Manajemen Unit Dialisis

dan
Permasalahan Kewilayahan
(Sumatera)

Abdurrahim Rasyid Lubis

Medan
 Definition of
Chronic Kidney Disease

AJKD 2002: 39(2)

 Stages of
Chronic Kidney Disease

AJKD 2002: 39(2)

Definition and Stages of
Chronic Kidney Disease

AJKD 2002: 39(2)

Stages in Progression of CKD and
Therapeutic Strategies

AJKD 2002: 39(2)

Potential Risk Factors for
Susceptibility to and
Initiation of CKD

AJKD 2002: 39(2)

 Stages of CKD:
A Clinical Action Plan

AJKD 2002: 39(2)

Schoolwerth A, ANNA
Eknoyan G, ASN Symp,Philadelphia,2002
Indikasi Dialisis :

Sindroma uremik berat

Ureum >200 mg%
Cr >8 mg%
K > 7 Meq/l
Perikarditis
Asidosis berat (HCO3 < 10 Meq/l)
Edema paru
UNIT HEMODIALISIS
 UNIT HEMODIALISIS
• TEMPAT PELAYANAN HEMODIALISIS
• MINIMAL 4 MESIN DIALISIS DENGAN WATER
TREATMENT
• MINIMAL 2 PERAWAT MAHIR HD (BERSERTIFIKAT)
• DOKTER BERSERTIFIKAT HD (PELAKSANA)
• INTERNIST BERSERTIFIKAT HD (PENANGGUNG
JAWAB/PELAKSANA)
• KGH (SUPERFISOR/PENANGGUNG
JAWAB/PELAKSANA)
PEDOMAN PELAYAN HEMODIALISIS DI
SARANA PELAYANAN KESEHATAN (DIR
BINA PEL MED SPESIALISTIK DIRJEN
BINA YANMED DEPKES RI 2008)
 UNIT HEMODIALISIS

IJIN UNIT DIALISIS DI RUMAH SAKIT

• VERIFIKASI PERNEFRI (KORWIL)
• DINAS KESEHATAN
• BERLAKU SELAMA 5 TAHUN
• PEMBAHARUAN DGN AKREDITASI DIN KES DAN
PERNEFRI

PEDOMAN PELAYAN HEMODIALISIS DI

SARANA PELAYANAN KESEHATAN (DIR
BINA PEL MED SPESIALISTIK DIRJEN
BINA YANMED DEPKES RI 2008)
 UNIT HEMODIALISIS

DENGAN MINIMAL 4 MESIN HD

• SEHARI 8 TINDAKAN (@ 5 JAM)
• SEMINGGU (6 HARI) 48 TINDAKAN
• SEBULAN (4 MINGGU) 192 TINDAKAN
• SEBULAN 24 PASIEN ( 2 X SEMINGGU)

• 1 MESIN HD UNTUK 6 PASIEN

• SEBULAN 1 PASIEN SEKITAR 8 - 10 TINDAKAN
 PERMASALAHAN
• DENGAN 4 MESIN HD
• PASIEN LEBIH DARI 24 ORANG
• TDK ADA YG AHLI PASANG DL UTK AKSES
• ADA PASIEN YG HbSAg (+)
• STR INTERNIST SERTIFIKAT (YG SDH > 3)
• DLM PELATIHAN PERAWAT/INTERNIST DILATIH
MAHIR AKSES FEMORAL PLUS PERAWATAN CAPD
• AKSES INTERNET UNTUK PELAPORAN IRR
DISKUSI INTERAKTIF
Measures of Dialysis Adequacy
Urea Reduction Rate (URR)
• Refers to change in urea concentration between
pre and post-dialysis blood tests
• Statistically significant predictor of mortality
• CMS goal is >65%
Kt/V
• The fractional clearance of urea as a function of
its distribution volume
• Goal is 1.2 or more
 The Goal of Dialysis
• Enables you to “do what you want to do
with the rest of your life” (?rehabilitation)
• Basic requirement for this tall order is
physiological adequacy of RRT
• Adequacy of hemodialysis is a minimum
URR of 65% (preferably > 70%)
• Basic requirement of adequacy is blood
flow to and through the dialyzer
Thank You