viii
DAFTAR ISI
HALAMAN JUDUL ............................................................................................... i
HALAMAN PENGESAHAN ................................................................................. ii
SURAT PERNYATAAN ...................................................................................... iii
PERNYATAAN PERSETUJUAN PUBLIKASI KARYA ILMIAH................... iv
PRAKATA .............................................................................................................. v
DAFTAR ISI ....................................................................................................... viii
DAFTAR SINGKATAN ...................................................................................... xi
DAFTAR TABEL ............................................................................................... xii
DAFTAR GAMBAR .......................................................................................... xiii
DAFTAR LAMPIRAN ....................................................................................... xiv
INTISARI .............................................................................................................. xv
BAB I PENDAHULUAN .................................................................................. 1
1.1. Latar Belakang ................................................................................. 1
1.2. Rumusan Masalah ........................................................................... 3
1.3. Tujuan Penelitian ............................................................................. 3
1.4. Manfaat Penelitian ........................................................................... 4
BAB II TINJAUAN PUSTAKA ......................................................................... 5
2.1 Gagal Ginjal Kronik (GGK) ............................................................ 5
2.1.1 Pengertian Gagal Ginjal Kronik (GGK) ................................. 5
2.1.2 Etiologi Gagal Ginjal Kronik (GGK) ..................................... 6
2.1.3 Klasifikasi Gagal Ginjal Kronik (GGK) ................................ 6
2.1.4 Patofisiologi Gagal Ginjal Kronik (GGK) ............................ 7
2.1.5 Manifestasi Klinis Gagal Ginjal Kronik (GGK) .................... 8
2.1.6 Faktor Resiko Gagal Ginjal Kronik (GGK) ......................... 10
2.1.7 Komplikasi Gagal Ginjal Kronik (GGK) ............................. 10
2.1.8 Diagnosis Gagal Ginjal Kronik (GGK) ............................... 12
2.1.9 Terapi Gagal Ginjal Kronik (GGK) ..................................... 14
2.1.10 Algoritma Gagal Ginjal Kronik (GGK) ............................. 17
2.2 Kerasionalan Penggunaan Obat ..................................................... 18
ix
2.2.1 Penggunaan Obat Yang Rasional ......................................... 18
2.2.2 Penggunaan Obat Yang Tidak Rasional .............................. 22
2.3 Rumah sakit ................................................................................... 23
2.4 Rekam Medik ................................................................................ 24
2.5 Kerangka Teori ............................................................................. 26
2.6 Kerangka Konsep .......................................................................... 26
2.7 Hipotesis ....................................................................................... 27
BAB III METODE PENELITIAN ........................................................................ 28
3.1 Jenis Penelitian Dan Rancangan Penelitian ................................... 28
3.2. Variabel Dan Definisi Operasional ............................................... 28
3.2.1 Variabel ................................................................................ 28
3.2.2 Definisi Operasional ............................................................ 28
3.3 Populasi dan Sampel ...................................................................... 29
3.3.1 Populasi penelitian ............................................................... 29
3.3.2 Sampel penelitian ................................................................. 30
3.4 Instrumen penelitian ...................................................................... 31
3.5 Cara Penelitian ............................................................................... 31
3.6 Tempat Dan Waktu Penelitian ....................................................... 32
3.6.1 Tempat penelitian ................................................................. 32
3.6.2 Waktu penelitian .................................................................. 32
3.7 Alur Penelitian ............................................................................... 33
3.8 Pengolahan Dan Analisa Data ....................................................... 33
3.8.1 Pengolahan data ................................................................... 33
3.8.2 Analisis Data ........................................................................ 34
BAB IV HASIL PENELITIAN DAN PEMBAHASAN .................................... 35
4.1 Hasil Penelitian 36
4.1.1 Data Karakteristik ................................................................ 36
4.1.2 Analisis Kerasionalan .......................................................... 40
4.1.3 Analisis Data 42
4.2 Pembahasan ................................................................................... 43
4.2.1 Data Karakteristik ................................................................ 43
x
4.2.1.1 Karakteristik Berdasarkan Umur menurut
(Depkes RI, 2009) .................................................. 43
4.2.1.2 Karakteristik Berdasarkan Jenis Kelamin ............... 43
4.2.1.3 Karakteristik Berdasarkan Diagnosa Utama dan
Komplikasi ............................................................. 44
4.2.1.4 Karakteristik Berdasarkan Lama Rawat Inap
Pasien ..................................................................... 46
4.2.1.5 Terapi Obat Antihipertensi Pada Pasien GGK
(Terapi Tunggal) ..................................................... 46
4.2.1.6 Terapi Obat Antihipertensi Pada Pasien GGK
(Terapi Kombinasi) ................................................ 47
4.2.1.7 Dosis Obat Antihipertensi Pada Pasien GGK
Terapi Tunggal dan Kombinasi ............................. 49
4.2.2 Analisis Kerasionalan .......................................................... 50
BAB V KESIMPULAN DAN SARAN ............................................................ 56
5.1 Kesimpulan .................................................................................... 56
5.2 Saran .............................................................................................. 57
DAFTAR PUSTAKA ........................................................................................... 58
LAMPIRAN .......................................................................................................... 64
xi
DAFTAR SINGKATAN
ACEI : Angiotensin Converting Enzyme Inhibitor
ARBs : Angiotensin Receptor Blocker
CCB : Calcium Channel Blocker
CKD : Chronic Kidney Disease
CPOB : Cara Pembuatan Obat yang Baik
EPO : Eritropoetin
GFR : Gromerular Filtration Rate
GGK : Gagal Ginjal Kronik
KDIGO : Kidney Disease Improving Global Outcomes
KDOQI : Kidney Disease Outcomes Quality Initiative
LFG : Laju Filtrasi Glomerulus
MCU : Mictuating Cysto Urography
NKF : National Kidney Foundation
PERKI : Perhimpunan Dokter Spesialis Kardiovaskular Indonesia
PERNEFRI : Perhimpunan Nefrologi Indonesia
USG : Ultrasonografi
xii
DAFTAR TABEL
Tabel 2.1. Penyebab Gagal Ginjal Kronik ................................................... 6
Tabel 2.2. Klasifikasi Penyakit Ginjal Kronik Menurut Derajat Penyakit .. 7
Tabel 2.3. Manifestasi Klinik Pada Gagal Ginjal Kronik ............................ 8
Tabel 2.4. Stadium Penyakit Ginjal Kronis: Rencana Aksi Klinik .............. 15
Tabel 2.5. Strategi Dan Target Terapi untuk Terapi Antihipertensi pada
CKD ............................................................................................ 15
Tabel 2.6. Topik Dan Pedoman ................................................................... 16
Tabel 4.1. Karakteristik Berdasarkan Umur menurut (Depkes RI, 2009) ... 36
Tabel 4. 2. Karakteristik Berdasarkan Jenis Kelamin ................................... 36
Tabel 4. 3. Karakteristik Berdasarkan Diagnosa Utama dan Komplikasi36
Tabel 4. 4. Karakteristik Berdasarkan Lama Rawat Inap Pasien .................. 37
Tabel 4.5. Obat Antihipertensi Pada Pasien GGK Kelompok Terapi
Tunggal ....................................................................................... 38
Tabel 4.6. Obat Antihipertensi Pada Pasien GGK Kelompok Terapi
Kombinasi ................................................................................... 38
Tabel 4.7. Dosis Obat Antihipertensi Pada Pasien GGK Kelompok Terapi
Tunggal dan Kombinasi .............................................................. 39
Tabel 4. 8. Analisis ketepatan indikasi ......................................................... 40
Tabel 4. 9. Analisis ketepatan obat ............................................................... 41
Tabel 4. 10. Analisa ketepatan pasien ............................................................. 41
Tabel 4.11. Analisis ketepatan dosis .............................................................. 42
Tabel 4. 12 Analisis Chi Square .................................................................... 42
xiii
DAFTAR GAMBAR
Gambar 2.1. Algoritma Gagal Ginjal Kronik .................................................. 17
Gambar 2.2. Kerangka Teori ........................................................................... 26
Gambar 2.3. Kerangka Konsep ........................................................................ 26
xiv
DAFTAR LAMPIRAN
Lampiran 1. Ethical Clearance ..................................................................... 65
Lampiran 2. Ethical Clearance dari Rumah Sakit Islam Sultan Agung
Semarang .................................................................................. 66
Lampiran 3. Surat Ijin Penelitian .................................................................. 67
Lampiran 4. Surat Keterangan telah Melaksanakan Penelitian .................... 68
Lampiran 5. Data Sampel .............................................................................. 69
Lampiran 6. Hasil analisis Chi-square .......................................................... 79