P H A R M A C O N S c i e n ti fi c J o u r n a l o f P h a r m a c y - U N S R A T V o l . 6 N o .

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RISK FACTORS CHRONIC RENAL FAILURE IN RSUP PROF. DR. R.

D. KANDOU MANADO

Intan Logani1), Heedy Tjitrosantoso1), Adithya Yudistira1)

1)
FMIPA UNSRAT Manado pharmaceutical study program, 95115

ABSTRACT
Risk factors are factor which can increase the incidence of a disease.
Chronic Kidney Disease (CKD) is a progressive development of kidney
disease and usually lasts for one year. Increased chronic renal disease
can be caused by several risk factors. This study aims to find out what
are the risk factors of Chronic Kidney Disease (CKD) in the Prof. Dr. R.
D. Kandou Hospital, Manado. This type of research is included in the
type of observational research with prospective data retrieval. This
research was conducted prospectively during December 2016 - February
2017 at the inpatient installation of Prof. Dr. R. D. Kandou Hospital,
Manado. This study was conducted on 50 records of patient medical
records and through interviews of respondents with chronic kidney
disease. The results showed that the risk factors of Chronic Kidney
Disease in inpatients at Prof. Dr. R. D. Kandou Hospital, Manado was
the patient with a history of hypertension, uric acid, diabetes mellitus,
with a long history of ≥10 years of illness, irregular use of medication
during previous history, and the use of painkillers. Other risk factors lie
in the patient's lifestyle which includes smoking habits, meat
consumption, coffee consumption, high salt content consumption,
excessive sugar consumption, lack of sleep and lack of exercise.

Keywords: Risk factor, Chronic Kidney Disease (CKD)

PRELIMINARY composition of body fluids under

normal food intake (Price and
Risk factors for a disease Wilson, 2006). Chronic Kidney
are factors that increase the risk Failure (CKD) is caused by
of disease occurrence (Bangun, several risk factors such as
2003). In an effort to prevent a hypertension, diabetes mellitus,
disease, it is necessary to aging, there is a family history of
consider risk factors. One of the Chronic Kidney Failure (CKD),
diseases that can be prevented by obesity, cardiovascular disease,
considering the factors that cause low birth weight, autoimmune
Chronic Kidney Failure (CKD). diseases such as systemic
erythematosus lupus, drug
Chronic Kidney Failure
poisoning, systemic infections,
(CRD) is a progressive and slow
urinary tract infections, urinary
development of kidney failure,
tract stones and congenital kidney
and usually lasts for one year.
disease (Krol DG, 2011). In
The kidneys lose the ability to
addition, factors suspected to be
maintain the volume and
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associated with an increased Prof. RSUP DR. R. D. Kandou

incidence of chronic kidney Manado and the time the study
failure include smoking (Ejerbald began in December 2016-January
et al, 2004), and the use of 2017.
analgesic drugs and NSAIDs
(Fored et al, 2003). Population and Research
Subjects
Research on the risk factors
for chronic kidney failure in Population
North Sulawesi has not been
The population in this study
carried out. Therefore, the
were all patients with CKD in
authors are encouraged to know
Prof. Dr. DR. R. D. Kandou
the risk factors for Chronic
Manado.
Kidney Failure (CKD) in patients
treated, especially in Prof. RSUP Subject
Dr. R. D. Pandou Manado. This
hospital is one of the hospitals The research subjects were
located in Manado City and is a CKD patients who received
teaching hospital and also a treatment and therapy at the
referral hospital in Eastern inpatient installation of Prof.
Indonesia. RSUP DR. R. D. Kandou Manado.
Subjects were taken by
RESEARCH METHODOLOGY consecutive sampling technique.
Subjects in this study were 50
Place and time of research
patients with CRF in December
This research was conducted 2016 - January 2017 who met the
at the Inpatient Installation of inclusion criteria in the study.

RESULTS AND DISCUSSION

Characteristic Data
Table 2. Data on the characteristics of CRF patients in inpatients at
RSUP. Prof. Dr. R. D. Kandou Manado.

Characteristic amount Percentage

Data

Age 18-44 years old 6 12 %

45-59 years old 19 38 %

60-69 years old 13 26%

≥70 years old 12 24%

Gender Male 25 50%

Female 25 50%
P H A R M A C O N S c i e n ti fi c J o u r n a l o f P h a r m a c y - U N S R A T V o l . 6 N o . A U G U S T 3 , 2 0 1 7 I S S N 2 3 0 2 -
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Long suffered ≥ 1 year 13 26%

Chronic
Kidney
Failure

≤ 1 year 37 74%

In the study, it was found that age characteristics of patients

there were as many patients with suffering from Chronic Kidney
chronic kidney disease as female Failure in General Hospital. Prof.
and male, 25 patients with female Dr. R. D. Kandou Manado shows
sex and 25 male patients with the that the number of patients> 45
number of samples in this study years more than the age of <45
were 50 patients. This shows that years this is because the
gender is not a major risk factor glomerular filtration rate
for chronic renal failure because decreases by about 1% per year
of this starting at the age of 40 years
(Aslam, et al, 2003).
related to other factors such as
age and lifestyle. Based on the

Table 3. Risk Factor Data for Chronic CRF in Hospitalized Patients Prof.
Dr. R. D. Kandou Manado.

amoun Percentag
Past medical history   t e
History of
Hypertension YES 34 68%
  NO 16 32%
History of Gout YES 28 56%
  NO 22 44%
History of DM YES 23 46%
  NO 27 54%
Duration (Time)
Suffered Previous
Disease History      
Hypertension ≥10 years 18 52,94%
Uric acid ≥10 years 13 46,62%
DM ≥10 years 16 69,56%
Medication  REGULA
Compliance R 18 36%
IREGULA
R 32 64%
The use of
painkillers YES  31 62%
   NO 19 38%
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Lifestyle      
Meat consumption YES   44 88% 
   NO 8 12%
Lack of exercise  YES 42 84%
   NO 8 16%
Consumption of
food and drinks
with lots of sugar  YES 38 76%
   NO 12 24%
Excessive Coffee
Consumption  NO 31 62%
    19 38%
Food Consumption
with High Salt
Content YES 30 60%
   NO 20 40%
Smoke  YES 26 52%
   NO 24 48%
Lack of sleep YES  26 52%
   NO 24 48%
The results obtained showed condition causes accelerated
that of the 50 patients mostly damage to kidney function.
with a history of hypertension,
gout and diabetes mellitus were The mechanism of
the most risk factors. Prolonged hyperuricemia in metabolic
hypertension will cause changes diseases is due to an increase in
in resistance of afferent arterioles kidney work so that over time it
and narrowing of the afferent causes kidney fatigue and
arterioles due to changes in decreases kidney work so that
microvascular structure. This uric acid excretion is reduced (Jin
condition will cause glomerular et al, 2012; Gustafsson and
ischemia and activate the Unwin, 2013).
inflammatory response. As a
Excessive use of pain
result, there will be release of
medication will be associated
inflammatory mediators,
with kidney damage or
endothelin and intrarenal
nephropathy. Analgesic
angiotensin II activation. This
nephropathy is damage to the
condition will cause apoptosis,
nephron due to analgesic use. The
increase matrix production and
use of drugs to relieve pain and
glomerular microvascular
suppress inflammation by the
deposits and glomerular sclerosis
mechanism of action suppress
or nephrosclerosis occur
prostaglandin synthesis. As a
(firmansyah M.A, 2013).
result of inhibiting prostaglandin
The state of long hyperglycemia synthesis causes renal
will have a bad effect on the vasoconstriction, decreases blood
kidneys and can cause fibrosis flow to the kidneys, and
and inflammation of the potentially causes glomerular
glomerulus and tubules. This ischemia. Painkillers cause
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nephrosclerosis which results in blood pressure. The benefits of

glomerular ischemia thereby exercise which is often called
reducing GFR which in a long isotonic sports such as walking,
time can cause terminal kidney jogging, swimming and cycling
failure (Fored et al., 2003). are very able to reduce
hypertension. In isotonic exercise
The results of the study can shrink noradrenalin and other
based on the lifestyle of patients hormones that cause blood
with Chronic Kidney Failure pressure to rise (Ariani, 2016).
(CRD) showed that 88% of The results showed that patients
patients often consume meat. the with a history of frequent coffee
content contained in meat is the consumption were 31 patients
content of purines. Purines are (62%). Caffeine is the biggest
compounds that are remodeled ingredient in coffee which has an
into gout in the body. Therefore, effect on blood pressure acutely,
foods containing high purines especially in people with
should be avoided. The next risk hypertension. The next pattern of
factor is in patients with a history life is often to consume foods and
of active smokers that is equal to beverages with high sugar content
52% or as many as 26 patients. as many as 38 patients (76%).
Smoking is also associated with Consuming excessive sugar will
an increase in high blood lead to diabetes mellitus, diabetes
pressure. mellitus is a degenerative disease
that is highly related to diet
Nicotine contained in
(Suyono, 2008).
cigarettes will cause an increase
in blood pressure because The results of subsequent
nicotine will be absorbed by the studies showed that patients with
small blood vessels in the lungs a sleep deprivation lifestyle were
and circulated by blood vessels to 26 patients (52%). Sleep
the brain, the brain will react to deprivation can refer to poor
nicotine by giving signals to the sleep quality. Sleep deprivation
adrenal glands to release can lead to the development of
efinephrine (Adrenaline). Patients hypertension by increasing
with a history of consuming foods sympathetic activity, increasing
with a high salt content of 60%. physical and psychological
Salt is closely related to the stressors, and increasing salt
occurrence of high blood retention (Gangwisch et al.,
pressure. Blood vessel disorders 2006). Based on the explanation
are almost not found in remote of lifestyle above, it can cause
tribes whose salt intake is low. If diseases including diabetes
salt intake is less than 3 grams a mellitus, hypertension and gout
day the prevalence of which are risk factors for Chronic
hypertension is low, but if salt Kidney Failure.
intake is 5-15 grams per day, the
prevalence will increase by 15- CONCLUSION
20% (Wiryowidagdo, 2002).
Subsequent research results Based on the results of the
showed that 42 patients (84%) did study showed that the risk factors
not exercise regularly. Lack of for chronic kidney failure in
exercise can risk an increase in hospitalized patients at Prof.
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RSUP Dr. R. D. Kandou Manado Penghargaan Pilihan Pasien.

is a patient with a history of Gramedia, Jakarta.
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history of diabetes mellitus, with Hipertensi dengan Pola Makan.
a long history of illness ≥10 PT. Gramedia Pustaka Utama.
years, irregular use of drugs Jakarta.
during a history of illness, and Bangun. 2003. Terapi Jus dan
the use of painkillers. Other risk Ramuan Tradisional untuk
factors are found in patients' life Kolestrol. Agromedia pustaka,
patterns which include smoking, Jakarta.
meat consumption, coffee Chadban, S.J, E.M. Briganti, P.G.
consumption, consumption of Kerr, D.W. Dunstan, T.a.
high salt content, consumption of Welborn, P.Z. Zimmet .
excessive sugar, lack of sleep and Prevalence of Kidney Damage in
lack of exercise. Australian Adults: The AusDiab
Kidney Study. Jam Soc Nephrol
SUGGESTION (2003) 14:S131-S138.
Chelliah. 2011. Gambaran
The need for further
Tingkat Depresi Dan Kualitas
research to determine the
Hidup Pasien Penyakit Ginjal
relationship between the
Kronik Yang Menjalani
incidence of Chronic Kidney
Hemodialisis Di RSUP H. Adam
Failure with Chronic Kidney
Malik Medan Tahun 2011.
Failure risk factors.
Skripsi. Fakultas Ilmu Kesehatan
Universitas Muhammadiyah
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