Penatalaksanaan Keperawatan Osteoporosis pada Pasien Hemodialisis: Studi Kasus

https://doi.org/10.22146/jkkk.78302

Pratiwi Lestari Putri(1), Haryani Haryani(2*), Tatik Dwi Wahyuni(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 Hemodialisa, RSUP Dr. Sardjito Yogyakarta
(*) Corresponding Author

Abstract


Background: Treatment of osteoporosis in hemodialysis patients is important since it slows down the worsening effect of osteoporosis and prevents bone fractures.
Objective: To know the description of osteoporosis nursing management in hemodialysis patients
Case description: A 62 years old male complained about his difficulty in walking, as well as back and ankle ache during strenuous activities after hemodialysis. Nursing actions were given with the aim of alleviating client complaints.
Results: This study found that the patient experienced back, knee, and ankle ache during strenuous activities. Pain management -as the nursing action- was given by administering paracetamol and CaCo3 as well as joint training education to strengthen muscles. The patient's pain level was decreased after the intervention from the severe category to the moderate category (pain range 7-8 to 4-5).
Conclusion: The treatment for osteoporosis in hemodialysis which includes phosphate buffer supplements, analgesic drugs, adherence to hemodialysis therapy, and muscle strengthening exercises, has pain reduction effect from severe to the moderate pain category.

ABSTRAK

Latar belakang: Penanganan osteoporosis pada pasien hemodialisis merupakan hal penting, agar dapat memperlambat perburukan osteoporosis dan mencegah terjadinya patah tulang.
Tujuan: Mengetahui gambaran penatalaksanaan keperawatan osteoporosis pada pasien hemodialisis.
Deskripsi kasus: Seorang lelaki, 62 tahun, mengeluh kesulitan berjalan, nyeri punggung, dan nyeri pada kaki saat beraktivitas berat selama 3 tahun terakhir setelah hemodialisis. Tindakan keperawatan diberikan dengan tujuan untuk meringankan keluhan klien.
Hasil: Hasil pengkajian didapatkan keluhan nyeri pada punggung, pergelangan kaki dan lutut saat beraktivitas berat. Tindakan keperawatan yang diberikan berupa penanganan nyeri akut dengan pemberian obat parasetamol dan CaCo3 serta edukasi latihan persendian untuk memperkuat otot. Setelah pemberian intervensi, tingkat nyeri pasien berkurang, dari kategori berat (rentang nyeri 7-8) menjadi kategori sedang (rentang nyeri 4-5).
Simpulan: Penanganan osteoporosis pada pasien hemodialisis mencakup suplemen penyangga fosfat, obat analgesik, kepatuhan terapi hemodialisis, dan penanganan non-farmakologis berupa latihan penguatan otot yang dapat memberi efek pengurangan nyeri, dari kategori nyeri berat menjadi nyeri sedang.


Keywords


hemodialisis, osteoporosis, perawatan

Full Text:

PDF


References

  1. Wilson S, Mone P, Jankauskas SS, Gambardella J, Santulli G. Chronic Kidney Disease: Definition, Updated Epidemiology, Staging, and Mechanisms of Increased Cardiovascular Risk. J Clin Hypertens. 2021; 23(4): 831–4. https://doi.org/10.1111/jch.14186.
  2. Wolff HN. Projected Number of People with A Chronic Kidney Disease Indonesia 2017-2024 [Internet]. Statistika State of Health. 2020. Available from: https://www.statista.com/statistics/1052607/indonesia-ncd-projection/.
  3. Wongrakpanich S, Susantitaphong P, Isaranuwatchai S, Chenbhanich J, Eiam-Ong S, Jaber BL. Dialysis Therapy and Conservative Management of Advanced Chronic Kidney Disease in The Elderly: A Systematic Review. Nephron. 2017; 137(3): 178–89. https://doi.org/10.1159/000477361.
  4. Levin A, Hemmelgarn B, Culleton B, Tobe S, McFarlane P, Ruzicka M, et al. Guidelines for The Management of Chronic Kidney Disease. Can Med Assoc J. 2008; 11(179): 1154–63. https://doi.org/10.1503%2Fcmaj.080351.
  5. Fassett RG. Current and Emerging Treatment Options for The Elderly Patient with Chronic Kidney Disease. Clin Interv Aging. 2014; 9: 191–9. https://doi.org/10.2147%2FCIA.S39763.
  6. Braun MM, Khayat M. Kidney Disease: Chronic Kidney Disease. FP Essent. 2021; 509 (Suppl 1): 20–5. Available from: https://pubmed.ncbi.nlm.nih.gov/34643361/.
  7. Morton RL, Snelling P, Webster AC, Rose J, Masterson R, Johnson DW, Howard K. Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease. CMAJ. 2012; 184(5): 277–84. https://doi.org/10.1503/cmaj.111355.
  8. Cannata-Andía JB, Rodriguez García M, Gómez Alonso C. Osteoporosis and Adynamic Bone in Chronic Kidney Disease. J Nephrol. 2013; 26(1): 73–80. https://doi.org/10.5301/jn.5000212.
  9. Khan MI, Syed GM, Khan AI, Sirwal IA, Anwar SK, Al-Oufi AR, et al. Mean Bone Mineral Density and Frequency of Occurrence of Osteopenia and Osteoporosis in Patients on Hemodialysis: A Single-Center Study. Saudi J Kidney Dis Transpl. 2013; 25(1): 38–42. https://doi.org/10.4103/1319-2442.124477.
  10. Khairallah P, Nickolas TL. Management of Osteoporosis in CKD. Clin J Am Soc Nephrol. 2018; 13(6): 962–9. https://doi.org/10.2215/cjn.11031017.
  11. Seyedzadeh A, Tohidi MR, Golmohamadi S, Omrani HR, Seyedzadeh MS, Amiri S, et al. Prevalence of Renal Osteodystrophy and Its Related Factors among End-stage Renal Disease Patients Undergoing Hemodialysis: Report from Imam Reza Referral Hospital of Medical University of Kermanshah, Iran. Oman Med J. 2022; 37(1). https://doi.org/10.5001/omj.2021.120.
  12. Slouma M, Sahli H, Bahlous A, Laadhar L, Smaoui W, Rekik S, et al. Mineral Bone Disorder and Osteoporosis in Hemodialysis Patients. Adv Rheumatol. 2020; 60(1): 1–7. https://doi.org/10.1186/s42358-020-0118-0.
  13. National Institute of Diabetes and Digestive and Kidney Disease. Mineral & Bone Disorder in Chronic Kidney Disease. National Institute of Diabetes and Digestive and Kidney Disease. 2020. Available from: https://www.niddk.nih.gov/health-information/kidney-disease/mineral-bone-disorder#:~:text=Mineral%20and%20bone%20disease%20occurs,become%20imbalanced%2C%20leading%20to%20damage.
  14. Heymann EP, Jenkins M, Goldsmith D. Clinical Features and Manifestations of CKD-MBD. Clin Rev Bone Miner Metab. 2012; 10(3): 142–8. https://doi.org/10.1007/s12018-011-9115-5.
  15. Pusdatin. Infodatin Osteoporosis [Internet]. Kementerian Kesehatan RI. 2020. Available from: https://pusdatin.kemkes.go.id/folder/view/01/structure-publikasi-pusdatin-info-datin.html.
  16. PERNEFRI. Konsesus Dialisis. Jakarta: Pernefri; 2003.
  17. Nitta K, Yajima A, Tsuchiya K. Management of Osteoporosis in Chronic Kidney Disease. Intern Med. 2017; 56(24): 3271–6. https://doi.org/10.2169%2Finternalmedicine.8618-16
  18. Saglimbene VM, Su G, Wong G, Natale P, Ruospo M, Palmer SC, et al. Dietary Intake in Adults on Hemodialysis Compared with Guideline Recommendations. J Nephrol [Internet]. 2021; 34(6): 1999–2007. https://doi.org/10.1007/s40620-020-00962-3
  19. Ismoyo PKDS, Yuwana S. Evaluasi Densitas Tulang Pasien dalam Terapi Hemodialisis: Faktor-faktor yang Berhubungan dengan Penurunan Massa Tulang [Tesis]. SP Orthopaedik Dan Traumatologi Universitas Gadjah Mada; 2015.
  20. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019; 393(10169): 364–76. https://doi.org/10.1016/s0140-6736(18)32112-3.
  21. Hruska KA, Seifert M, Sugatani T. Pathophysiology of The Chronic Kidney Disease - Mineral Bone Disorder. Curr Opin Nephrol Hypertens. 2015; 24(4): 303–9. https://doi.org/10.1097%2FMNH.0000000000000132.
  22. Nuti R, Brandi ML, Checchia G, Di Munno O, Dominguez L, Falaschi P, et al. Guidelines for The Management of Osteoporosis and Fragility Fractures. Intern Emerg Med [Internet]. 2019; 14(1): 85–102. https://doi.org/10.1007/s11739-018-1874-2.
  23. Rees L. Assessment of Dialysis Adequacy: Beyond Urea Kinetic Measurements. Pediatr Nephrol. 2019; 34(1): 61–9. https://doi.org/10.1007%2Fs00467-018-3914-6.
  24. Hashimoto H, Shikuma S, Mandai S, Adachi S, Uchida S. Calcium-based Phosphate Binder Use is Associated with Lower Risk of Osteoporosis in Hemodialysis Patients. Sci Rep [Internet]. 2021; 11(1): 1–9. https://doi.org/10.1038/s41598-021-81287-4.
  25. Andika GD, Kawiyana IKS, Wiratnaya IGE, Kandarini Y. Hemodialysis Duration and Underweight as A Risk Factors of Renal Osteodystrophy (Chronic Kidney Disease - Mineral Bone Disorder) on Regular Hemodialysis Patient. Int J Res Med Sci. 2021; 9(4): 970. https://dx.doi.org/10.18203/2320-6012.ijrms20211339.
  26. Evenepoel P, Cunningham J, Ferrari S, Haarhaus M, Javaid MK. European Consensus Statement on The Diagnosis and Management of Osteoporosis in Chronic Kidney Disease Stages G4 – G5D. Nephrol Dial Transpl. 2021; (October 2020): 42–59. https://doi.org/10.1093/ndt/gfaa192.
  27. Karcioglu O, Topacoglu H, Dikme O, Dikme O. A Systematic Review of The Pain Scales in Adults: Which to Use? Am J Emerg Med [Internet]. 2018; 36(4): 707–14. https://doi.org/10.1016/j.ajem.2018.01.008.
  28. Borda IM, Dogaru G, Onac I, Ungur R, Ciortea V, Cluj-napoca P. Pharmacological Pain Management in Patients with Chronic Kidney Disease. Baalneo Res J. 2019; 1(1): 12–6. https://doi.org/10.1097/mnh.0000000000000646.
  29. Caravaca F, Gonzales B, Bayo MÁ, Luna E. Musculoskeletal Pain in Patients with Chronic Kidney Disease. Nefrologia [Internet]. 2016; 36(4): 433–40. http://dx.doi.org/10.1016/j.nefroe.2016.10.005.
  30. Alchin J, Dhar A, Siddiqui K, Christo PJ. Why Paracetamol (Acetaminophen) is A Suitable First Choice for Treating Mild to Moderate Acute Pain in Adults with Liver, Kidney, or Cardiovascular Disease, Gastrointestinal Disorders, Asthma, or Who are Older. Curr Med Res Opin [Internet]. 2022; 38(5): 811–25. https://doi.org/10.1080/03007995.2022.2049551.
  31. Zhou L, Fu P. The Interpretation of KDIGO 2017 Clinical Practice Guideline Update for The Diagnosis, Evaluation, Prevention and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Chinese J Evidence-Based Med. 2017; 17(8): 869–75. https://doi.org/10.1016/j.kisu.2017.04.001
  32. Xiao Q, Murphy RA, Houston DK, Harris TB, Chow W-H, Park Y. Dietary and Supplemental Calcium Intake and Cardiovascular Disease Mortality: The National Institutes of Health AARP diet and Health Study. JAMA Intern Med. 2013; 8(173): 639–49. https://doi.org/10.1001/jamainternmed.2013.3283.
  33. Martins AM, Rodrigues JCD, Santin FG de O, Moreira ASB, Lourenço RA, Avesani CM. Food intake Assessment of Elderly Patients on Hemodialysis. J Ren Nutr. 2015; 25(3): 321–6. https://doi.org/10.1053/j.jrn.2014.10.007.
  34. Kwon YE, Hyung Yun Choi, Kim S, Ryu D-R, Oh HJ. Fracture Risk in Chronic Kidney Disease: A Korean Population-based Cohort Study. Kidney Res Clin Pract. 2019; 38(2): 220–8. https://doi.org/10.23876/j.krcp.18.0099.
  35. Santoro D, Satta E, Messina S, Costantino G, Savica V, Bellinghieri G. Pain in End-stage Renal Disease: A Frequent and Neglected Clinical Problem. Clin Nephrol. 2013; 79 (SUPPL 13): 102-11. Available from: https://pubmed.ncbi.nlm.nih.gov/23249527/.
  36. Lang E V., Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, et al. Adjunctive Non-pharmacological Analgesia for Invasive Medical Procedures: A Randomised Trial. Lancet. 2000; 355(9214): 1486–90. https://doi.org/10.1016/s0140-6736(00)02162-0.
  37. University Health Network. The Hemodialysis Exercise Program. Toronto: University Health Network; 2020.
  38. Lambert K, Lightfoot CJ, Jegatheesan DK, Gabrys I, Bennett PN. Physical Activity and Exercise Recommendations for People Receiving Dialysis: A Scoping Review. PLoS One [Internet]. 2022; 17(4 April): 1–20. http://dx.doi.org/10.1371/journal.pone.0267290.
  39. Watanabe K, Kamijo Y, Yanagi M, Ishibashi Y, Harada T, Kohzuki M. Home-based Exercise and Bone Mineral Density in Peritoneal Dialysis Patients: A Randomized Pilot Study. BMC Nephrol. 2021; 22(1): 1–9. https://doi.org/10.1186/s12882-021-02289-y
  40. Pinheiro MB, Oliveira J, Bauman A, Fairhall N, Kwok W, Sherrington C. Evidence on Physical Activity and Osteoporosis Prevention for People Aged 65+ Years: A Systematic Review to Inform The Who Guidelines on Physical Activity and Sedentary Behaviour. Vol. 17, International Journal of Behavioral Nutrition and Physical Activity. International Journal of Behavioral Nutrition and Physical Activity. 2020. 1–53 p. https://doi.org/10.1186/s12966-020-01040-4
  41. Tabiee S, Momeni A, Saadatjoo SA. The Effects of Comfort-Based Interventions (Back Massage and Patient and Family Education) on The Level of Comfort Among Hemodialysis Patients. Mod Care J. 2017; 14(3): 12-30. https://doi.org/10.5812/modernc.64687.
  42. Nied RJ, Franklin B. Promoting and Prescribing Exercise for The Elderly. Am Fam Physician. 2002; 65(3): 419–28. Available from: https://www.aafp.org/pubs/afp/issues/2002/0201/p419.html.
  43. Tański W, Kosiorowska J, Szymaḿska-Chabowska A. Osteoporosis - Risk Factors, Pharmaceutical and Non-pharmaceutical Treatment. Eur Rev Med Pharmacol Sci. 2021; 25(9): 3557–66. https://doi.org/10.26355/eurrev_202105_25838.



DOI: https://doi.org/10.22146/jkkk.78302

Article Metrics

Abstract views : 6782 | views : 8593

Refbacks

  • There are currently no refbacks.


Copyright (c) 2023 Pratiwi Lestari Putri, Haryani Haryani, Tatik Dwi Wahyuni



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.