• Alfrina Hany Universitas Brawijaya
  • Linda Wieke Noviyanti Universitas Brawijaya
  • Endang Susilowati Lavalette Hospital Malang



hemodialysis adequacy, quality of life


Hemodialysis adequacy describes a measure of the hemodialysis doses. Automatic measurement of adequacy through a hemodialysis machine has a more efficient advantage and can be accessed at any time. The purpose of this study was to determine the association between adequacy hemodialysis and the quality of life among chronic renal failure patientsundergoing hemodialysis. This study used a correlational analytic observational study with a cross sectional design. Data analysedwith the Spearman Rank correlation test. The subjects were 31 chronic renal failure patients undergoing hemodialysis, determined by consecutive sampling method. Data were collected retrospectively through hemodialysis record and the KDQOL SF-36 questionnaire. The result was there was no significant relationship between the adequacy of hemodialysis and quality of life in all dimensions of quality of life except for the dimensions of the physical composite (p=0,013, α=0,05) r=-0,449. There was a relationship between length of time undergoing hemodialysis and physical composite (p= 0,046, α=0,05), r = -0,367. The conclusion is confirmation of adequacy with blood urea examination is necessary.Monitoring machine monitor curves for smooth access, Qb, duration of hemodialysis and recirculation during hemodialysis is important to support the achievement of the expected adequacy. Evaluating the quality of life of patients needs to be done regularly.


  • Aiyegbusi, O. L., Kyte , D., Cockwell, P., Marshall, T., Georghe, A., Keeley, T., . . . Calvert, M. (2017). Measurement properties of patient-reported outcome measures (PROMs) used in adult patients with chronic kidney disease: A systematic review. PLOS one.
  • Albalate, M., Garcia, R. P., de Sequera, P., Corchete, E., Alcazar, R., Ortega, M., & Puerta, M. (2015). Is it useful to increase dialysate flow rate to improve the delivered Kt? BMC Nephrology.
  • Arikunto, S. (2010). Prosedur Penelitian Suatu Pendekatan Praktik. Jakarta: Rineka Cipta.
  • Black, J. M., & Hawks, J. H. (2014). Medical-Surgical Nursing: Clinical Management for Positive Outcomes. Elsevier.
  • Callaghan, C. O. (2009). The renal system at a glance. (A. Safitri, R. Astikawati, Eds., & E. Yasmine, Trans.) Penerbit Erlangga.
  • Chandrashekar, A., Ramakrishnan, S., & Rangarajan, D. (2014). Survival analysis of patients on maintenance hemodialysis. Indian Journal of Nephrology, 206-213. doi:10.4103/0971-4065.132985
  • Chen , J. Y., Choi, E., Wan, E. Y., Chan, A. K., Tsang, J. P., Chan, K. H., Lam, C. L. (2016). Validation of the disease-specific components of the kidney disease quality of life-36 (KDQOL-36) in Chinese patients undergoing maintenance dialysis. PLOS one.
  • Chen, S. S., Unruh, M., & Al Mawed, S. (2016 ). Health-related quality of life in end-stage renal desease patients: how often should we ask and what do we do with the answer? Blood Purification, 218-224.
  • Daugirdas, J. T., & Tattersall, J. E. (2010). Automated monitoring of hemodialysis adequacy by dialysis machines: potential benefits to patients and cost savings. Kidney International, 833-835.
  • Daurgirdas, J. T. (2015, December 16). Kt/V (and especially its modifications) remains a useful measure of hemodialysis dose. Kidney International, 88(3), 466-473. Retrieved from
  • Divisi Ginjal Hipertensi. (2015). Modul Pelatihan Perawat Dialisis. Malang: Instalasi Pelatihan RSUD Dr. Saiful Anwar .
  • Djukanovic, L., Dimkovic, N., Marinkovic, J., Andric, B., Bogdanovic, J., Budosan, I., . . . Djordevic, V. (2015). Compliance with guidelines and predictors of mortlity in hemodialysis. Learning from Serbia patients. Nefrologia, 35(3), 287-295. Retrieved from
  • Eriksson, D., Goldsmith, D., Teitsson, S., Jackson, J., & Nooten , F. v. (2016). Cross-sectional survey in CKD patients. Bio Med Central Nephrology, 17(97). doi:10.1186/s12882-016-0312-9
  • Garg, A. X., Suri, R. S., Eggers, P., Finkelstein, F. O., Greene, T., Kimmel, P. L., Chertow, G. M. (2017). Patients receiving frequent hemodialysis have. Kidney International, 746-754.
  • Glover, C., Banks, P., Carson, A., Martin, C. R., & Duffy, T. (2011). Understanding and assessing the impact of end-stage renal disease on quality of life. Patient, 19-28.
  • Gomez, A. M., Garcia, S., & Gomez, M. P. (2012). SpKT/V measurement through ultraviolet absorptiometry. Nephrology Dialysis Transplantation , 197-226.
  • Gunawan, A. (2015). Adekuasi Hemodialisis. In D. Ginjal-Hipertensi, Modul Pelatihan Perawat Hemodialisa (pp. 22-29). Malang: Instalasi Pelatihan RSUD Dr. Saiful Anwar Malang.
  • Hall, R.K., Luciado, A, Pieper,C., & Colon-Emeric, C.(2018). Association of Kidney Disease Quality of Life (KDQOL-36) with Mortlity and Hospitalization in older adult receiving hemodialysis. Bio Med Central Nephrology
  • Hays, RD (1994). The Medical Outcomes Study (MOS) Measures of Patient Adherence. Retrieved April 19, 2004, from the RAND Corporation web site:
  • Kementerian Kesehatan Republik Indonesia. (2010). Penyelenggaraan pelayanan dialisis pada fasilitas pelayanan kesehatan. PMK No 812/MENKES/PER/VII/2010 tentang penyelenggaraan pelayanan dialisis pada fasilitas pelayanan kesehatan. Jakarta, Indonesia: Kementerian Kesehatan Republik Indonesia.
  • Kim, J. Y., Kim, B., Park, K. S., Choi, J. Y., Seo, J. J., Park, S. H., Kim, Y. L. (2013). Health-related quality of life with KDQOL-36 and its association with self-efficacy and treatment satisfaction in Korean dialysis patients. Qual Life Res, 22, 753-758.
  • Li, Y., Shapiro, B., Kim, JC, Zhang, M, Porszasz, J., Bross, R., Feroze, U.,Upreti, R., Martin, D.,Kalantar-Zadeh, K., Kopple, JD. (2016). Association between quality of life and anxiety, depression, physical activity and physical performance in maintenance, hemodialysis patient. Chronic Diseases and Translantional Medicine 2 (2016): 110-119.
  • Letdumrongluk, P., Streja, E., Rhee, C. M., Park, J., Arah, O. A., Brunelli, S. M., Zadeh, K. K. (2014, April 26). Dose of hemodialysis and survival: a marginal structural model analysis. American Journal of Nephrology, 383-391.
  • Loon, I.V., Hamaker, M.E., Boereboom, F.t., Grooteman., M.P., Blankestijn, P.J., Van Der Dorpel, R.M., Bots, M.L (2017). A closer look at trajectory of physical functioning in chronic hemodialysis, Age and Ageing.
  • Lopes, A. A., Lantz, B., Morgenstrens, H., Wang, M., Bieber, B. A., Gillespie, B. W., Pisoni, R. M. (2014). Associations of self reported physical activity types & levels with quality of life, depression sumptoms and mortality in hemodialysis patients: The DOPPS. Clin J Am Soc Nephrol, 1702-1712.
  • Marta, A., Gracia, R. P., de Sequera, P., Corchete, E., Alcazar, R., Ortega, M., & Puerta, M. (2015). Is it useful to increase dialysate flow rate to improve the delivered Kt? BMC Nephrology, 16(20), 2-6. doi:10.1186/s12882-015-00139
  • Mazairac, A. H., de Wit, G. A., Grooteman, M. P., Penne, E. L., Van der Weerd, N. C., den Hoedt, C. H., . . . Bots, M. L. (2011). Clinical permormance targets and quality of life in hemodialysis patients. Blood Purification.
  • National Kidney Foundation. (2015). KDOQI Clinical practice guideline for hemodialysis adequacy: 2015 update . American Journal of Kidney Diseases, 884-930.
  • National Kidney Foundation Center for Guideline Development and Implementation. (2006). Hemodialysis Adequacy 2006. American Journal of Kidney Diseases.
  • Niti Madan, J. Y. (2018). Urea Kinetics, Efficiency, and Adequacy of Hemodialysis and Other Intermittent Treatments . In J. A. Claudio nollRonco (Ed.), Critical Care Nephrology (Third Edition) (3 ed., pp. 947-955.e2). Elsevier. doi:10.1016/B978-0-323-44942-7.00156-4
  • Noll, H. H. (2014). Social indicators and quality of life research: background, achievements and current trends. 151-181.
  • Nursalam. (2017). Metodologi penelitian ilmu keperawatan: pendekatan praktis. Jakarta: Salemba Medika.
  • Pernefri. (2017). 9 th Report Of Indonesian Renal Registry 2016. Pernefri.
  • Piedmont, R. L., & Friedman, P. H. (2012). Spirituality,religiosity and subjective quality of life. In R. L.
  • Piedmont, & P. H. Friedman, Handbook of social indicators and quality of life research (pp. 313-329). Research Gate.
  • Pusat Data dan Informasi Kementerian Kesehatan RI. (2017). Situasi Penyakit Ginjal Kronis. Jakarta : Kementerian Kesehatan RI.
  • Pusat Data dan Informasi Kementerian Kesehatan RI. (2017). Situasi Penyakit Ginjal Kronis. Kementerian Kesehatan. Jakarta: Kementerian Kesehatan RI.
  • Rezaei, Z., Jalali, A., Jalali, R., & Paveh, B. K. (2018). Psychological problems as the major cause of fatigue in clients. International Journal of Nursing Sciences, 262-267.
  • Ross, A. E., Paugh-Miller, J. L., & Nappo, R. W. (2017). Interventions to improve hemodialysis adequacy: protocols based on real-time monitoring of dialysate solute clearance. Clinical Kidney Journal.
  • Sastroasmoro,S., & Ismael,S. (2016). Dasar-dasar metodologi penelitian klinis Edisi 5. Sagung Seto
  • Senanayake, S., Gunawardena, N., Palihawadana, P., Kularatna, S., & Peiris, T. (2017). Validity and reliability of the Sri Lankan version of the kidney disease quality of life questionnaire (KDQOL SF).
  • Senanayake, S., Gunawardena, N., Palihawadana, P., Suraweera, C., Karunarathna, R., & Kumara, P. (2018). Depression and psychological distress in patients with chronic renal failure:. Journal of Psychosomatic Research, 25-31.
  • Thaweethamcharoen, P. W. (2013). Patient-Reported Outcomes Quality Of Life (QOL) Studies. Value in health journal, 98-102. Retrieved from
  • Theofilou, P. (2013). Quality of Life: Definition and Measurement. Europe's Journal of Psychology, 9(1), 150-162. doi:10.5964/ejop.v9i1.337
  • Vero, L. M., Gray, L. B., Parrott, J. S., & Steiber, A. L. (2013, March). Use of the subjective global asessment to predict health-related quality of life in chronic kidney disease stage 5 patients on maintenance hemodialysis. Journal of Renal Nutrition, 23(2), 141-147.
  • Widiana, I. G. (2013). Preskripsi dan adekuasi hemodialisis. Jurnal Ilmiah Kedokteran, 44, 27-36.
  • Winata, L. C., Putranto, W., & Fanani, M. (2017). Association between hemodialysis adequacy, family support and quality of life in chronic renal failure patients.
  • Indonesian Journal of Medicine, 2(1), 63-72. Retrieved from
  • Wong, S. P., Yu, M. K., Green, P. K., Liu, C. F., Hebert, P. L., & O'Hare, A. M. (2017). End-of-Life Care for Patients With Advanced Kidney. AJKD, 20(20), 1-8.
  • Yang, S.-C., Kuo, P. W., Wang, J. D., Lin, M. I., & Su, S. (2005). Quality of life and its determinants of hemodialysis patients in Taiwan measured with WHOQOL-BREF (TW). American Journal of Kidney Diseases, 46(4), 635-641.