Hubungan Subjective Global Assessment (SGA) dengan Asupan Energi, Protein, Kekuatan Genggam Tangan, dan Indeks Massa Tubuh pada Pasien Penyakit Ginjal Kronis (PGK) dengan Continuous Ambulatory Peritoneal Dialysis (CAPD)

Yudhi Adrianto, Ni Made Hustrini, Triyani Kresnawan, Annisa Eka Amelia, Fitri Hudayani

Abstract

Pendahuluan. Asupan energi dan protein pada penyakit ginjal kronis (PGK) dengan terapi continuous ambulatory peritoneal dialysis (CAPD) berperan penting dalam menyeimbangkan kondisi hiperkatabolik. Asupan tidak seimbang akan mengakibatkan defisit energi dan protein yang sangat berisiko meningkatkan katabolisme otot dan berdampak pada penurunan indeks massa tubuh (IMT) dan malnutrisi. Subjective global assessment (SGA) sebagai gold standard dalam asesmen gizi diperlukan dalam penilaian status gizi dan penentuan malnutrisi sehingga dapat diberikan intervensi gizi optimal yang berdampak terhadap peningkatan kualitas hidup pasien CAPD. Penelitian ini dilakukan untuk mengetahui hubungan antara SGA dengan asupan energi dan protein, kekuatan genggam tangan, dan indeks massa tubuh pada pasien PGK yang menjalani CAPD.
Metode. Penelitian ini menggunakan desain potong lintang, subjek penelitian adalah pasien rawat jalan CAPD yang rutin kontrol setiap bulan yang dipilih dengan cara purposive. Studi dilakukan selama bulan Desember 2018 sampai Januari 2019 menggunakan total sampling pada 30 pasien CAPD. Status gizi dinilai menggunakan SGA, asupan energi dan protein diukur melalui food record, dan kekuatan genggam tangan diukur menggunakan jamar hydraulic hand dynamometer. Kenormalan data diuji menggunakan Kolmogorov-Smirnoff test dan analisis bivariat dilakukan dengan menggunakan uji chi-square.
Hasil. Dari total 30 pasien PGK pada penelitian ini, sebagian besar berusia 25-55 tahun (76,6%), sedangkan kelompok usia <25 tahun hanya sebesar 6,7%. Lebih dari 73% pasien memiliki status gizi SGA normal dan 26% dengan gizi kurang. Rerata kebutuhan energi CAPD adalah 1.942 (SB 277) Kkal, asupan energi terendah yaitu 921 kkal/hari dan tertinggi 1.959 kkal/hari dengan rerata asupan energi dialisat sebesar 404 (SB 42) kkal. Rerata asupan protein subjek adalah 54 (9,5) gram, sedangkan rerata kebutuhan protein adalah 70,7 (SB 9,7) gram/hari. Indeks massa tubuh dalam kategori underweight atau kurus ditemukan pada sebanyak 20% subjek, normal pada 60% subjek, dan berat badan lebih pada 20% subjek. Sebanyak 53,3% subjek memiliki kekuatan genggam tangan kurang dan hanya 46,7% yang normal dengan rerata kekuatan genggam tangan sebesar 26,7 (SB 9,3) kg. Tidak didapatkan hubungan antara asupan energi (p<0,857), kekuatan genggam tangan (p<0,307), dan indeks massa tubuh (p<0,829) dengan SGA. Akan tetapi, terdapat hubungan antara asupan protein dengan SGA (p<0,048, OR: 1,233 [IK 95%: 1,058 – 2,389).
Simpulan. Asupan protein yang tidak adekuat berisiko berhubungan dengan SGA kurang atau malnutrisi pada CAPD dibandingkan asupan protein cukup. Tidak didapatkan hubungan antara asupan energi, kekuatan genggam tangan, dan indeks massa tubuh pada nilai SGA.
Kata Kunci: Asupan, energi, kekuatan genggam tangan, PGK, protein, subjective global assessment (SGA)

 

The Relationship of Subjective Global Assessment (SGA) with Energy Intake, Protein, Hand Grip Strength and Body Mass Index in Chronic Kidney Disease (CKD) Patients with Continuous Ambulatory Peritoneal Dialysis (CAPD)

Introduction. Energy and protein intake in chronic kidney disease (CKD) with continuous ambulatory peritoneal dialysis (CAPD) therapy plays an important role in balancing hypercatabolic conditions. Unbalanced intake will result in energy and protein deficits which are increasing the risk of muscle catabolism, decreasing body mass index (BMI), and malnutrition. Subjective global assessment (SGA) as the gold standard in nutritional assessment is needed in assessing nutritional status and determining malnutrition, therefore nutritional intervention can be delivered and improve CAPD patients’ quality of life. This study was conducted to determine the relationship between SGA with energy and protein intake, hand grip strength, and body mass index on CKD patients undergoing CAPD.
Methods. A cross-sectional study was conducted among 30 CKD patients undergoing CAPD which were purposively selected using total sampling. Nutritional status was assessed using SGA questionnaire, energy and protein intake was assessed through food records, and hand grip strength was measured by jamar hydraulic hand dynamometer. The normality of the data was tested using the Kolmogorov-Smirnoff test and bivariate analysis was conducted using the Chi-Square test.
Results. Of a total of 30 CKD patients, most of them were aged 25-55 years (76.6%), while the age group <25 years was only 6.7%. More than 73% of patients had normal SGA nutritional status and 26% were malnourished. The average energy requirement was 1,942 (SD 277) Kcal, the lowest energy intake was 921 kcal/day and the highest was 1,959 kcal/day with an average dialysate energy intake of 404 (SD 42) kcal. The average protein intake was 54 (SD 9.5) grams, while the average protein requirement was 70.7 (SD 9.7) grams/day. Based on BMI status, 20% of subjects were underweight, 60% normal, and 20% overweight. A total of 53.3% of patients had poor hands grip strength and only 46.7% were normal with an average grip strength was 26.7 (SD 9.3) kg. Analysis showed that SGA was not related to energy intake (p<0.857), grip strength (p<0.307), and BMI (p<0.829). However, there was a relation between protein intake and SGA (p<0.048, OR: 1.233, 95% CI: 1,058 – 2,389).
Conclusions. Inadequate protein intake is related to the risk of malnutrition than adequate protein intake. There is no relationship between energy intake, hands grip strength, and BMI on SGA scores.

Keywords

CAPD, hand grip strength, protein intake, subjective global assessment (SGA)

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