HRQoL) in
patients with chronic kidney failure at Arifin Achmad Hospital, Riau Province, it was found
that chronic kidney failure affects health-related quality of life, with average utility values
of EQ-5D-5L and VAS of 0.6235 and 0.7177, respectively. The most frequently reported
health problems were pain or discomfort (52.7%) and anxiety or depression (40.5%).
References
1. Berawi K. Fisiologi ginjal dan cairan tubuh. Bandar Lampung: Universitas Lampung;
2016.
2. Riskesdas. Laporan nasional Riskesdas 2018. Badan Penelitian dan
Pengembangan Kesehatan. Jakarta; 2018.
3. Wakhid A, Widodo GG. Konsep diri pasien gagal ginjal kronik yang menjalani
Hemodialisis. J Ilm Permas J Ilm STIKES Kendal. 2019;9(1):7–11.
4. Haris RNH, Makmur R, Andayani TM, Kristina SA. Penilaian properti psikometrik
instrumen kualitas hidup (HRQol) pada populasi umum: tinjauan sistematik. J Manaj
dan Pelayanan Farm. 2019;9(2):65–75.
5. Lisa Lolowang NN, Lumi WM., Rattoe AA. Kualitas hidup pasien gagal ginjal kronis
dengan terapi Hemodialisa. J Ilm Perawat Manad. 2021;8(2):21–32.
6. Siwi AS. Kualitas hidup pasien gagal ginjal kronik yang menjalani terapi hemodialisa.
J Keperawatan Muhammadiyah Bengkulu. 2021;9(2):1–9.
7. Sari S, Andayani TM, Endarti D, Widayati K. Efikasi afatinib dan gefitinib pada pasien
non-small cell lung cancer EGFR mutasi positif. Indones J Clin Pharm.
2019;8(4):289.
8. Purba FD, Hunfeld JAM, Iskandarsyah A, Fitriana TS, Sadarjoen SS, Ramos-Goñi
JM, et al. The Indonesian EQ-5D-5L value set. Pharmacoeconomics.

www.journal.uniga.ac.id ISSN: 2087-0337

81
E-ISSN:2715-9949
Jurnal Ilmiah Farmako Bahari Seftika Sari
Vol.15; No.1; January 2024
Page 72-83

2017;35(11):1153–65.
9. Mait G, Nurmansyah M, Bidjuni H. Gambaran adaptasi fisiologis dan psikologis pada
pasien gagal ginjal kronis yang menjalani hemodialisis di Kota Manado. J
Keperawatan. 2021;9(2):1–6.
10. Firmansyah F, Agustini TT, Andayani TM. Health related quality of life : chronic
kidney disease dengan hemodialisa menggunakan instrumen Eq-5D-5L di
pekanbaru. J Ilm Manuntung Sains Farm dan Kesehat. 2022;8(1):55–62.
11. Badariah, Kusuma FHD, Dewi N. Karakteristik pasien penyakit ginjal kronik yang
menjalani hemodialisis di RSUD Kabupaten Kotabaru. Nurs News (Meriden).
2017;2(2):281–5.
12. Sembiring LP, Hanifah ZN. Hubungan status gizi terhadap kualitas hidup pada
pasien penyakit ginjal kronik yang menjalani hemodialisis di RSUD Arifin Achmad
Provinsi Riau. J Ilmu Kedokt. 2021;14(2):103.
13. Husna H, Maulina N. Hubungan antara lamanya hemodialisis dengan kualitas hidup
pasien penyakit ginjal kronik Di Rumah Sakit Umum Cut Meutia Kabupaten Aceh
Utara tahun 2015. AVERROUS J Kedokt dan Kesehat Malikussaleh. 2015;1(2):39–
45.
14. Lin JJ, Morey F, Wu HY, Yang JY, Peng Y Sen, Mendez D, et al. Prevalence and
risk factors for chronic kidney disease in Belize: a population-based survey:
prevalence and risk factors for CKD in Belize. Lancet Reg Heal - Am. 2021;1(10):13.
15. Oktavia WS. Faktor-faktor yang berhubungan dengan penyakit gagal ginjal kronis
pada penduduk usia >18 tahun di indonesia tahun 2018. UIN Syarif Hidayatullah;
2022.
16. Myh E, Manuputty D. Pola sensitifitas dan resistensi kuman urin, ujung kateter dan
ujung drain pasien resipient transplantasi ginjal di RS PGI Cikini Jakarta. J Kesehat
Andalas. 2012;1(1):6–9.
17. Suwanti S, Wakhid A, Taufikurrahman T. Gambaran kualitas hidup pasien gagal
ginjal kronis yang menjalani terapi hemodialisa. J Keperawatan Jiwa.
2017;5(2):107–14.
18. Tiar MA, Agustina W, Firdaus AD. Hubungan antara kepatuhan terhadap terapi
hemodialisis dengan kualitas hidup pasien gagal ginjal kronik. Media Husada J Nurs
Sci. 2022;3(2):143–52.
19. Pranandari R, Supadmi W. Faktor resiko gagal ginjal kronik diunit hemodialisis
RSUD Wates Kulon Progo. Maj Farm. 2015;11(2):316–20.
20. Edriyan D. Dukungan keluarga berhubungan dengan kualitas hidup pasien gagal
ginjal kronik yang menjalani terapi hemodialisis. J Penelit Perawat Prof.
2022;4(3):795–801.
21. Anasulfalah H, Tri Handayani R, Widiyanto A, Dwi Kurniawan H, Tri Atmojo J, Syauqi
Mubarok A, et al. Gambaran kualitas hidup dengan chronic kidney disease yang
menjalani hemodialisa di RSUD Dr.Moewardi. Avicenna J Heal Res. 2022;5(2):71–
6.
22. Toulasik N. Analisis faktor yang berhubungan dengan kualitas hidup wanita
penderita kanker di RSUD Prof. Dr. W. Z. Johannes Kupang. Vol. 53, Journal of
Chemical Information and Modeling. 2019. 1689–1699 p.
23. Ge’e ME, Lebuan A, Purwarini J. Hubungan antara karakteristik, pengetahuan
dengan kejadian kanker serviks. J Keperawatan Silampari. 2021;4(2):397–404.
24. Hartati, S Winarti R. Gambaran tingkat pengetahuan ibu tentang penyakit kanker di
wilayah Jakarta Timur. J Ilm Keperawatan Altruistik. 2020;3(1):1–15.
25. Tarwaka. Ergonomi industri. Surakarta: Harapan Press; 2013.
26. A. Abdelghany M, E. Elgohary E. Assessment of health-related quality of life in
patients receiving regular hemodialysis. J Nephrol Ther. 2016;6(2):1–4.
27. Firmansyah F, Fadraersada J, Rusli R. Kajian kualitas hidup pasien yang menjalani

www.journal.uniga.ac.id ISSN: 2087-0337

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E-ISSN:2715-9949
Jurnal Ilmiah Farmako Bahari Seftika Sari
Vol.15; No.1; January 2024
Page 72-83

hemodialisa di RSUD. A.W. Sjahranie. In: Proceeding of Mulawarman

Pharmaceuticals Conferences. Samarinda: Universitas Mulawarman; 2018. p. 51–
6.
28. Tsai YC, Chen HM, Hsiao SM, Chen CS, Lin MY, Chiu YW, et al. Association of
physical activity with cardiovascular and renal outcomes and quality of life in chronic
kidney disease. PLoS One. 2017;12(8):26–34.
29. Suparti S, Solikhah U. Perbedaan kualitas hidup pasien gagal ginjal kronik ditinjau
dari tingkat pendidikan, frekuensi dan lama hemodialisis di RSUD Goeteng
Taroenadibrata Purbalingga. Medisains J Ilm Ilmu-Ilmu Kesehat. 2016;14(2):50–8.
30. Putri SAK, Muna N, Erawantini F, Sistem pengambilan dan pengembalian rekam
medis rawat inap berbasis web menggunakan metode prototype Di RSUD Arifin
Achmad Provinsi Riau. J Ilm Rekam Medis dan Inform Kesehat. 2021;11(1):1–3.
31. Amaliyah A, Sarnianto P, Ramadaniati HU. Analisis profil pengobatan, biaya medis
langsung dan kualitas hidup pada pasien hemodialisis di Rumah Sakit Islam Pondok
Kopi Jakarta. J Pendidik dan Konseling. 2022;4(5):4132–8.
32. Yuliawati AN, Ratnasari PMD, Pratiwi IGAS. Hubungan kepatuhan pengobatan
dengan kualitas hidup pasien gagal ginjal kronik disertai hipertensi dan menjalani
hemodialisis. J Manaj dan Pelayanan Farm. 2022;12(1):28–39.
33. Rika S, Fitri M. Gambaran kualitas hidup pasien gagal ginjal kronik yang menjalani
hemodialisa di Rumah Sakit Tingkat III Dr. Reksodiwiryo. J Amanah Kesehat.
2019;1(1):46–55.
34. Hartini, S., Muhtadi, A., dan Sumaryadi D. Pengaruh anemia tanpa terapi
eritropoetin terhadap kualitas hidup pasien gagal ginjal kronik dengan terapi
hemodialisa di RSBSA Bandung Dan RSD Cimahi. Farmaka. 2020;18(1):1–15.
35. Nurcahyati S, Karim D. Implementasi self care model dalam upaya meningkatkan
kualitas hidup penderita gagal ginjal kronik. J Keperawatan Sriwij. 2016;3(2):25–32.
36. Goran AA, Luyet AD, Haller DM, Zeller A, Rosemann T, Streit S, et al. Comparing
the self-perceived quality of life ofmultimorbid patients and the general population
using the EQ-5D-3L. PLoS One. 2017;12(12):1–13.
37. Madania M, Tuloli TS, Rasdianah N, Akuba J. Analisis biaya dan nilai utilitas pada
pasien hemodialisis yang diberikan terapi erythropoiesis di rumah sakit. Indones J
Pharm Educ. 2022;1(3):190–202.
38. Maulida F, Halimah E, Hartini S, Prihartanto B. Pengaruh konseling farmasi
terhadap kualitas hidup pasien gagal ginjal kronik dengan terapi hemodialisis di
RSUD Cibabat. Farmaka (Suplemen). 2020;18(4):22–6.
39. Idzharrusman M, Budhiana J. Hubungan dukungan keluarga dengan kualitas hidup
pasien gagal ginjal kronik RSUD Sekarwangi. J Keperawatan Bsi. 2022;10(1):61–9.
40. Rahmani, Sarnianto, Ramadaniati. Analisis profil pengobatan, biaya perspektif
rumah sakit dan hroqol pada pasien hemodialisis rawat jalan di RSUP Fatmawati
Jakarta. Nusant J Ilmu Pengetah Sos. 2022;9(1):38–45.
41. The EuroQol group. EQ-5D-5L user guide version 3.0 basic information on how to
use the EQ-5D-5L instrument. EuroQol Research Foundation. Rotterdam: EuroQol
Research Foundation; 2019.

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DOI: http://dx.doi.org/10.33846/sf14209
EQ-5D-5L untuk Pengukuran Biaya dan Indeks Utilitas pada Pasien Gagal Ginjal Kronik dengan
Hemodialisis

Clara Ritawany Sinaga

Fakultas Farmasi, Universitas Setia Budi Surakarta / STIKES Dirgahayu Samarinda, Samarinda, Indonesia;
clarasinaga24@gmail.com (koresponden)
Gunawan Pamudji Widodo
Fakultas Farmasi, Universitas Setia Budi Surakarta, Indonesia; gunawanpamudji@yahoo.com
Tri Murti Andayani
Fakultas Farmasi, Universitas Gadjah Mada, Yogyakarta, Indonesia; trimurtia@yahoo.com
ABSTRACT
Treatment of chronic kidney failure requires a large amount of money, especially if the patient has
complications, so cost analysis and utility index measurements are needed. This study aimed to determine the
effect of complications on cost and utility index in patients with chronic kidney failure on hemodialysis. This
research was an observational study that applied a cross-sectional design from the perspective of the service
provider. The subjects of the study were 76 outpatients with chronic kidney failure who underwent hemodialysis
at the Hemodialysis Unit at the Abdoel Wahab Sjahranie Regional General Hospital, Samarinda from October
to November 2020. Complication data were obtained from medical records, financing data were obtained from
the finance department, and data on complications the utility index were obtained through direct interviews with
patients using the EQ-5D-5L questionnaire. Data were analyzed using the Kruskal-Wallis test. The results of the
research showed that the real cost for one month was Rp. 972,540,696 with an average cost of Rp.
12,796,588±120,241. Meanwhile, the real cost per episode of hemodialysis was Rp. 119,582,312 with an
average cost of IDR 1,573,451 ± 77,506. The patient utility index was 0.645±0.210. The p-value for the impact
of complications on the utility index was 0.012 (<0.05), while the p-value for the impact of complications on
costs was 0.095 (>0.05). Thus it could be concluded that complications in chronic renal failure patients had an
impact on the utility index.
Keywords: chronic kidney failure; hemodialysis; complications; utility index
ABSTRAK
Penanganan gagal ginjal kronis membutuhkan biaya yang besar, terutama apabila pasien mengalami komplikasi,
sehingga diperlukan analisis biaya dan pengukuran indeks utilitas. Penelitian ini bertujuan untuk mengetahui
pengaruh komplikasi terhadap biaya dan indeks utilitas pada pasien dengan gagal ginjal kronis dengan
hemodialisis. Penelitian ini merupakan studi observasional yang menerapkan rancangan cross-sectional menurut
perspektif pemberi layanan. Subyek penelitian adalah 76 pasien rawat jalan dengan gagal ginjal kronis yang
menjalani hemodialisis di Unit Hemodialisis Rumah Sakit Umum Daerah Abdoel Wahab Sjahranie, Samarinda
pada bulan Oktober sampai November 2020. Data komplikasi diperoleh dari rekam medik, data pembiayaan di
peroleh dari bagian keuangan, dan data indeks utilitas diperoleh melalui wawancara secara langsung dengan
pasien menggunakan kuesioner EQ-5D-5L. Data dianalisis menggunakan uji Kruskal-Wallis. Hasil penelitian
menunjukkan bahwa biaya riil selama satu bulan adalah Rp. 972.540.696 dengan biaya rata-rata Rp.
12.796.588±120.241. Sedangkan biaya riil per episode hemodialisis adalah Rp. 119.582.312 dengan biaya rata-
rata Rp.1.573.451±77.506. Indeks utilitas pasien adalah 0,645±0,210. Nilai p untuk dampak komplikasi
terhadap indeks utilitas adalah 0,012 (<0,05), sedangkan nilai p untuk dampak komplikasi terhadap biaya adalah
0,095 (>0,05). Dengan demikian bisa disimpulkan bahwa komplikasi pada pasien gagal ginjal kronis berdampak
pada indeks utilitas.
Kata kunci: gagal ginjal kronis; hemodialisis; komplikasi; indeks utilitas
PENDAHULUAN
Gagal ginjal kronis (GGK) merupakan salah satu penyakit kronis yang menjadi perhatian dalam bidang
kesehatan karena tingkat prevalensinya terus meningkat. Pada penurunan 90% fungsi ginjal seperti pada
penyakit ginjal terminal, baik transplantasi ginjal maupun dialisis sangat dianjurkan untuk memperpanjang dan
memaksimalkan kualitas hidup pasien. Biaya terapi pada pasien penyakit ginjal kronik (PGK) mengalami
peningkatan dari tahun ke tahun dan dengan adanya komplikasi akan meningkatkan total biaya yang diperlukan,
oleh karena itu perlu dilakukan kendali mutu dan biaya. Cost Utility Analysis (CUA) merupakan salah satu
kajian farmakoekonomi yang mencakup biaya dan pengukuran quality of life sebagai outcome pengukuran.
Untuk melakukan kajian farmakoekonomi diperlukan data biaya dan peningkatan biaya akibat progresivitas
penyakit ginjal. Biaya perawatan dan penyembuhan penyakit ginjal kronis sangat mahal. Pembiayaan penyakit
ginjal merupakan peringkat kedua pembiayaan terbesar dari Badan Penyelenggara Jaminan Sosial (BPJS)
kesehatan setelah penyakit jantung.(1)
Penanganan penyakit ginjal kronis di Indonesia semakin memakan biaya cukup tinggi apabila pasien
mengalami komorbid dan komplikasi yang dapat membebani pasien menjalani perawatan dengan rawat inap.
Dengan berkurangnya lama rawat inap, diharapkan biaya medis langsung pasien juga akan lebih rendah. Selain
itu, untuk meningkatkan outcome klinik maupun ekonomik, maka penggunaan sumber daya (biaya) harus dapat
dioptimalkan dan pengeluaran harus dikendalikan.(2) Penelitian yang dilakukan oleh Charlson et al., (2008)

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menunjukkan hasil bahwa total biaya tahunan meningkat seiring dengan meningkatnya komorbiditas, dalam hal
ini semakin tinggi skor komorbiditas (CCI) maka biaya tahunan yang dikeluarkan juga semakin besar.(3)
Nurwanti (2018) menunjukkan bahwa biaya rata-rata pasien PGK adalah sebesar Rp 4.395.614 dan biaya rata-
rata hemodialisis adalah Rp 5.094.010.(4)
Selain biaya, diperlukan juga data indeks utilitas berdasarkan progresivitas penyakit ginjal. Nilai utilitas
selain untuk melihat outcome pasien, dapat digunakan untuk analisis farmakoekonomi untuk menghitung QALY
sebagai outcome dari CUA. Penilaian kualitas hidup terhadap outcome klinis pasien bisa dinilai dengan salah
satunya adalah nilai utilitas dengan kuesioner EQ-5D-5L. Di beberapa negara dalam penilaian teknologi
kesehatan, instrumen EQ-5D-5L merupakan pilihan yang paling banyak dilakukan. Instrumen EQ-5D-5L
memiliki kelebihan di antaranya mudah diperoleh, bersifat generik dan mudah dimengerti dan dapat digunakan
hasilnya untuk mengukur persepsi kualitas hidup untuk pasien dengan penyakit yang berbeda merupakan alasan
yang seringkali dikemukakan.(5)
Pasien yang menjalani hemodialisis (HD) dapat dihadapkan dengan berbagai masalah di antaranya
adalah masalah medis, sosial, dan ekonomi yang dapat mempengaruhi kualitas hidup pasien. Penelitian yang
dilakukan oleh Susanto (2018) menyatakan bahwa pasien akan memiliki kualitas hidup yang semakin baik dari
waktu ke waktu jika menjalani HD secara reguler. Lamanya HD berpengaruh terhadap kualitas hidup karena
dengan menjalani HD yang lama maka pasien akan semakin memahami pentingnya kepatuhan dalam
menjalankan HD dan pasien sudah merasakan manfaatnya apabila menjalankan HD secara teratur serta
akibatnya jika tidak menjalankan HD, sehingga hal ini mempengaruhi kualitas hidup.(6) Penelitian lainnya
tentang kualitas hidup pasien penyakit ginjal kronik dengan menggunakan instrumen EQ-5D-5L yang dilakukan
Sukawati (2019) didapatkan nilai utilitas dengan komplikasi anemia dan GGK yaitu 0,63 dan 0,65 di mana
berbagai komplikasi akan berpengaruh terhadap nilai kualitas hidup pasien(7). Hasil pengukuran kualitas hidup
di setiap negara dapat menunjukkan hasil yang berbeda karena dipengaruhi oleh berbagai faktor, di antaranya
adalah faktor demografi maupun sosial budaya. Penelitian ini bertujuan untuk mengetahui biaya terapi, indeks
utilitas pasien menggunakan kuesioner EQ-5D-5L, dan pengaruh komplikasi terhadap biaya dan indeks utilitas
pada pasien dengan penyakit ginjal kronis yang dilakukan HD di RSUD Abdoel Wahab Sjahranie Samarinda.
METODE
Penelitian ini termasuk dalam jenis penelitian analitik menurut perspektif pemberi layanan (provider)
dengan rancangan penelitian cross-sectional. Penelitian ini dilaksanakan pada bulan Oktober - November 2020
di Unit Hemodialisis, Bagian Rekam Medis, dan Bagian Keuangan RSUD Abdoel Wahab Sjahranie Samarinda.
Sampel pada penelitian ini adalah pasien rawat jalan gagal ginjal kronik yang menjalani hemodialisis yang
datang ke unit hemodialisis rumah sakit lokasi penelitian pada periode penelitian (1 bulan). Responden dipilih
secara non random sampling dengan teknik purposive sampling. Penelitian ini dilakukan setelah mendapatkan
persetujuan kelayakan etik oleh Komite Etik dan ijin penelitian dari RSUD Abdoel Wahab Sjahranie Samarinda.
Variabel bebas adalah komplikasi pada pasien GGK, sedangkan variabel terikat adalah biaya terapi dan
indeks utilitas. Komplikasi diukur berdasarkan studi dokumentasi rekam, biaya diterapi diukur berdasarkan studi
dokumentasi pada data bagian keuangan, sedangkan indeks utilitas diperoleh melalui wawancara secara
langsung serta membagikan daftar pertanyaan yang terdapat dalam instrumen EQ-5D-5L. Data yang telah
terkumpul dianalisis secara deskriptif, lalu dilanjutkan dengan analisis biaya untuk menghitung biaya medis
langsung rawat jalan, penilaian skor utilitas kuesioner EQ-5D-5L dengan menghitung persentase tiap level
permasalahan berdasarkan 5 domain EQ-5D-5L. Untuk mengetahui dampak komplikasi terhadap biaya terapi
dan indeks utilitas pasien GGK dengan hemodialisis, dilakukan analisis statistik menggunakan uji Kruskal-
Wallis.
HASIL
Hasil penelitian menunjukkan bahwa mayoritas pasien GGK dengan HD berusia 45-49 tahun, jenis
kelamin yang dominan adalah laki-laki, penyakit komorbid terbanyak adalah hipertensi, komplikasi terbanyak
adalah anemia, dan mayoritas pasien telah menjalani HD lebih dari 24 bulan (tabel 1).
Tabel 1. Karakteristik demografi pasien GGK dengan hemodialisis di RSUD Abdoel Wahab Sjahranie Samarinda
Karakteristik demografi Frekuensi Persentase Karakteristik demografi Frekuensi Persentase
Usia Komorbid
18-44 tahun 23 30,26 Hipertensi 66 32,20
45-59 tahun 41 53,95 DM Tipe 2 27 13,17
60-69 tahun 9 11,84 Hepatitis C 21 10,24
≥70 tahun 3 3,95 Congestive Heart Failure (CHF) 18 8,78
Jenis Kelamin Gout (asam urat) 15 7,32
Laki-laki 45 59,21 Edema Paru 15 7,32
Perempuan 31 40,79 Infeksi Saluran Kemih (ISK) 12 5,85
Komplikasi Coronary Artery Disease (CAD) 11 5,37
Anemia 52 78,46 Efusi Pleura 8 3,90
Congestive Heart Failure (CHF) 8 12,31 Pneumonia 5 2,44
Kram Otot 6 9,23 TB Paru 4 1,95
Lama Hemodialisis Benign Prostatic Hyperplasia (BPH) 2 0,98
Baru (<12 bulan) 16 21,05 Sindrom Nefrotik 1 0,49
Sedang (12-24 bulan) 19 25
Lama (>24 bulan) 41 53,95

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Tabel 2. Komponen biaya riil pasien GGK rawat jalan dengan HD di RSUD Abdoel Wahab Sjahranie Samarinda
Komponen biaya Biaya total (Rp) Rata-rata±SD (Rp) Persentase
Biaya per episode hemodialisis
Biaya Administrasi 3.800.000 50.000±0 3,18
Biaya obat dan BHP 57.262.312 753.451±87.332 47,88
Biaya jasa rumah sakit 36.282.400 477.400±0 30,34
Biaya jasa pelayanan 22.237.600 292.600±0 18,60
Total per episode hemodialisis 119.582.312 1.573.451±77.506 100
Total biaya 1 bulan hemodialisis x 8 kunjungan 956.658.496 12.587.612
Biaya laboratorium 15.882.200 208.976±78.568
Total biaya 1 bulan hemodialisis 972.540.696 12.796.588±120.241

Tabel 3. Hasil penghitungan indeks utilitas dengan kuesioner EQ-5D-5L

Pasien GGK dengan HD Frekuensi Rata-rata indeks utilitas±SD
Komplikasi anemia 45 0,679±0,196
Komplikasi CHF 3 0,743±0,104
Komplikasi kram otot 2 0,490±0,056
Komplikasi anemia + CHF 4 0,552±0,193
Komplikasi anemia + Kram Otot 3 0,417±0,262
Komplikasi CHF + kram otot 1 0,495±0
Non komplikasi 18 0,632±0,240
Total pasien komplikasi dan tanpa komplikasi 76 0,645±0,210

Tabel 4. Hasil analisis dampak komplikasi terhadap biaya dan indeks utilitas
Kejadian komplikasi n Indeks utilitas Biaya
Tanpa komplikasi 18 0,632 12.868.827
Dengan komplikasi 58 0,563 12.784.363
Nilai p 0,012 0,093

Hasil penelitian menunjukkan bahwa biaya riil selama satu bulan adalah Rp. 972.540.696 dengan biaya
rata-rata Rp. 12.796.588±120.241. Sedangkan biaya riil per episode hemodialisis adalah Rp. 119.582.312
dengan biaya rata-rata Rp.1.573.451±77.506 (tabel 2). Indeks utilitas pasien adalah 0,645±0,210 (tabel 3).
Sementara itu, hasil analisis dampak komplikasi terhadap indeks utilitas, menunjukkan nilai p = 0,012 (<0,05),
yang bisa diartikan bahwa ada dampak secaa signifikan. Sedangkan hasil analisis dampak komplikasi terhadap
biaya terapi menunjukkan nilai p = 0,095 (>0,05), yang bisa diartikan bahwa ada tidak ada dampak secaa
signifikan (tabel 4).
PEMBAHASAN

Hasil penelitian terkait karakteristik pasien berdasarkan usia menunjukkan bahwa penderita GGK dengan
HD mempunyai persentase terbesar pada usia 45-59 tahun. Dengan bertambahnya usia, maka fungsi ginjal
semakin berkurang karena terjadinya penurunan kecepatan ekskresi glomerulus dan penurunan fungsi tubulus
pada ginjal sekitar 30%. Fungsi renal akan berubah bersamaan dengan pertambahan usia, dan sesudah usia 40
tahun akan terjadi penurunan laju filtrasi glomerulus secara progresif hingga usia 70 tahun.(8) Persentase pasien
laki-laki (59,21%) lebih tinggi dibandingkan perempuan (40,79%). Laki-laki banyak mempunyai kebiasaan
yang dapat mempengaruhi kesehatan seperti merokok, minum kopi, alkohol, dan minuman suplemen yang dapat
memicu terjadinya penyakit sistemik yang dapat menyebabkan penurunan fungsi ginjal dan berdampak terhadap
kualitas hidupnya.(9)
Penyakit GGK sebagian besar disertai oleh komorbid. Komorbid adalah kondisi (penyakit) lain selain
GGK yang mempengaruhi organ lain, tetapi juga dapat menyebabkan GGK, dan dapat berdampak buruk
terhadap kelangsungan hidup pasien dengan hemodialisis. Hasil penelitian menunjukkan bahwa semua pasien
HD memiliki komorbid. Penyakit penyerta terbanyak adalah hipertensi (32,20%). Tingginya tekanan darah akan
membuat pembuluh darah dalam ginjal tertekan, kemudian pembuluh darah menjadi rusak dan menyebabkan
fungsi ginjal menurun hingga mengalami kegagalan ginjal.
Pasien penyakit ginjal kronik bergantung pada terapi hemodialisis untuk mempertahankan dan
meningkatkan kualitas hidup. Meskipun hemodialisis dapat menggantikan fungsi ginjal dan dianggap terapi
yang dianjurkan, tetapi terdapat berbagai komplikasi yang menyertai pasien hemodialisis. Komplikasi dengan
persentase terbesar dalam penelitian ini adalah anemia sebesar 78,46%. Pasien gagal ginjal kronik yang telah
menjalani hemodialisis secara rutin akan menimbulkan berbagai komplikasi, salah satunya yang paling sering
terjadi adalah anemia dan terjadi lebih awal dibandingkan dengan komplikasi lainnya. Anemia pada pasien
GGK disebabkan karena adanya proses penyakit yang mengakibatkan menurunnya produksi hormon
eritropoietin (EPO) oleh ginjal.
Pasien GGK menjalani hemodialisis umumnya 2 kali dalam seminggu dan pasien GGK harus bergantung
pada terapi ini seumur hidup untuk mempertahankan kualitas hidup. Pada penelitian ini didapatkan hasil
terbanyak bahwa pasien GGK yang sedang menjalani HD masuk dalam kategori lama (>24 bulan) dengan
persentase 53,95%. Penelitian yang dilakukan oleh Nurchayati (2010) menyebutkan semakin lama pasien
menjalani HD, maka pasien semakin patuh untuk menjalani HD karena biasanya pasien telah mencapai tahap
menerima dan kemungkinan pasien telah banyak mendapatkan pendidikan kesehatan dari perawat dan juga
dokter tentang penyakit dan pentingnya menjalani HD secara teratur.(10)

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p-ISSN 2086-3098 e-ISSN 2502-7778

Dari data keuangan RS diperoleh hasil bahwa biaya riil selama satu bulan untuk 76 pasien HD adalah Rp.
972.540.696 dengan biaya rata-rata per pasien Rp. 12.796.588±120.241. Sedangkan biaya riil per episode HD
yaitu sebesar Rp. 119.582.312 dengan biaya rata-rata Rp. 1.573.451±77.506. Total biaya riil per bulan ini
diperoleh dari data keuangan pasien selama 8 kali kunjungan (2 kali/minggu), sedangkan biaya laboratorium
merupakan biaya yang sudah dikalkulasi selama 1 bulan dan bukan per episode HD. Jumlah biaya yang
membedakan antar pasien adalah biaya laboratorium, biaya obat dan BHP. Biaya tersebut berbeda antara pasien
karena masing-masing pasien memiliki pemeriksaan dan kebutuhan yang berbeda-beda tergantung pada
kondisi/tingkat keparahan yang dialami pasien. Penelitian lain yang dilakukan Rohenti et al. (2019) pada pasien
HD rawat jalan, rata-rata biaya riil untuk satu kali hemodialisa sejumlah Rp. 705.523. Komponen biaya
hemodialisa meliputi biaya hemodialisa set, pemeriksaan laboratorium, obat, bahan habis pakai atau alat
kesehatan, dan konsultasi dokter. Biaya yang terbesar adalah hemodialisa set sejumlah Rp. 548.750 dan biaya
konsultasi dokter sejumlah Rp. 50.000. Komponen biaya/pembiayaan dari tindakan HD tergantung pada
masing-masing fasilitas pelayanan kesehatan, dan tidak semua komponen tersebut sama.(11)
Komponen biaya terbesar dalam penelitian ini yaitu biaya obat dan BHP, dengan biaya rata-rata untuk 76
pasien selama sebulan sebesar Rp. 753.451±87.332 (47,88% dari total biaya tindakan HD) dan terbesar kedua
yaitu biaya jasa rumah sakit sebesar Rp. 477.400±0 (30,34% dari total biaya tindakan HD). Obat dan BHP
menyerap biaya yang tinggi dikarenakan masing-masing pasien memiliki kebutuhan obat yang cukup banyak,
tergantung pada komorbid dan komplikasi yang menyertai pasien. Komponen biaya/pembiayaan dari tindakan
HD tergantung pada masing-masing fasilitas pelayanan kesehatan, dan tidak semua komponen tersebut sama.
Jika dibandingkan dengan pasien rawat inap, maka komponen biayanya jauh lebih banyak dibandingkan dengan
rawat jalan, seperti pada penelitian yang dilakukan oleh Astuti (2018) pada pasien rawat inap penyakit ginjal
kronik dengan hemodialisis menunjukkan hasil bahwa pada tingkat keparahan I, tingkat keparahan II, dan
tingkat keparahan III di semua kelas perawatan, biaya yang paling besar diperoleh dari biaya laboratorium,
biaya rawat inap dan biaya obat. Tingginya biaya-biaya ini disebabkan oleh banyaknya jumlah pemeriksaan
yang digunakan, lama perawatan dan obat-obatan yang digunakan. Hal ini dipengaruhi juga oleh jumlah dan
jenis diagnosis sekunder yang dialami pasien.(2)
Pada hasil penelitian dapat dilihat bahwa pasien dengan adanya komplikasi dapat mempengaruhi kualitas
hidup mereka (lebih rendah) dibandingkan dengan non komplikasi. Pasien bisa bertahan hidup dengan adanya
komplikasi dari terapi hemodialisis, namun masih menyisakan sejumlah persoalan penting terutama perubahan
fisik dan kesehatan mental yang pada akhirnya dapat menurunkan kualitas hidup. Total keseluruhan indeks
utilitas yang didapatkan dalam penelitian ini adalah 0,645±0,210 dengan rata-rata kondisi kesehatan pasien yang
menjalani HD tidak dalam keadaan yang sempurna maupun sangat buruk. Sebagian besar pasien masih
mempunyai harapan dan semangat hidup karena adanya dukungan yang besar dari keluarga. Hasil ini sejalan
dengan penelitian yang dilakukan oleh Nabila (2015), diketahui bahwa rata-rata nilai utility pasien yang
menjalani hemodialisis yaitu 0,62. Artinya, pasien merasa cukup sehat dengan menjalani hemodialisis.(14)
Hasil penelitian menunjukkan bahwa terdapat dampak komplikasi terhadap kualitas hidup pasien GGK
dengan HD, yang berarti terdapat perbedaan indeks utilitas antara pasien dengan komplikasi dan pasien tanpa
komplikasi. Berkaitan dengan kualitas hidup, terapi hemodialisis pada pasien gagal ginjal kronik dapat merubah
kondisi fisik, psikologi, sosial dan ekonomi pasien karena harus dijalani seumur hidup yang kemudian akan
menyebabkan menurunnya kualitas hidup pasien terutama jika adanya komplikasi. Setiap pasien memerlukan
waktu yang berbeda-beda dalam beradaptasi terhadap perubahan yang dialaminya seperti gejala, komplikasi
serta terapi yang dijalani seumur hidup. Sehingga kualitas hidup pada pasien gagal ginjal kronik juga mengalami
fluktuasi sesuai dengan waktu yang diperlukan untuk setiap tahapan adaptasi terhadap terapi hemodialisis.
Komplikasi pada pasien GGK dengan HD tak berdampak terhadap biaya, yang berarti tidak ada
perbedaan biaya antara pasien dengan komplikasi dengan pasien tanpa komplikasi. Hal ini disebabkan karena
pada umumnya kondisi pasien rawat jalan tidak terlalu berbeda antara satu dengan yang lain, sehingga biaya
terapi juga tidak berbeda signifikan. Biaya tidak hanya dipengaruhi oleh komplikasi tetapi ada faktor lainnya
yang bisa mempengaruhi biaya terapi misalnya tingkat keparahan penyakit, sistem pembiayaan, dan pemilihan
obat. Penelitian lain yang dilakukan oleh Nurwanti (2018) juga tidak menunjukkan perbedaan yang signifikan
antara biaya pasien dengan penyakit penyerta dan tanpa penyakit penyerta.
KESIMPULAN
Dari hasil penelitian tentang analisis biaya dan indeks utilitas yang diukur menggunakan EQ-5D-5L pada
pasien gagal ginjal kronik dengan hemodialisis di RSUD Abdoel Wahab Sjahranie Samarinda maka dapat
disimpulkan bahwa adanya komplikasi berdampak terhadap indeks utilitas pasien GGK dengan hemodialisis di
RSUD Abdoel Wahab Sjahranie Samarinda.
DAFTAR PUSTAKA
1. Kemenkes RI. Situasi penyakit ginjal kronis. Infodatin Pusat Data dan Informasi. 2017;11:1-8.
2. Astuti N. Analisis kesesuaian biaya riil pada pasien rawat inap penyakit ginjal kronik dengan hemodialisis
di RSUD Dr. Moewardi Surakarta dengan INA-CBG’s tahun 2017. Thesis. Surakarta: Fakultas Farmasi,
Universitas Setia Budi; 2018.
3. Charlson ME, et al. The Charlson comorbidity index is adapted to predict costs of chronic disease in
primary care patients. Journal of Clinical Epidemiology. 2008;61:1234-1240.
4. Nurwanti R. Analisis biaya pengobatan gagal ginjal kronik dengan hemodialisis pada pasien rawat inap di
RSD Dr. Soebandi Jember periode 2009. Pharmauho. 2018;4(1):42-47.

289 Jurnal Penelitian Kesehatan Suara Forikes ------ http://forikes-ejournal.com/index.php/SF

Jurnal Penelitian Kesehatan Suara Forikes ----------------------------------- Volume 14 Nomor 2, April 2023
p-ISSN 2086-3098 e-ISSN 2502-7778

5. Kemenkes RI. Buku panduan penilaian teknologi kesehatan “efektivitas klinis dan evaluasi ekonomi”.
Jakarta: Kementerian Kesehatan Republik Indonesia; 2017.
6. Susanto Y, Alfian R, Rahim Z, Karani. Uji validitas dan reliabilitas kuesioner EQ-5D Bahasa Indonesia
untuk mengukur kualitas hidup pasien hemodialisa gagal ginjal kronik. Jurnal Ilmiah Manuntung.
2018;4(1):41-47.
7. Sukawati NW. Perbandingan kuesioner EQ-5D-5L dan SF-6D untuk mengukur kualitas hidup pasien
penyakit ginjal kronik di RSUD Kota Yogyakarta. Thesis. Surakarta: Fakultas Farmasi, Universitas Setia
Budi; 2019.
8. Smeltzer B. Medical surgical nursing. Brunner and Suddarth. Jakarta: Penerbit EGC; 2006.
9. Septiwi C. Hubungan antara adekuasi hemodialisis dengan kualitas hidup pasien hemodialisis di unit
hemodialisis RS Prof. Dr. Margono Soekarjo Purwokerto. Thesis. Depok: Fakultas Ilmu Keperawatan,
Universitas Indonesia; 2010.
10. Nurchayati S. Analisa faktor yang berhubungan dengan kualitas hidup pasien penyakit ginjal kronik yang
menjalani hemodialisis di Rumah Sakit Islam Fahmawati Cilacap dan RSUD Banyumas. Thesis. Depok:
Fakultas Ilmu Keperawatan, Universitas Indonesia; 2010.
11. Rohenti IR, Rahmadaniati HU, Sarnianto P. Analisis biaya medis langsung pasien hemodialisa di Rumah
Sakit X wilayah Bekasi. Jurnal Farmasi Indonesia. 2019;16(2):386-395.
12. Curtin RB, Mapes DI, Schatell D, Burrows-Hudson S. Self mangement in patients with end stage renal
desease: exploring domains and dimenstion. Neprologi Nursing Journal. 2005;32(4):389-395.
13. Cook WL, Jassal SV. Functional dependences among the elderly on hemodialysis. Journal of International
Society of Nefrology. 2008;73(7):1289-1295.
14. Arsi. Analisis biaya satuan dan kualitas hidup penderita gagal ginjal kronik yang menggunakan tindakan
hemodialisis di Rumah Sakit Tebet tahun 2015. Jurnal ARSI. 2008;1(3):124–134.
15. Brunner, Suddarth. Keperawatan Medikal Bedah. Jakarta: EGC; 2005.
16. Gerasimoula K, Lefkothea L, Maria L, Victoria A, Paraskevi T, Maria P. Quality of life in haemodialysis
patients. Mater Sociomed. 2015;27(5):305-309.
17. Farida A. Pengalaman pasien hemodialisis terhadap kualitas hidup dalam konteks asuhan keperawatan di
RSUP Fatmawati Jakarta. Thesis. Depok: Fakultas Ilmu Keperawatan, Universitas Indonesia; 2010.
18. Hagita D, Bayhakki, Woferst R. Studi fenomenologi kualitas hidup pasien gagal ginjal kronik yang
menjalani hemodialisis di RSUD Arifin Achmad Pekanbaru. JOM. 2015;2(2):1032-1040.

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