DRUG THERAPY AND CLINICAL OUTCOMES ON THE PATIENTS WITH KIDNEY DISORDER IN THE HOSPITAL UNIVERSITI SAINS MALAYSIA: THE EFFECT DIURETIC DRUGS AND COMBINATION THERAPY TO CLINICAL OUTCOMES

AFNITA, WULANDARI (2013) DRUG THERAPY AND CLINICAL OUTCOMES ON THE PATIENTS WITH KIDNEY DISORDER IN THE HOSPITAL UNIVERSITI SAINS MALAYSIA: THE EFFECT DIURETIC DRUGS AND COMBINATION THERAPY TO CLINICAL OUTCOMES. Diploma thesis, UNIVERSITAS ANDALAS.

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Abstract

Kidneys is one of the most important organs that determining human health. It plays an important role in removing the toxins substances or poisons, retaining the liquid balance of salt and maintaining the balance of acid and alkaline levels of body fluids and the other body substances, and also removing the final residue of protein metabolism, creatinine and urea ammonia (Chris, 2007) Indonesia is a country that has the quite high rate of kidneys failure. Based on the data of PERNEFRI (Association of Nephrology Indonesia), there are 70 thousand people with kidneys failure in Indonesia (Vitahealth, 2008). In United State, in 1995-1999 it is estimated that 100 million cases of kidney disease per year was declared and increased about 8% per year. In Malaysia, 18 million population about 1800 kidneys diseases cases per year is estimated in 2010 and in other developing countries, this condition is estimated at around 40-60 cases per year. The prevalence of End stage renal failure in Malaysia was estimated to 100 per million populations (Allan, 2010). Diagnosis end stage renal failure (ESRF) 3 increase because of drug relative problems (DRP). Therefore, the most important thing how to identify and resolve DRP and also improve the quality of ESRF is the providers of health care (Mansour, 2008). The implementation of treatment guidelines and standard therapy for the patient with kidney disease is one the best optimal, effective and efficiencies therapy. Continuous it needs a system or mechanism to monitors and observes therapy patients. Therefore, it is important for the pharmaceutical to understand the Pathophysiology of kidney disease in order to select the national effective therapy without and with a minimal mortality (Chris, 2007). This study is conducted to evaluate the drug therapy on the patient with n renal disorder in nephrology ward at the HUSM according to guidelines appropriate therapy. This study was conducted using a longitudinal observational study designs. Data collection was performed prospectively by census method in the sense that all patients who took the drug during the period 1 April to 31 May 2012 were the subject of research. Sources of data include data from patient medical records and interview patients themselves if the patient is in a state that has begun to improve. Statistical of analysis data with categorical data continuous and analyzed with Chi-Square, Multivariate test and Paired T test. Socio demography data collected includes: sex, race and age. A number of 38 patients are involved in study consisted of (76.3%) 29 patients were male and (23.6%) 9 patients were female. Most of them are Malay race 100%. The average ages of 57.40±15.586 for male and 47.80±8.189 for female. 4 Diagnose of patient with renal disorder in nephrology ward at the Hospital Universiti Sains Malaysia. During the research 38 patient were as follow, endstage renal failure is the most frequency disease diagnosed (36.8%), while (18.4%) have chronic kidney disease stage VI, (13.1%) have acute renal failure, (10.5%) have chronic kidney disease stage II, (7.8%) have chronic kidney injury, (5.2%) have chronic kidney disease stage III, (5.2%) have nephritic syndrome and (2.5%) have lupus nephritic. In the study, the most frequent risk factor of the patients with kidneys disease in nephrology ward at the HUSM are hypertension, while diabetes mellitus, auto immune and tobacco smoking. Female with diabetes mellitus is more tend to experience kidney failure than male (OR: 0.421 Cl: 95%). Male with hypertension is more tend to experience kidney failure than female (OR: 1.571 Cl: 95%). Female with auto immune is more tend to experience kidney failure than male (OR: 0.923 Cl: 95%). Male with smoking is more tend to experience kidney failure than female (OR: 1.038 Cl: 95%). The most frequent complication patients with kidney disorder in nephrology ward at the HUSM are hypertension, while acute coronary syndrome, cardio heart disease, infection, ischemic heart disease and anemia are rare. Male with hypertension complication is more tend to experience kidney failure than female (OR: 1.312, Cl: 95%). Male with acute coronary syndrome complication is more tend to experience kidney failure than female (OR: 2.086, Cl: 95%). Female with cardio heart disease complication is more tend to experience kidney failure than male (OR: 0.285, Cl: 95%). Female with infection complication is more tend to experience kidney failure than male (OR: 0.285, Cl: 95%). Female with 5 ischemic heart disease complication is more tend to experience kidney failure than male (OR: 0.900, Cl: 95%). Female with anemia complication is more tend to experience kidney failure than male (OR: 0.913, Cl: 95%). Drug therapy of patient with renal disorder in nephrology ward at the HUSM are antibiotics (76.3%), anti-hypertension (66.7%), diuretics (55.5%) antiplatelet (50.0%), anti-diabetic (39.4%) and cardiac drug (28.9%). Outcome patient renal disorder with age were significantly (P<0.05). The average of age patient with renal disease without complication was 37 year old, while the average of age patient with renal disease discharge with complication was 55 year old and the average of age patient with renal disease died was 69 year old. Outcome therapy the patients in nephrology ward at the HUSM mostly discharges with complication (89.4%), less of then discharges without complication (5.2%) and died (5.2%). None of patients with renal disorder in HUSM was completely recovered.

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