Manajemen Hemodialisis pada Pasien Gagal Ginjal Kronik Stadium V dengan Kehamilan Trimester Pertama: Studi Kasus

https://doi.org/10.22146/jkkk.104747

Alfina Fitri Purbasari(1*), Arifin Triyanto(2), Sukardi Sukardi(3)

(1) Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(2) Departemen Keperawatan Medikal Bedah, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan Universitas Gadjah Mada
(3) Instalasi Hemodialisis Rumah Sakit Umum Pusat Dr. Sardjito
(*) Corresponding Author

Abstract


Background: Chronic kidney disease in pregnancy is a medical disorder that can increase the mother and her fetal morbidity as well as mortality. The high risk of morbidity and mortality in pregnant woman undergoing hemodialysis requires the role of nurses as direct caregivers to patients.
Objective: To determine the management of pregnant woman with chronic kidney disease undergoing hemodialysis.
Case report: A patient, 30 years old G4P1A2 had undergone routine hemodialysis since 2018. The patient was currently pregnant with a gestational age of 7 weeks and there was an increase in the frequency of hemodialysis after her pregnancy was discovered. The patient started hemodialysis 3 times a week with a duration of 4,5 hours. The left femoral was used as dialysis access.
Outcomes: After undergoing hemodialysis 3 times a week, the patient had an interdialysis weight gain of 1,3 to 2,8 kg, with a HD prescription of blood flow rate (QB) of 180-200 ml/min, QD of 500 ml/min, total fluid withdrawal (UF goal) of 2.000-3.500 ml, mini/free heparin dose and Kt/V achievement of 1,33 to 1,67 points. The patient said she felt lighter and more comfortable after undergoing hemodialysis frequency of 3 times a week.
Conclusion: Interventions that need to be carried out on pregnant woman undergoing hemodialysis are dialysis intensification with increased hemodialysis frequency, UF adjusted to interdialysis weight gain, minimal use of heparin, and maternal nutritional support as the principles in supporting this high-risk pregnancy.

INTISARI

Latar belakang: Penyakit ginjal kronis pada kehamilan adalah suatu kelainan medis yang dapat meningkatkan morbiditas dan mortalitas ibu dan janin. Dengan adanya risiko tinggi morbiditas dan mortalitas pada ibu hamil yang menjalani hemodialisis, maka dibutuhkan peran perawat sebagai pemberi asuhan langsung pada pasien.
Tujuan: Mengetahui penatalaksanaan ibu hamil dengan penyakit ginjal kronis yang menjalani hemodialisis.
Laporan kasus: Seorang pasien berusia 30 tahun G4P1A2 sudah menjalani hemodialisis rutin sejak tahun 2018. Pasien saat ini sedang hamil dengan usia kehamilan jalan 7 minggu dan terdapat peningkatan frekuensi hemodialisis setelah diketahui sedang hamil. Pasien mulai melakukan hemodialisis 3 kali seminggu dengan durasi 4,5 jam. Akses dialisis yang digunakan adalah femoral sinistra.
Hasil: Setelah menjalani hemodialisis 3 kali seminggu, pasien mengalami kenaikan berat badan interdialisis 1,3-2,8 kg, dengan resep HD kecepatan aliran darah (QB) 180-200 ml/menit, QD 500 ml/menit, jumlah total penarikan cairan (UF goal) 2.000-3.500 ml, dosis heparin mini/ free dan capaian Kt/V 1,33-1,67. Pasien mengatakan merasa lebih ringan dan nyaman setelah menjalani hemodialisis dengan frekuensi 3 kali seminggu.
Simpulan: Intervensi yang perlu dilakukan pada ibu hamil yang menjalani hemodialisis, yaitu intensifikasi dialisis dengan peningkatan frekuensi hemodialisis, UF yang disesuaikan dengan peningkatan berat badan interdialisis, penggunaan heparin seminimal mungkin, dan dukungan nutrisi ibu menjadi prinsip dalam mendukung kehamilan berisiko tinggi ini.


Keywords


gagal ginjal kronik; hemodialisis; ibu hamil

Full Text:

PDF


References

  1. Vaidya S.R, Aeddula N.R. Chronic Kidney Disease. Florida: StatPearls Publishing; 2022.

  2. Centers for Disease Control and Prevention. Chronic Kidney Disease Basics [homepage on the Internet]. c.2022. [updated 2024; cited 2024]. Available from https://www.cdc.gov/kidney-disease/about/index.html.

  3. Indonesian Renal Registry. 11th Report of Indonesian Renal Registry 2018 [homepage on the internet]. c.2018. [updated 2018; cited 2025]. Available from https://indonesianrenalregistry.org.

  4. Murdeshwar, H.N, Anjum, F. Hemodialysis. Florida: StatPearls Publishing; 2023.

  5. Aprilia D. Penyakit Ginjal Kronis pada Kehamilan. Jurnal Kesehatan Andalas. 2019;3 (8):708–716. https://doi.org/http://dx.doi.org/10.25077/jka.v8i3.1060.

  6. Wiles K, Webster P, Seed PT, Bennett-Richards K, Bramham K, Brunskill N. The Impact of Chronic Kidney Disease Stages 3-5 on Pregnancy Outcomes. Nephrology Dialysis Transplantation. 2021; 36 (11):2008–17. https://doi.org/10.1093/ndt/gfaa247.

  7. Hui D, Hladunewich MA. Chronic Kidney Disease and Pregnancy. Obstetrics and Gynecology. 2019;133(6):1182–1194. https://doi.org/10.1097/AOG.0000000000003256.

  8. Maharani CR, Farsya PT. Penyakit Ginjal Kronis dan Kehamilan. Jurnal Kedokteran Nanggroe Media. 2022;5(3):74–80.https://doi.org/10.35324/jknamed.v5i3.204.

  9. Baouche H, Jais JP, Meriem S, Kareche M, Moranne O, Vigneau C, et al. Pregnancy in Women on Chronic Dialysis in The Last Decade (2010–2020): A Systematic Review. Clinical Kidney Journal. 2023;16(1):138–150. https://doi.org/10.1093/ckj/sfac204.

  10. Ribeiro CI, Silva N. Pregnancy and Dialysis. J Bras Nefrol. 2020;42(3):349–356. https://doi.org/10.1590/2175-8239-jbn-2020-0028.

  11. Al-Saran KA, Sabry AA. Pregnancy in Dialysis Patients: A Case Series. Journal of Medical Case Reports. 2008;2(10):1–4. https://doi.org/10.1186/1752-1947-2-10.

  12. Herdman TH, K S. Nanda Internasional Diagnosis Keperawatan: Definisi dan Klasifikasi 2018-2020. Edisi 11. Jakarta: EGC; 2018.

  13. Moorhead S, Dkk. Nursing Outcomes Classification (NOC). Edisi 6. Philadelphia: Elsevier; 2018.

  14. Bulechek GM, Butcher HK, Dochterman JM, M.Wagner C. Nursing Interventions Classification (NIC). Jakarta: Mocomedia; 2013.

  15. Kementerian Kesehatan Republik Indonesia. Olahraga bagi Ibu Hamil [homepage on the internet]. c.2024. [updated 2024; cited 2024] Available from https://sehatnegeriku.kemkes.go.id/baca//20240626/4445835/olahraga-bagi-ibu-hamil/text=Ibu.

  16. Williams D, Davison J. Pregnancy plus: Chronic Kidney Disease in Pregnancy. BMJ. 2008;336(7637):211–215. https://doi.org/10.1136/bmj.39406.652986.BE.

  17. National Kidney Foundation. Fluid Overload in A Dialysis Patient. National Kidney Foundation. 2024[homepage on the internet]. c.2024. [udpated 2024; cited 2024]. Available from https://www.kidney.org/kidney-topics/fluid-overload-dialysis-patient

  18. Piccoli GB, Minelli F, Versino E, Cabiddu G, Attini R, Vigotti FN, Rolfo, Giuffrida, Colombi N, Pani A, Todros T. Pregnancy in Dialysis Patients in The New Millennium: A Systematic Review and Meta-Regression Analysis Correlating Dialysis Schedules and Pregnancy Outcomes. Nephrology Dialysis Transplantation. 2016;31(11):1915–1934. https://doi.org/10.1093/ndt/gfv395.

  19. Orlowska-Kowalik G, Malecka-Massalska T, Ksiazek A. Successful Pregnancy in A Chronically Hemodialyzed Patient with End-Stage Renal Failure. Indian Journal Nephrology. 2009;19(1):27–29. https://doi.org/10.4103/0971-4065.50678.

  20. Nugroho P. Apakah Hemodialisis Tiga Kali Seminggu Lebih Baik?. Jurnal Penyakit Dalam Indonesia. 2017;4(3):103. https://doi.org/10.7454/jpdi.v4i3.142.

  21. Naryati, Aisyah, Widakdo G, Nuraenah, Handayani R, Waluyo IK, Mahmudah A, Adelia A. Peningkatan Kemampuan Adekuasi Perawat Ruang Hemodialisa. In Tata Mutiara Hidup Indonesia. 2023:6(10):4298-4306. https://doi.org/10.33024/jkpm.v6i10.12151.

  22. Manisco G, Potì M, Maggiulli G, Di Tullio M, Losappio V, Vernaglione L. Pregnancy in End-Stage Renal Disease Patients on Dialysis: How to Achieve A Successful Delivery. Clinical Kidney Journal. 2015;8(3):293–299. https://doi.org/10.1093/ckj/sfv016.

  23. Laksono S, Masrie MS. Hipertensi dalam Kehamilan: Tinjauan Narasi. Herb-Medicine Journal. 2022;5(2):27–39. https://doi.org/10.30595/hmj.v5i2.13043.

  24. Hwang, D.S, Mahdy, H. Polyhydramnios. Florida: StatPearls Publishing; 2023

  25. Hladunewich, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M, Tennankore K, Keunen J, Hui D, Chan C. Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison. Journal of The American Society of Nephrology. 2014;25(5):1103–1109. https://doi.org/10.1681/ASN.2013080825.

  26. Kothari M, Hampton T, Singh M. Dialysis and Pregnancy-A Review. International Journal Nephrology and Kidney Failure. 2019;5(3):1–7. https://doi.org/10.16966/2380-5498.175.

  27. Hladunewich M, Schatell D. Intensive Dialysis and Pregnancy. Hemodialyasis International. 2016;20(3):339–348. https://doi.org/10.1111/hdi.12420.

  28. Cabiddu G, Castellino S, Gernone G, Santoro D. A Best Practice Position Statement on Pregnancy in Chronic Kidney Disease: The Italian Study Group on Kidney and Pregnancy. Journal of Nephrology. 2016;29(3):277–303. https://doi.org/10.1007/s40620-016-0285-6.

  29. Vázquez-Rodríguez JG. Hemodialysis and Pregnancy: Technical Aspects. Cirugia y Cirujanos. 2010;78(1):93–96. http://www.ncbi.nlm.nih.gov/pubmed/20226136.

  30. Marques L, Marinho P, Rocco R, Martins CDA, Pereira H, Ferreira A. Effect of Ultrafiltration on Placental-Fetal Blood Flow in Pregnancy of Woman Undergoing Chronic Hemodialysis. Hemodialysis International. 2017;22(3):1–8. https://doi.org/10.1111/hdi.12624.

  31. Shehaj L, Kazancıo R. Pregnancy in Chronic Kidney Disease. Kidney Dial. 2023;3:152–162.

  32. Warnock L, Huang D. Heparin. Florida: StatPearls Publishing; 2023

  33. Luders C, Titan SM, Kahhale S, Francisco RP, Zugaib M. Risk Factors for Adverse Fetal Outcome in Hemodialysis Pregnant Women. Kidney International Reports. 2018;3(5):1077–1088. https://doi.org/10.1016/j.ekir.2018.04.013.

  34. Tangirala N, Hladunewich MA. Hemodialysis Prescription in Pregnant Women. ASN Kidney News. 2023;15(8):17. Avaliable from https://www.kidneynews.org/view/journals/kidney-news/15/8/article-p17_10.xml.

  35. Reyes-López MA, Piccoli GB, Leone F, Orozco-Guillén A, Perichart-Perera O. Nutrition Care for Chronic Kidney Disease during Pregnancy: An Updated Review. European Journal of Clinical Nutrition. 2020;74(7):983–990. http://dx.doi.org/10.1038/s41430-019-0550-6.

  36. Lakin H, Sheehan P, Soti V. Maternal Caffeine Consumption and Its Impact on The Fetus: A Review. Cureus. 2023;15(11). https://doi.org/10.7759/cureus.48266.



DOI: https://doi.org/10.22146/jkkk.104747

Article Metrics

Abstract views : 384 | views : 220

Refbacks

  • There are currently no refbacks.


Copyright (c) 2025 Alfina Fitri Purbasari, Arifin Triyanto, Sukardi Sukardi



Jurnal Keperawatan Klinis dan Komunitas (Clinical and Community Nursing Journal) 
collaborates with DPW PPNI DIY

Lisensi Creative Commons  

Jurnal Keperawatan Klinis dan Komunitas (Clinical and Community Nursing Journal) is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.