Background/ introduction

Hypertension is very prevalent among patient with end stage renal disease (ESRD) treated with
hemodialysis and often poorly controlled. As is for general population, hypertension is one of the major
causes of cardiovascular mortality for patients who take dialysis. Patients who remains hypertension
after management is challenging, and there are many unsolved problems. However, many variety of
other non-pharmacologic treatment have been developed as alternative approaches for lowering blood
pressure. Mirroring the AHA scientific statement, zikir is classed into behavioral therapies. Zikir is a
mind-body practice in Islam.

There are several theory and hypothesis about the pathogenesis of hypertension and about how blood
pressure is affected by mind-body practice intervention, Zikir could make patients relax. According to
previous study, this condition makes slower breathing, reduces sympathetic activity and increase
baroreceptor sensitivity, increase heart rate variability, indicate and increase parasympathetic activity.
Zikir also utilize to affect reducing level of cortisol, but the mechanism still unknown, it is suggested that
it might be through inhibition of the vasodilator nitric oxide system and through increasing
vasoconstrictor erithopoetin concentration.

The present study was design to evaluate the effectiveness of Zikir’s on blood pressure among
hypertensive hemodialysis patient at hemodialysis room at Hasan Basry Hospital “Peduli Ibadah”

Materials and methods

Study design

We conducted a prospective, randomized, open labelled, blinded end evaluation, trial/study with follow
up after 12 weeks intervention completion. After 3 weeks or 21 days intervention, we plan to ?????
analysis. A sample calculation we had assumed a 5 mmHg between a different group in systolic blood
pressure, to allow 80% power to detect as significant as the 5% level, allowing 5% dropout (two sided
test) we determined that………………… patients were required (….. per group)

The study design and procedures were approved by the regional ethical review board in Lambung
Mangkurat University, Faculty of Medicine.

Participant and recruitment

Patient ESRD at Hemodialysis Unit at Hasan Basry Hospital, aged…. with comorbid hypertension
identified or diagnosed according to the 2004 National kidney foundation kidney disease outcome
quality initiative guideline, hypertension in haemodialysis patient is diagnosed with blood pressure
before (>140/90 mmHg) and after (>130/80) dialysis. Participant were invited to participate if their BP
fulfilled the criteria, and signed the informed consent. Exclusion ciriteria : patients inability to
understand intervention about zikir excercises; physical or mental incapacity to carry oyt zikir or
language problem. Inclusion and exclusion criteria were established before study start.
A random sample of... patients (table randomization list) was screen and blinded to allocation and to
eligibility by the investigator (dr. S/dr. D). About the half of patient were assigned to intervention group.
The Baseline data and follow up were conducted by trained nurses and care assistants. All patients
(intervention and control groups) were asked not to changetheir medication during the study, and any
change in medicatiojwas registered of follow up.

Intervention Group

Zikir performed in this study is a form....., develoved of the doctor, nurses and orayer (bimroh) and
participat were trained the zikir. The zikir program used in study was trained and practises by ulama for
one week. The participants were aasked to perform these zikir for 20-30 minutes, twice daily (morning
and afternoon zikir)

Control Group

Control group received treatment as usual.

Study Measures

Data were collected at baseline andafter completion of the 12 week intervention. The researchassistant
who collected the data were blinded to the group assignment. Blood pressure was measured following
the guideline of the NKF-KDOQI and ESH (pre-intra-post dialysis) with validated electronic blood
pressure devices. The mean of two reading were calculated.

Statistic/ Data analysis

Data were analyzed using SPSS...

Result

Discussion

Conclusions