Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor Serum dengan Skor Pruritus pada Pasien yang Menjalani Hemodialisis di RSUP Haji Adam Malik Medan
HUBUNGAN ANTARA KALSIUM, FOSFOR DAN
PRODUK KALSIUM FOSFOR SERUM DENGAN
SKOR PRURITUS PADA PASIEN YANG MENJALANI
HEMODIALISIS DI RSUP HAJI ADAM MALIK
MEDAN
TESIS
Oleh :
WISYANTI MIAN ULI SIAHAAN
PROGRAM PENDIDIKAN DOKTER SPESIALIS
DEPARTEMEN ILMU KESEHATAN KULIT DAN KELAMIN
FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA
MEDAN
2016
Universitas Sumatera Utara
HUBUNGAN ANTARA KALSIUM, FOSFOR DAN
PRODUK KALSIUM FOSFOR SERUM DENGAN
SKOR PRURITUS PADA PASIEN YANG MENJALANI
HEMODIALISIS DI RSUP HAJI ADAM MALIK
MEDAN
TESIS
Diajukan sebagai syarat untuk memperoleh gelar Dokter Spesialis
Dalam Program Pendidikan Dokter Spesialis Kulit dan Kelamin
Fakultas Kedokteran Universitas Sumatera Utara
Oleh:
WISYANTI MIAN ULI SIAHAAN
PROGRAM PENDIDIKAN DOKTER SPESIALIS
DEPARTEMEN ILMU KESEHATAN KULIT DAN KELAMIN
FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA
MEDAN
2016
Universitas Sumatera Utara
HALAMAN PERSETUJUAN
Judul Tesis
: Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor Serum
dengan Skor Pruritus pada Pasien yang Menjalani Hemodialisis di RSUP Haji
Adam Malik Medan
Nama
: dr. Wisyanti Mian Uli Siahaan
Nomor Induk
: 117105009
Program Studi
: Program Pendidikan Dokter Spesialis
Bidang
: Ilmu Kesehatan Kulit dan Kelamin
Menyetujui:
Pembimbing I
Pembimbing II
(dr. Chairiyah Tanjung, SpKK(K),FINSDV,FAADV)
(dr. Abdurrahim Rasyid Lubis, SpPD, KGH)
NIP: 195012111978112001
NIP: 195010111980121001
Ketua Program Studi
Ketua Departemen
(dr.Chairiyah Tanjung,SpKK(K),FINSDV,FAADV)
(Prof.Dr.dr.Irma D Roesyanto, SpKK(K))
NIP. 195012111978112001
NIP. 194712241976032001
Universitas Sumatera Utara
HALAMAN PERNYATAAN ORISINALITAS
Tesis ini adalah hasil karya penulis sendiri,
dan semua sumber baik yang dikutip maupun dirujuk
telah penulis nyatakan dengan benar
Nama
: Wisyanti Mian Uli Siahaan
NIM
: 117041210
Tanda tangan
:
Universitas Sumatera Utara
Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor Serum
dengan Skor Pruritus pada Pasien yang Menjalani Hemodialisis
di RSUP Haji Adam Malik Medan
Wisyanti Mian Uli Siahaan, *Abdurrahim Rasyid Lubis, Chairiyah Tanjung
Departemen Ilmu Kesehatan Kulit dan Kelamin
*Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas Sumatera Utara
RSUP Haji Adam Malik Medan-Indonesia
Abstrak
Latar belakang: Pruritus uremikum adalah suatu gejala yang sering ditemukan pada
pasien-pasien penyakit ginjal stadium akhir yang menjalani hemodialisis, dengan
mekanisme yang masih belum jelas diketahui. Beberapa studi telah meneliti faktorfaktor risiko terkait yang mempengaruhi kejadian pruritus pada pasien hemodialisis.
Kalsium, fosfor dan produk kalsium fosfor dapat berperan pada patofisiologi
pruritus, yang diduga disebabkan oleh mikropresipitasi zat-zat tersebut pada kulit.
Tujuan: Untuk menentukan korelasi antara kalsium, fosfor dan produk kalsium
fosfor dengan skor pruritus pada pasien hemodialisis di RSUP Haji Adam Malik
Medan.
Metode: Studi ini bersifat analitik korelatif dengan rancangan potong lintang, yang
mengikutsertakan 90 pasien hemodialisis. Skor pruritus didapatkan dengan
menggunakan kuesioner pruritus. Kadar kalsium dan fosfor serum diperiksa di
laboratorium patologi klinik. Uji Saphiro-Wilk menunjukkan bahwa data tidak
terdistribusi normal, dan korelasi dianalisis secara statistik dengan Uji Korelasi
Spearman.
Hasil: Sembilan puluh pasien hemodialisis ikut serta dalam studi ini dan 64,4%
diantaranya adalah laki-laki. Pruritus didapatkan pada 77,8% pasien. Tidak
ditemukan adanya korelasi antara kalsium, fosfor dan produk kalsium fosfor serum
dengan skor pruritus, dengan koefisien korelasi 0,046 (nilai p 0,670), 0,015 (nilai p
0,891), dan 0,007 (nilai p 0,949), secara berturut-turut.
Kesimpulan: Sebagian besar pasien hemodialisis mengalami pruritus (77,8%) dan
tidak ada hubungan antara kalsium, fosfor dan produk kalsium fosfor serum dengan
pruritus.
Kata kunci: pruritus, pruritus uremikum, kalsium, fosfor dan produk kalsium fosfor
serum
i
Universitas Sumatera Utara
Correlation between Calcium, Phosphorus and Calcium-Phosphorus Product
Serum and Pruritus Score in Hemodialysis Patients
at Haji Adam Malik General Hospital Medan
Wisyanti Mian Uli Siahaan, *Abdurrahim Rasyid Lubis, Chairiyah Tanjung
Department of Dermatology and Venereology
*Department of Internal Medicine
Faculty of Medicine University of Sumatera Utara
Haji Adam Malik General Hospital Medan-Indonesia
Abstract
Background: Uremic pruritus is a frequent symptom in patients with end stage renal
disease on hemodialysis, which mechanism remains unclear. Several studies
examined associated risk factors contributed to pruritus in hemodialysis patients.
Calcium, phosphorus and calcium-phosphorus product may play a role in the
pathophysiology of pruritus, that allegedly caused by microprecipitation of those
substances in the skin.
Objective: To determine the correlation between calcium, phosphorus and calciumphosphorus product and pruritus score in hemodialysis patients at Haji Adam Malik
General Hospital Medan.
Methods: This is a cross-sectional correlative analytic study involving 90
hemodialysis patients. Pruritus score was accessed by using pruritus questionnaire.
Calcium and phosphorus serum levels were examined in clinical pathology
laboratory. Saphiro-Wilk test showed that the data were not normally distributed, and
the correlation was analyzed statistically with Spearman correlation test.
Results: Ninety hemodialysis patients were involved in this study and 64,4% were
male. Pruritus was found in 77,8% of patients. We found no correlation between
calcium, phosphorus, and calcium-phosphorus product serum and pruritus score,
with correlation coefficients were 0,046 (p-value 0,670), 0,015 (p-value 0,891), and
0,007 (p-value 0,949), respectively. Conclusion: Most of the hemodialysis patients
had pruritus (77,8%) and there was no correlation between calcium, phosphorus, and
calcium-phosphorus product serum and pruritus.
Keywords: pruritus, uremic pruritus, calcium, phosphorus, and calcium-phosphorus
product serum
ii
Universitas Sumatera Utara
DAFTAR ISI
DAFTAR ISI ................................................................................................................. i
DAFTAR SINGKATAN ............................................................................................ vi
DAFTAR GAMBAR ................................................................................................. vii
DAFTAR TABEL ..................................................................................................... viii
DAFTAR LAMPIRAN ............................................................................................... ix
BAB 1 PENDAHULUAN
1.1 Latar Belakang .......................................................................................... 1
1.2 Rumusan Masalah ...................................................................................... 4
1.3 Tujuan Penelitian ....................................................................................... 4
1.3.1 Tujuan umum ................................................................................... 4
1.3.1 Tujuan khusus .................................................................................. 4
1.4 Manfaat Penelitian ..................................................................................... 5
BAB 2 TINJAUAN PUSTAKA
2.1 Pruritus Uremikum ..................................................................................... 6
2.1.1 Pendahuluan ..................................................................................... 6
2.1.2 Epidemiologi .................................................................................... 7
2.1.3 Etiolologi dan patogenesis ............................................................... 7
2.1.4 Pendekatan diagnostik .................................................................... 10
2.1.5 Pemeriksaan laboratorium .............................................................. 11
2.1.6 Penatalaksanaan ............................................................................. 12
2.2 Derajat Keparahan Pruritus ...................................................................... 12
2.2.1 Visual analogue scale (VAS) ......................................................... 13
2.2.2 Penilaian pruritus modifikasi Duo dan Mettang ............................ 14
2.3 Penyakit Ginjal Kronik ............................................................................ 16
2.3.1 Pendahuluan ................................................................................... 16
2.3.2 Epidemiologi .................................................................................. 17
2.3.3 Etiologi dan patogenesis................................................................. 17
2.3.4 Pendekatan diagnostik .................................................................... 19
2.3.5 Penatalaksanaan ............................................................................. 20
2.4 Hemodialisis ............................................................................................. 21
2.5 Beberapa Faktor Metabolik yang Terkait Pruritus Uremikum................. 22
2.5.1 Kadar kalsium serum ...................................................................... 22
2.5.2 Kadar fosfor serum ......................................................................... 26
2.5.3 Produk kalsium fosfor .................................................................... 28
2.6 Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor .....
Serum dengan Skor Pruritus ................................................................... 28
2.7 Kerangka Teori ......................................................................................... 31
2.8 Kerangka Konsep ..................................................................................... 32
2.9 Hipotesis ................................................................................................... 32
iii
Universitas Sumatera Utara
BAB 3 METODE PENELITIAN
3.1 Desain Penelitian ...................................................................................... 33
3.2 Waktu dan Tempat Penelitian .................................................................. 33
3.3 Populasi Penelitian .................................................................................. 33
3.3.1 Populasi ....................................................................................... 33
3.3.2 Subyek penelitian......................................................................... 34
3.4 Kriteria Inklusi dan Eksklusi .................................................................... 34
3.4.1 Kriteria inklusi ............................................................................. 34
3.4.2 Kriteria eksklusi ........................................................................... 34
3.5 Besar Sampel ............................................................................................ 35
3.6 Cara Pengambilan Sampel ....................................................................... 35
3.7 Identifikasi Variabel ................................................................................. 36
3.7.1 Variabel bebas.............................................................................. 36
3.7.2 Variabel terikat ............................................................................ 36
3.8 Definisi Operasional ................................................................................. 36
3.9 Alat dan Cara Kerja .................................................................................. 38
3.9.1 Alat .............................................................................................. 38
3.9.2 Cara kerja ..................................................................................... 38
3.9.3 Uji validitas .................................................................................. 40
3.10 Kerangka Operasional ............................................................................ 41
3.11 Pengolahan dan Analisis Data ................................................................ 41
3.12 Ethical Clearance ................................................................................... 42
BAB 4 HASIL DAN PEMBAHASAN
4.1 Karakteristik Subyek Penelitian .............................................................. 43
4.1.1 Distribusi berdasarkan proporsi pruritus...................................... 43
4.1.2 Karakteristik berdasarkan usia ..................................................... 44
4.1.3 Karakteristik berdasarkan jenis kelamin ...................................... 45
4.1.4 Karakteristik berdasarkan derajat keparahan pruritus ................. 45
4.1.5 Karakteristik berdasarkan kadar kalsium serum .......................... 46
4.1.6 Karakteristik berdasarkan kadar fosfor serum ............................. 47
4.1.7 Karakteristik berdasarkan produk kalsium fosfor ........................ 48
4.2 Karakteristik Skor Pruritus ...................................................................... 49
4.2.1 Karakteristik berdasarkan usia .................................................... 49
4.2.2 Karakteristik berdasarkan jenis kelamin ...................................... 49
4.2.3 Karakteristik berdasarkan kadar kalsium serum .......................... 50
4.2.4 Karakteristik berdasarkan kadar fosfor serum ............................. 51
4.2.5 Karakteristik berdasarkan produk kalsium fosfor ........................ 51
4.2 Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor .....
Serum dengan Skor Pruritus ................................................................... 52
BAB 5 KESIMPULAN DAN SARAN
5.1 Kesimpulan.............................................................................................. 56
5.2 Saran ........................................................................................................ 57
iv
Universitas Sumatera Utara
DAFTAR PUSTAKA ................................................................................................ 58
LAMPIRAN 1 ............................................................................................................ 63
LAMPIRAN 2 ............................................................................................................ 65
LAMPIRAN 3 ............................................................................................................ 66
LAMPIRAN 4 ............................................................................................................ 71
LAMPIRAN 5 ............................................................................................................ 73
LAMPIRAN 6 ............................................................................................................ 74
LAMPIRAN 7 ............................................................................................................ 77
LAMPIRAN 8 ............................................................................................................ 85
LAMPIRAN 9 ............................................................................................................ 88
v
Universitas Sumatera Utara
DAFTAR SINGKATAN
ATP
Ca
CaSR
DNA
DOPPS
ESRD
HIV
LFG
NRS
P
PGK
PTH
RNA
RSUD
RSUP
SMF
UVB
VAS
VRS
: Adenosine triphosphate
: Kalsium
: Calcium sensor receptor
: Deoxyribonucleic acid
: Dialysis Outcomes and Practice Pattern Study
: End-Stage Renal Disease
: Human Immunodeficiency Virus
: Laju filtrasi glomerulus
: Numeric rating scale
: Fosfor
: Penyakit ginjal kronik
: parathyroid hormone
: Ribonucleic acid
: Rumah Sakit Umum Daerah
: Rumah Sakit Umum Pusat
: Staf Medik Fungsional
: Ultraviolet B
: Visual Analogue Scale
: Verbal rating scale
vi
Universitas Sumatera Utara
DAFTAR GAMBAR
No.
Judul
Halaman
Gambar 2.1 Kerangka teori ........................................................................................ 31
Gambar 2.2 Kerangka konsep .................................................................................... 32
Gambar 3.1 Kerangka operasional ............................................................................. 41
vii
Universitas Sumatera Utara
DAFTAR TABEL
No.
Judul
Halaman
Tabel 4.1 Proporsi pruritus pada pasien hemodialisis ................................................ 43
Tabel 4.2 Distribusi subyek penelitian berdasarkan usia ........................................... 44
Tabel 4.3 Distribusi subyek penelitian berdasarkan jenis kelamin ............................ 45
Tabel 4.4 Distribusi subyek penelitian berdasarkan derajat keparahan pruritus ........ 45
Tabel 4.5 Distribusi subyek pruritus berdasarkan derajat keparahan pruritus ........... 45
Tabel 4.6 Distribusi subyek penelitian berdasarkan kadar kalsium serum ................ 46
Tabel 4.7 Distribusi subyek pruritus berdasarkan kadar kalsium serum ................... 46
Tabel 4.8 Distribusi subyek penelitian berdasarkan kadar fosfor serum ................... 47
Tabel 4.9 Distribusi subyek pruritus berdasarkan kadar fosfor serum....................... 47
Tabel 4.10 Distribusi subyek penelitian berdasarkan produk kalsium fosfor ............ 48
Tabel 4.11 Distribusi subyek pruritus berdasarkan produk kalsium fosfor ............... 48
Tabel 4.12 Distribusi skor pruritus berdasarkan usia ................................................. 49
Tabel 4.13 Distribusi skor pruritus berdasarkan jenis kelamin .................................. 49
Tabel 4.14 Distribusi skor pruritus berdasarkan kadar kalsium serum ...................... 50
Tabel 4.15 Distribusi skor pruritus berdasarkan kadar fosfor serum ......................... 51
Tabel 4.16 Distribusi skor pruritus berdasarkan produk kalsium fosfor serum ......... 51
Tabel 4.17 Hubungan antara kalsium, fosfor dan produk kalsium fosfor .....................
serum dengan skor pruritus ..................................................................... 52
Tabel 4.18 Hubungan antara kalsium, fosfor dan produk kalsium fosfor .....................
serum dengan pruritus ............................................................................. 52
viii
Universitas Sumatera Utara
DAFTAR LAMPIRAN
No.
Judul
Halaman
LAMPIRAN 1: Naskah penjelasan kepada subjek penelitian ................................... 63
LAMPIRAN 2: Persetujuan setelah penjelasan (PSP) ............................................... 65
LAMPIRAN 3: Status penelitian ............................................................................... 66
LAMPIRAN 4: Kuesioner Pruritus ............................................................................ 71
LAMPIRAN 5: Persetujuan komisi etik .................................................................... 73
LAMPIRAN 6: Karakteristik subyek penelitian ........................................................ 74
LAMPIRAN 7: Data statistik penelitian .................................................................... 77
LAMPIRAN 8: Dokumentasi penelitian.................................................................... 85
LAMPIRAN 9: Daftar riwayat hidup ........................................................................ 88
ix
Universitas Sumatera Utara
PRODUK KALSIUM FOSFOR SERUM DENGAN
SKOR PRURITUS PADA PASIEN YANG MENJALANI
HEMODIALISIS DI RSUP HAJI ADAM MALIK
MEDAN
TESIS
Oleh :
WISYANTI MIAN ULI SIAHAAN
PROGRAM PENDIDIKAN DOKTER SPESIALIS
DEPARTEMEN ILMU KESEHATAN KULIT DAN KELAMIN
FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA
MEDAN
2016
Universitas Sumatera Utara
HUBUNGAN ANTARA KALSIUM, FOSFOR DAN
PRODUK KALSIUM FOSFOR SERUM DENGAN
SKOR PRURITUS PADA PASIEN YANG MENJALANI
HEMODIALISIS DI RSUP HAJI ADAM MALIK
MEDAN
TESIS
Diajukan sebagai syarat untuk memperoleh gelar Dokter Spesialis
Dalam Program Pendidikan Dokter Spesialis Kulit dan Kelamin
Fakultas Kedokteran Universitas Sumatera Utara
Oleh:
WISYANTI MIAN ULI SIAHAAN
PROGRAM PENDIDIKAN DOKTER SPESIALIS
DEPARTEMEN ILMU KESEHATAN KULIT DAN KELAMIN
FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA
MEDAN
2016
Universitas Sumatera Utara
HALAMAN PERSETUJUAN
Judul Tesis
: Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor Serum
dengan Skor Pruritus pada Pasien yang Menjalani Hemodialisis di RSUP Haji
Adam Malik Medan
Nama
: dr. Wisyanti Mian Uli Siahaan
Nomor Induk
: 117105009
Program Studi
: Program Pendidikan Dokter Spesialis
Bidang
: Ilmu Kesehatan Kulit dan Kelamin
Menyetujui:
Pembimbing I
Pembimbing II
(dr. Chairiyah Tanjung, SpKK(K),FINSDV,FAADV)
(dr. Abdurrahim Rasyid Lubis, SpPD, KGH)
NIP: 195012111978112001
NIP: 195010111980121001
Ketua Program Studi
Ketua Departemen
(dr.Chairiyah Tanjung,SpKK(K),FINSDV,FAADV)
(Prof.Dr.dr.Irma D Roesyanto, SpKK(K))
NIP. 195012111978112001
NIP. 194712241976032001
Universitas Sumatera Utara
HALAMAN PERNYATAAN ORISINALITAS
Tesis ini adalah hasil karya penulis sendiri,
dan semua sumber baik yang dikutip maupun dirujuk
telah penulis nyatakan dengan benar
Nama
: Wisyanti Mian Uli Siahaan
NIM
: 117041210
Tanda tangan
:
Universitas Sumatera Utara
Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor Serum
dengan Skor Pruritus pada Pasien yang Menjalani Hemodialisis
di RSUP Haji Adam Malik Medan
Wisyanti Mian Uli Siahaan, *Abdurrahim Rasyid Lubis, Chairiyah Tanjung
Departemen Ilmu Kesehatan Kulit dan Kelamin
*Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas Sumatera Utara
RSUP Haji Adam Malik Medan-Indonesia
Abstrak
Latar belakang: Pruritus uremikum adalah suatu gejala yang sering ditemukan pada
pasien-pasien penyakit ginjal stadium akhir yang menjalani hemodialisis, dengan
mekanisme yang masih belum jelas diketahui. Beberapa studi telah meneliti faktorfaktor risiko terkait yang mempengaruhi kejadian pruritus pada pasien hemodialisis.
Kalsium, fosfor dan produk kalsium fosfor dapat berperan pada patofisiologi
pruritus, yang diduga disebabkan oleh mikropresipitasi zat-zat tersebut pada kulit.
Tujuan: Untuk menentukan korelasi antara kalsium, fosfor dan produk kalsium
fosfor dengan skor pruritus pada pasien hemodialisis di RSUP Haji Adam Malik
Medan.
Metode: Studi ini bersifat analitik korelatif dengan rancangan potong lintang, yang
mengikutsertakan 90 pasien hemodialisis. Skor pruritus didapatkan dengan
menggunakan kuesioner pruritus. Kadar kalsium dan fosfor serum diperiksa di
laboratorium patologi klinik. Uji Saphiro-Wilk menunjukkan bahwa data tidak
terdistribusi normal, dan korelasi dianalisis secara statistik dengan Uji Korelasi
Spearman.
Hasil: Sembilan puluh pasien hemodialisis ikut serta dalam studi ini dan 64,4%
diantaranya adalah laki-laki. Pruritus didapatkan pada 77,8% pasien. Tidak
ditemukan adanya korelasi antara kalsium, fosfor dan produk kalsium fosfor serum
dengan skor pruritus, dengan koefisien korelasi 0,046 (nilai p 0,670), 0,015 (nilai p
0,891), dan 0,007 (nilai p 0,949), secara berturut-turut.
Kesimpulan: Sebagian besar pasien hemodialisis mengalami pruritus (77,8%) dan
tidak ada hubungan antara kalsium, fosfor dan produk kalsium fosfor serum dengan
pruritus.
Kata kunci: pruritus, pruritus uremikum, kalsium, fosfor dan produk kalsium fosfor
serum
i
Universitas Sumatera Utara
Correlation between Calcium, Phosphorus and Calcium-Phosphorus Product
Serum and Pruritus Score in Hemodialysis Patients
at Haji Adam Malik General Hospital Medan
Wisyanti Mian Uli Siahaan, *Abdurrahim Rasyid Lubis, Chairiyah Tanjung
Department of Dermatology and Venereology
*Department of Internal Medicine
Faculty of Medicine University of Sumatera Utara
Haji Adam Malik General Hospital Medan-Indonesia
Abstract
Background: Uremic pruritus is a frequent symptom in patients with end stage renal
disease on hemodialysis, which mechanism remains unclear. Several studies
examined associated risk factors contributed to pruritus in hemodialysis patients.
Calcium, phosphorus and calcium-phosphorus product may play a role in the
pathophysiology of pruritus, that allegedly caused by microprecipitation of those
substances in the skin.
Objective: To determine the correlation between calcium, phosphorus and calciumphosphorus product and pruritus score in hemodialysis patients at Haji Adam Malik
General Hospital Medan.
Methods: This is a cross-sectional correlative analytic study involving 90
hemodialysis patients. Pruritus score was accessed by using pruritus questionnaire.
Calcium and phosphorus serum levels were examined in clinical pathology
laboratory. Saphiro-Wilk test showed that the data were not normally distributed, and
the correlation was analyzed statistically with Spearman correlation test.
Results: Ninety hemodialysis patients were involved in this study and 64,4% were
male. Pruritus was found in 77,8% of patients. We found no correlation between
calcium, phosphorus, and calcium-phosphorus product serum and pruritus score,
with correlation coefficients were 0,046 (p-value 0,670), 0,015 (p-value 0,891), and
0,007 (p-value 0,949), respectively. Conclusion: Most of the hemodialysis patients
had pruritus (77,8%) and there was no correlation between calcium, phosphorus, and
calcium-phosphorus product serum and pruritus.
Keywords: pruritus, uremic pruritus, calcium, phosphorus, and calcium-phosphorus
product serum
ii
Universitas Sumatera Utara
DAFTAR ISI
DAFTAR ISI ................................................................................................................. i
DAFTAR SINGKATAN ............................................................................................ vi
DAFTAR GAMBAR ................................................................................................. vii
DAFTAR TABEL ..................................................................................................... viii
DAFTAR LAMPIRAN ............................................................................................... ix
BAB 1 PENDAHULUAN
1.1 Latar Belakang .......................................................................................... 1
1.2 Rumusan Masalah ...................................................................................... 4
1.3 Tujuan Penelitian ....................................................................................... 4
1.3.1 Tujuan umum ................................................................................... 4
1.3.1 Tujuan khusus .................................................................................. 4
1.4 Manfaat Penelitian ..................................................................................... 5
BAB 2 TINJAUAN PUSTAKA
2.1 Pruritus Uremikum ..................................................................................... 6
2.1.1 Pendahuluan ..................................................................................... 6
2.1.2 Epidemiologi .................................................................................... 7
2.1.3 Etiolologi dan patogenesis ............................................................... 7
2.1.4 Pendekatan diagnostik .................................................................... 10
2.1.5 Pemeriksaan laboratorium .............................................................. 11
2.1.6 Penatalaksanaan ............................................................................. 12
2.2 Derajat Keparahan Pruritus ...................................................................... 12
2.2.1 Visual analogue scale (VAS) ......................................................... 13
2.2.2 Penilaian pruritus modifikasi Duo dan Mettang ............................ 14
2.3 Penyakit Ginjal Kronik ............................................................................ 16
2.3.1 Pendahuluan ................................................................................... 16
2.3.2 Epidemiologi .................................................................................. 17
2.3.3 Etiologi dan patogenesis................................................................. 17
2.3.4 Pendekatan diagnostik .................................................................... 19
2.3.5 Penatalaksanaan ............................................................................. 20
2.4 Hemodialisis ............................................................................................. 21
2.5 Beberapa Faktor Metabolik yang Terkait Pruritus Uremikum................. 22
2.5.1 Kadar kalsium serum ...................................................................... 22
2.5.2 Kadar fosfor serum ......................................................................... 26
2.5.3 Produk kalsium fosfor .................................................................... 28
2.6 Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor .....
Serum dengan Skor Pruritus ................................................................... 28
2.7 Kerangka Teori ......................................................................................... 31
2.8 Kerangka Konsep ..................................................................................... 32
2.9 Hipotesis ................................................................................................... 32
iii
Universitas Sumatera Utara
BAB 3 METODE PENELITIAN
3.1 Desain Penelitian ...................................................................................... 33
3.2 Waktu dan Tempat Penelitian .................................................................. 33
3.3 Populasi Penelitian .................................................................................. 33
3.3.1 Populasi ....................................................................................... 33
3.3.2 Subyek penelitian......................................................................... 34
3.4 Kriteria Inklusi dan Eksklusi .................................................................... 34
3.4.1 Kriteria inklusi ............................................................................. 34
3.4.2 Kriteria eksklusi ........................................................................... 34
3.5 Besar Sampel ............................................................................................ 35
3.6 Cara Pengambilan Sampel ....................................................................... 35
3.7 Identifikasi Variabel ................................................................................. 36
3.7.1 Variabel bebas.............................................................................. 36
3.7.2 Variabel terikat ............................................................................ 36
3.8 Definisi Operasional ................................................................................. 36
3.9 Alat dan Cara Kerja .................................................................................. 38
3.9.1 Alat .............................................................................................. 38
3.9.2 Cara kerja ..................................................................................... 38
3.9.3 Uji validitas .................................................................................. 40
3.10 Kerangka Operasional ............................................................................ 41
3.11 Pengolahan dan Analisis Data ................................................................ 41
3.12 Ethical Clearance ................................................................................... 42
BAB 4 HASIL DAN PEMBAHASAN
4.1 Karakteristik Subyek Penelitian .............................................................. 43
4.1.1 Distribusi berdasarkan proporsi pruritus...................................... 43
4.1.2 Karakteristik berdasarkan usia ..................................................... 44
4.1.3 Karakteristik berdasarkan jenis kelamin ...................................... 45
4.1.4 Karakteristik berdasarkan derajat keparahan pruritus ................. 45
4.1.5 Karakteristik berdasarkan kadar kalsium serum .......................... 46
4.1.6 Karakteristik berdasarkan kadar fosfor serum ............................. 47
4.1.7 Karakteristik berdasarkan produk kalsium fosfor ........................ 48
4.2 Karakteristik Skor Pruritus ...................................................................... 49
4.2.1 Karakteristik berdasarkan usia .................................................... 49
4.2.2 Karakteristik berdasarkan jenis kelamin ...................................... 49
4.2.3 Karakteristik berdasarkan kadar kalsium serum .......................... 50
4.2.4 Karakteristik berdasarkan kadar fosfor serum ............................. 51
4.2.5 Karakteristik berdasarkan produk kalsium fosfor ........................ 51
4.2 Hubungan antara Kadar Kalsium, Fosfor dan Produk Kalsium Fosfor .....
Serum dengan Skor Pruritus ................................................................... 52
BAB 5 KESIMPULAN DAN SARAN
5.1 Kesimpulan.............................................................................................. 56
5.2 Saran ........................................................................................................ 57
iv
Universitas Sumatera Utara
DAFTAR PUSTAKA ................................................................................................ 58
LAMPIRAN 1 ............................................................................................................ 63
LAMPIRAN 2 ............................................................................................................ 65
LAMPIRAN 3 ............................................................................................................ 66
LAMPIRAN 4 ............................................................................................................ 71
LAMPIRAN 5 ............................................................................................................ 73
LAMPIRAN 6 ............................................................................................................ 74
LAMPIRAN 7 ............................................................................................................ 77
LAMPIRAN 8 ............................................................................................................ 85
LAMPIRAN 9 ............................................................................................................ 88
v
Universitas Sumatera Utara
DAFTAR SINGKATAN
ATP
Ca
CaSR
DNA
DOPPS
ESRD
HIV
LFG
NRS
P
PGK
PTH
RNA
RSUD
RSUP
SMF
UVB
VAS
VRS
: Adenosine triphosphate
: Kalsium
: Calcium sensor receptor
: Deoxyribonucleic acid
: Dialysis Outcomes and Practice Pattern Study
: End-Stage Renal Disease
: Human Immunodeficiency Virus
: Laju filtrasi glomerulus
: Numeric rating scale
: Fosfor
: Penyakit ginjal kronik
: parathyroid hormone
: Ribonucleic acid
: Rumah Sakit Umum Daerah
: Rumah Sakit Umum Pusat
: Staf Medik Fungsional
: Ultraviolet B
: Visual Analogue Scale
: Verbal rating scale
vi
Universitas Sumatera Utara
DAFTAR GAMBAR
No.
Judul
Halaman
Gambar 2.1 Kerangka teori ........................................................................................ 31
Gambar 2.2 Kerangka konsep .................................................................................... 32
Gambar 3.1 Kerangka operasional ............................................................................. 41
vii
Universitas Sumatera Utara
DAFTAR TABEL
No.
Judul
Halaman
Tabel 4.1 Proporsi pruritus pada pasien hemodialisis ................................................ 43
Tabel 4.2 Distribusi subyek penelitian berdasarkan usia ........................................... 44
Tabel 4.3 Distribusi subyek penelitian berdasarkan jenis kelamin ............................ 45
Tabel 4.4 Distribusi subyek penelitian berdasarkan derajat keparahan pruritus ........ 45
Tabel 4.5 Distribusi subyek pruritus berdasarkan derajat keparahan pruritus ........... 45
Tabel 4.6 Distribusi subyek penelitian berdasarkan kadar kalsium serum ................ 46
Tabel 4.7 Distribusi subyek pruritus berdasarkan kadar kalsium serum ................... 46
Tabel 4.8 Distribusi subyek penelitian berdasarkan kadar fosfor serum ................... 47
Tabel 4.9 Distribusi subyek pruritus berdasarkan kadar fosfor serum....................... 47
Tabel 4.10 Distribusi subyek penelitian berdasarkan produk kalsium fosfor ............ 48
Tabel 4.11 Distribusi subyek pruritus berdasarkan produk kalsium fosfor ............... 48
Tabel 4.12 Distribusi skor pruritus berdasarkan usia ................................................. 49
Tabel 4.13 Distribusi skor pruritus berdasarkan jenis kelamin .................................. 49
Tabel 4.14 Distribusi skor pruritus berdasarkan kadar kalsium serum ...................... 50
Tabel 4.15 Distribusi skor pruritus berdasarkan kadar fosfor serum ......................... 51
Tabel 4.16 Distribusi skor pruritus berdasarkan produk kalsium fosfor serum ......... 51
Tabel 4.17 Hubungan antara kalsium, fosfor dan produk kalsium fosfor .....................
serum dengan skor pruritus ..................................................................... 52
Tabel 4.18 Hubungan antara kalsium, fosfor dan produk kalsium fosfor .....................
serum dengan pruritus ............................................................................. 52
viii
Universitas Sumatera Utara
DAFTAR LAMPIRAN
No.
Judul
Halaman
LAMPIRAN 1: Naskah penjelasan kepada subjek penelitian ................................... 63
LAMPIRAN 2: Persetujuan setelah penjelasan (PSP) ............................................... 65
LAMPIRAN 3: Status penelitian ............................................................................... 66
LAMPIRAN 4: Kuesioner Pruritus ............................................................................ 71
LAMPIRAN 5: Persetujuan komisi etik .................................................................... 73
LAMPIRAN 6: Karakteristik subyek penelitian ........................................................ 74
LAMPIRAN 7: Data statistik penelitian .................................................................... 77
LAMPIRAN 8: Dokumentasi penelitian.................................................................... 85
LAMPIRAN 9: Daftar riwayat hidup ........................................................................ 88
ix
Universitas Sumatera Utara