Survival Analysis of Chronic Kidney Disease Patients with Hemodialysis in West Java. Indonesia, Year 2007 - 2018

The prevalence of chronic kidney disease on dialysis or CKD5D is increasing with a significant impact on disease burden in many countries. Patients are usually listed in the national renal registries, which report demographic data, incidence, prevalence, and outcome. The survival rate is an important outcome measure to characterize the impact of treatment in the CKD5 patient population in the national and international renal registries. Indonesian Society of Nephrology (InaSN) has the Indonesian Renal Registry program to collect data that was endorsed to monitor dialysis treatment quality in Indonesia.  IRR releases an annual report, but there is no survival analysis yet.   This study aimed to discover the five-year survival rate of CKD5D patients in West Java between 2007–2018 and its factor based on the IRR database. A retrospective cohort study was performed by gaining all patients' data from the IRR database, then data on all of the patients from West Java province who completed a 5-year follow-up on December 31, 2018.  Kaplan-Meier analysis and Cox proportional hazard's model were used to analyze the risk factors. There were 3,199 data included in this study. In total, the 1, 2, 3, 4, and 5 year survival rates are 82%, 70%, 62%, 58%, and 55 %, respectively.  Patients whose age is above 55 years and with unknown underlying kidney disease have a worse survival rate with a hazard ratio of 1.28 and 1.50, respectively. Further exploration of IRR data will provide better information on dialysis treatment in Indonesia. Ketahanan Hidup Pasien Penyakit Ginjal Kronis dengan Hemodialisis di Jawa Barat Indonesia tahun 2007-2018Prevalensi penyakit ginjal kronis pada dialisis atau PGK5D meningkat dan memberi beban penanganan penyakit di banyak negara. Pasien biasanya terdaftar dalam register ginjal nasional yang melaporkan data demografis, insiden, prevalensi dan luaran klisis. Tingkat ketahanan hidup merupakan parameter penting dalam registrasi ginjal untuk menggambarkan kualitas terapi pada  populasi pasien PGK stadium 5. Perhimpunan Nefrologi Indonesia (Pernefri) memiliki program Registri Ginjal Indonesia yang disebut Indonesian Renal Registry (IRR) untuk mengumpulkan data pasien PGK5D untuk  memantau kualitas pengobatan dialisis di Indonesia. IRR merilis laporan tahunan tetapi belum dilengkapi dengan  analisis ketahanan hidup. Tujuan penelitian ini adalah mengetahui angka ketahanan hidup lima tahun pasien PGK5D di Jawa Barat antara tahun 2007-2018 dan faktor risikonya berdasarkan basis data dari IRR. Studi kohort retrospektif dengan mengambil semua data pasien dari basis data IRR kemudian ditentukan data pasien Jawa Barat yang lengkap dan di follow up selama 5 tahun pada 31 Desember 2018.   Analisis Kaplan-Meier dan model proporsional hazard Cox digunakan untuk menganalisis faktor risiko. Subjek berjumlah 3199 data yang dimasukkan dalam penelitian ini. Kesimpulannya, angka harapan hidup satu, 2, 3, 4, dan 5 tahun berturut-turut adalah 82%, 70%, 62%, 58%, dan 55%. Usia lebih dari 55 tahun dan penyakit ginjal yang mendasari memiliki kelangsungan hidup yang lebih buruk dengan hazard ratio 1,28 dan 1,50. Eksplorasi lebih lanjut dari data IRR akan memberikan informasi yang lebih baik tentang perawatan dialisis di Indonesia

Qualitative Analysis of Establishing Diagnosis and Management of Hypertension from Patient’s Perspective in Jatinangor

Background: Blood pressure control is necessary to prevent complications in patients with hypertension. A previous study in Jatinangor showed the failure of controlling blood pressure even with pharmacological treatment. Proper diagnosis and effective management are considered to influence the condition. This study was performed to describe the process of establishing diagnosis and management for hypertension from the patient’s perspective in Jatinangor. Methods: A phenomenological approach was used. Data were collected through semi-structured questions in focus group discussions (FGDs) led by a moderator. Participants of FGDs were patients with hypertension who had undergone antihypertensive drugs therapy based on a previous study, and were invited by the local health cadres.  The study was held in two villages in Jatinangor, namely Hegarmanah and Cilayung in the period of July to August 2015. Data were presented as narration and figures. Results: There were five and eight hypertensive participants for Hegarmanah and Cilayung villages FGD, respectively. Diagnosis of hypertension in FGD participants was not only confirmed by doctors but also other health professionals, due to various accessibilities to health care facilities. Diagnosis establishment and management of hypertension were not following the protocol. Education on pharmacological and non-pharmacological management was provided by health professionals, however still lacked details and was not reviewed on every visit, resulting in a lack of compliance. Conclusions: Process of establishing diagnosis and management of hypertension from the patient’s perspective in Jatinangor is unfortunately not following the protocol, thus may influence the blood pressure control outcome

Prevalence and Characteristics of Low Back Pain among Productive Age Population in Jatinangor

Background: Low back pain is one of the global health issues which prevalence is high among productive ages. It oftentimes corresponds with one’s physical activity during work . The purpose of this study was to determine theprevalence and characteristics of low back pain among productive age population in Jatinangor, West Java, Indonesia.Methods: This study was a cross-sectional descriptive study conducted during the period of August to October 2014 in the three villages in Jatinangor, West Java, Indonesia. In order to determine the demographic data and history of low back pain in the last three months, about 1075 productive age populations were selected through validated questionnaire as the secondary data. These data consisting of 310 subjects were then described according to the pain characteristics and physical activity during work.Results: During three months of examination, s the prevalence of low back pain was 38.4%, with the average age 50–59 years old. Furthermore, about 22.3% subjects were indicated chronic low back pain. The most prevalent qseverity of the pain was dull pain (29.4%), followed with pins and needles pain (23.1%), As the intensity of the pain increased, there was a tendency of increasing interference in daily activities. Static posture was also the most frequent physical activity during work (53.2%).Conclusions: The prevalence of low back pain is more than one third (38.4%) among productive age populations in Jatinangor, West Java, Indonesia.[AMJ.2016;3(3):468–75]DOI: 10.15850/amj.v3n3.86

Cardiovascular Risk Profile in Health Cadres in Jatinangor, West Java

Background: Cardiovascular disease has very high morbidity and mortality, therefore, prevention of this disease becomes a national priority in the health programs. Health cadres, as an agent in community primary prevention, should have a good health condition. This study aimed to describe the cardiovascular risk profile in health cadresin Jatinangor, West Java.Methods: This was a cross-sectional study, conducted in Cilayung Village, Jatinangor, in September 2018. Consecutive sampling was performed on 20 health cadres aged 25 - 64 years old who did not have previous cardiovascular events such as coronary heart disease or stroke. Clinical data were collected consisting of blood pressure, body mass index (BMI), random blood glucose, history of diabetes mellitus, physical activity and active smoking habits. Cardiovascular risk was assessed using Jakarta cardiovascular scores and European Relative Risk Score.Results: Only 17 of 20 health cadres fulfilled the inclusion criteria with a systolic and diastolic blood pressure of 133.5±27.8 mmHg and 81.1±14.8 mmHg, respectively, and BMI of 27.4±5.3 kg/m2.The risk of cardiovascular disease in healthy cadres was at low (47.1%), moderate (41.2%) and high risk (11.7%). The average of the European Relative Risk score was 1.88±0.9. BMI >30 has a 40% high risk of cardiovascular disease.Conclusions: Most of the health cadres in Jatinangor, West Java have a low and moderate risk of cardiovascular disease, even though there is a small percentage that is at a high risk. The awareness for prevention and management programs for risk factors needs to be raised among health cadres. .