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