THE RELATIONSHIP OF FAMILY SUPPORT WITH FLUID INTAKE RESTRICTION

COMPLIANCE IN CHRONIC KIDNEY FAILURE PATIENTS IN THE UNIT

Hemodialysis of Avisena General Hospital
1)
Rosa Anugrah Kusuma Dewi 1, 2) Afrieani Deasy 2, 3) Karwati
1)
Student of the Education Study Program of STIKes Budi Luhur Cimahi Ners
Education
2)
Lecturer of STIKes Budi Luhur Cimahi

Abstract

Chronic Kidney Failure (CKD) is a kidney function problem caused by a decrease in the rate of
filtration (filtering) over time, resulting in severe and permanent kidney damage. Fluid balance in
the body will be disturbed in patients with CKD so it is necessary to limit fluids. If the patient can
not control the consumption of fluids, it will cause a buildup of fluid in the body. Compliance with
fluid intake is a major component in determining the health and quality of life of hemodialysis
patients. One of the risk factors that can affect patient compliance in limiting fluid consumption is
family support. This study aims to determine the relationship between family support and
compliance with fluid intake restrictions in patients with chronic kidney failure at the
Hemodialysis Unit of Avisena RSU. This research method is a type of quantitative research with
analytical descriptive method using a cross sectional design. The sample studied in this study
were 30 respondents using the purposive sampling technique. The research instrument used a
questionnaire for family support and compliance with fluid intake restrictions. The results
showed that almost all 24 respondents (80.0%) had good family support and most of the 22
respondents (73.3%) were obedient in limiting fluid intake. Based on the Fisher's Exact Test
analysis, p value = 0.002 < (0.05) so it can be concluded that there is a relationship between
family support and compliance with fluid intake restrictions in patients with chronic kidney failure
in the hemodialysis unit of Avisena Hospital. The results of this study are expected to be used
as a reference and basis for improving patients' health status and improving health services,
especially for CKD patients to carry out hemodialysis therapy regularly and to educate patients
and families in preventing fluid intake restrictions.

Keywords : Chronic Kidney Failure, Hemodialysis, Family Support, Compliance with Fluid
Intake Restrictions

THE RELATIONSHIP BETWEEN FAMILY SUPPORT WITH COMPLIANCE WITH

FLUID INTAKE RESTRICTIONS IN CHRONIC KIDNEY FAILURE PATIENT AT THE
HEMODIALYSIS UNIT AT AVISENA HOSPITAL

Abstract

Chronic Kidney Disease (CKD) is a kidney function disorder characterized by a gradual decline
in the rate of filtration (filtering), resulting in severe and irreversible kidney damage. In patients
with CKD, the body's fluid balance will be disrupted, necessitating the use of fluids. Fluid in the
body will result if the patient is unable to control his or her fluid intake. Hemodialysis patients'
health and quality of life are largely determined by their fluid compliance. Family support is one
of the risk variables that can influence a patient's willingness to reduce fluid intake. The purpose
of this study is to see if there's a link between family support and the need for fluid contact in
kidney failure patients at Avisena General Hospital's hemodialysis unit. This is a quantitative
research method that employs an analytical descriptive method with a cross-sectional design.
The purposive sampling strategy was used to select 30 respondents for this investigation. A
family support and fluid request questionnaire was employed as the research tool. Almost all of
the 24 respondents (80.0%) had good family support, and the majority of the 22 respondents
(73.3%) were obedient in restricting fluid intake, according to the findings. According to Fisher's
Exact Test Analysis, p value = 0.002 < (0.05), there is a significant relationship between family
support and fluid intake adherence in patients with chronic kidney failure in Avisena Hospital's
hemodialysis unit. The findings of this study are likely to be utilized as a guide and foundation
for future research.

Keywords : Chronic Kidney Disease, Hemodialysis, Family Support, Compliance with Fluid
Intake Restrictions

Rosa Anugrah Kusuma Dewi

STIKes Budi Luhur Cimahi Nurse Education Study Program
Jln. Kerkof No. 243 Leuwigajah, Cimahi
+62-877-2649-5331
Email: rosaanugrah09@gmail.com

1 JKBL, Volume 1 Number 1 June 2022

Introduction

Chronic Kidney Failure (CKD) is a kidney function problem caused by a decrease in the rate of
filtration (filtering) over time, resulting in severe and permanent kidney damage. (Naryati and
Nugrahandari, 2021) One of the tasks of the kidneys is to maintain the body's fluid and
electrolyte balance . Hemodialysis therapy is the treatment of choice for CKD patients.
According to the World Health Organization (WHO) states that patients with kidney failure
account for 50% of all cases while only 25% are diagnosed and treated and only 12.5 % had
good treatment . (Idarahyuni, et al 2019) WHO interprets that there will be an increase of 41.4%
of patients with kidney failure in Indonesia between 1995 and 2025 .
According to data from the Indonesian Ministry of Health (2018), it shows that more than 2
million patients worldwide undergo hemodialysis or kidney transplantation and only about 10%
of them undergo such therapy. (Indonesian et al. , 2017) According to Riskesdas data (2018),
the incidence of CKD in Indonesia is 0.38% of the total population of 252,124,458, so that
713,783 people suffer from the disease. (Srianti et al. , 2021) The Indonesian Nephrology
Association (2017) stated that the number of patients receiving hemodialysis therapy has
increased from year to year, including new patients and active patients. (Indonesian et al. ,
2017)
The main problem faced by CKD patients is an increase in fluid volume between two dialysis
times which is characterized by edema, shortness of breath and weight gain. Apart from the
recorded fluid input and output data , daily body weight measurements can also be used as a
relevant parameter in terms of fluid intake by patients with advanced CKD. Excess fluid intake
can lead to edema and circulatory overload. To avoid fluid accumulation, the amount of fluid that
can be consumed every day is calculated during the last 24 hours, namely the total urine
excreted and then added to 500 ml of fluid lost that cannot be measured, such as through
evaporation and sweat (Invisible Water Loss) . (Karyati, et al 2019)
Fluid balance in the body will be disturbed in patients with CKD so it is necessary to limit
fluids. If the patient can not control the consumption of fluids, it will cause a buildup of fluid in the
body. Compliance with fluid intake is a major component in determining the health and quality of
life of hemodialysis patients. (Intan Saraswati, et al 2019) This rule requires patient compliance
to maximize therapeutic outcomes including preventing problems such as heart failure,
shortness of breath, and edema due to excessive fluid accumulation. (Rachmawati, et al 2019)
According to data from the Report of the Indonesian Renal Registry (2017), the prevalence of
CKD in West Java occupies the first position in the province with the highest number of new
patients for hemodialysis therapy, which is 7,444 patients. (Indonesian et al. , 2017)
Based on data obtained from Riskesdas (2013) noted that the City of Cimahi is in the 8th
position, equivalent to the City of Depok and Cirebon City, which is 0.4% of CKD patients from
the total population of West Java. Meanwhile, in Cimahi City in 2016 there were 1,292 patients
with acute kidney failure and 2,008 patients with chronic kidney failure. (Supriadi, 2019)
The results of the initial survey conducted by interview with the head of the Hemodialysis Unit
at Avisena RSU obtained data on the number of CKD patients with hemodialysis in April-
December 2019 as many as 191 patients, in 2020 as many as 371 patients and in January-
November 2021 as many as 325 patients undergoing hemodialysis therapy regularly. routinely
and based on the characteristics of the examination before and after hemodialysis therapy from
33 patients, it was found that 8-16 CKD patients who will undergo hemodialysis therapy
experience weight gain, 7-10 people experience edema in the extremities and 4 people
experience ascites caused by excess fluid. consumed.
In the Hemodialysis Unit of Avisena RSU there are 6 bed capacities equipped with 6 dialysis
machines. Based on the results of interviews with 10 patients undergoing hemodialysis, 3
people stated that they received full support from their families because the family has a
responsibility to assist patients in undergoing hemodialysis therapy, help with treatment costs,

2
remind patients to maintain nutritional and fluid intake and always support them in undergoing
hemodialysis. hemodialysis, 3 other people said that they did not always get support either
when undergoing hemodialysis therapy at the hospital or at home because sometimes other
family members have their own busy lives.
Even though they don't get support, their families always help with medical expenses and
remind them about things that can worsen CKD and the remaining 4 people say that they don't
get full family support to undergo hemodialysis because they accompany and wait for the
hemodialysis therapy process for a long time. In addition, when at home, family members
sometimes rarely pay attention to the nutritional intake and fluids consumed by patients
because of their respective busy lives, but the family always helps for the patient's medical
expenses because there is a Social Security Administering Body (BPJS). Based on these data,
it can be concluded that the number of hemodialysis patients at Avisena Hospital, Cimahi City
needs special attention.
One of the risk factors that can affect patient compliance in limiting fluid consumption is
family support. In a situation like this, CKD patients need family support to increase high morale
for patients to achieve recovery, so that it has an impact on the level of adherence to the
program recommended by nurses. (Budianto, et al 2019)
Families must be able to overcome the difficulties faced by CKD patients while undergoing
hemodialysis, especially family is the most important source of family support for patients
because family is the closest environment for the patient's life. (Karyati, et al 2019) Confidence
and adherence to the treatment program that CKD patients will receive can be influenced by
family support factors. The family also plays a role in providing follow-up care, providing
motivation and making decisions about the care of sick family members. (Karyati, et al 2019) By
providing emotional family support & appreciation, facilities and information/knowledge, families
can help improve fluid intake compliance.
The nursing model theory related to this research is the model theory according to Sister
Callista Roy, where humans, the environment, health and nursing are 4 important elements that
influence each other. Roy's nursing model, known as adaptation where Roy views that every
human being must be able to adapt both to internal and external stimuli. The application of the
adaptive nursing model is expected to increase compliance in limiting fluid intake in
hemodialysis patients. (Aini, 2018)
Based on this background, researchers are interested in conducting research that focuses on
the relationship between family support and compliance with fluid intake restrictions in patients
with chronic kidney failure at the Hemodialysis Unit of Avisena RSU. The general purpose of
this study was to determine the relationship between family support and compliance with fluid
intake restrictions in patients with chronic kidney failure at the Hemodialysis Unit of Avisena
RSU .
Method

This research is a type of quantitative research with analytical descriptive method using a cross
sectional design , namely research that emphasizes the measurement time or data observation
of independent and dependent variables at one time. Samples in this study were taken from
patients with chronic kidney failure who underwent hemodialysis in the hemodialysis unit of
Avisena General Hospital as many as 30 patients. In this study using a sampling technique with
the purposive sampling . Purposive sampling is a sampling method that is carried out by
selecting samples that meet the research criteria for a certain period of time, so that the
required number of samples is met or sampling is intentionally in accordance with the required
sample requirements. This research was carried out at the Hemodialysis Unit of Avisena RSU,
data collection was carried out in January-May 2022.
The data collection tool in this study used a questionnaire consisting of a questionnaire on
family support and compliance with fluid intake restrictions. The analysis in this study uses

3
statistical science which is adapted to the purpose of the analysis. The data analysis design in
this study was carried out by means of univariate analysis and bivariate analysis. For univariate
analysis, it describes family support and compliance with fluid intake restrictions in patients with
chronic kidney failure. In the bivariate analysis using the Fisher's Exact Test statistical test ,
namely linking family support with compliance with fluid intake restrictions in patients with
chronic kidney failure.
This research has received approval from the Budi Luhur Cimahi STIKes Research Ethics
Committee dated April 12, 2022 with Number 03/D/KEPK-STIKes/IV/2022. In this research, the
researcher tries to maximize the benefits of the research and minimize the losses that arise as a
result of the research. The confidentiality of the research must be guaranteed by the researcher.
Researchers will not share this information with others. Confidentiality in this study is always
maintained by the researcher, the data and results obtained by the researcher are only known
by the researcher and supervisor. Researchers will provide data and results of this research, if
needed for research accountability. The treatment carried out by the researcher as justice for
the respondents, such as there is no aggravating behavior if the respondent resigns from this
study after agreeing and always respecting the respondent.

Results

This research was analyzed in the form of univariate analysis and bivariate analysis. Univariate
analysis was carried out to see the description of the studied variables, while bivariate analysis
was used to see the relationship between the variables studied. The description of the
relationship variables between the results of the research is as follows:

Table 1. Frequency Distribution of Family Support in Patients with Chronic Kidney

Failure in the Hemodialysis Unit of Avisena General Hospital

Variable
Frequency (f) Percentage (%)
Family support
Good Family Support 24 80.0
Bad Family Support 6 20.0
Total 30 100.0
Source: Primary Data, 2022

Based on Table 1, the results of the study on the description of family support in
patients with chronic kidney failure in the Hemodialysis Unit of Avisena RSU from 30
respondents, almost all of the results obtained as many as 24 respondents (80.0%)
had good family support and a small part, namely 6 respondents (20.0%) ) have poor
family support.
Tab el 2. Distribution of Compliance with Fluid Intake Restrictions in Patients with
Chronic Kidney Failure in the Hemodialysis Unit of Avisena RSU

Variable
Fluid Intake Restriction Frequency (f) Percentage (%)
Compliance
Obey 22 73.3
Not obey 8 26.7
Total 30 100.0
Source: Primary Data, 2022

4
 Based on Table 4.2 the results of the study regarding the description of
compliance with fluid intake restrictions in patients with chronic kidney failure in the
hemodialysis unit of Avisena General Hospital from 30 respondents, the results
obtained that most of the 22 respondents (73.3%) were obedient in limiting fluid
intake and a small portion of 8 respondents ( 26.7%) did not comply in limiting fluid
intake.

Table 3. Distribution of the Relationship between Family Support and Compliance with
Fluid Intake Restrictions in Patients with Chronic Kidney Failure in the
Hemodialysis Unit of Avisena RSU

Fluid Intake Restriction Compliance

p Nilai
Obey Not obey Total r value
Family support value
f % f % f %

Well 21 87.5 3 12.5 24 100

Bad 1 16.7 5 83.3 6 100 0.002 0.539

Total 22 73.3 8 26.7 30 100

Source: Primary Data, 2022

Based on Table 4.3 the results of the study regarding the relationship between
family support and compliance with fluid intake restrictions in patients with chronic
kidney failure in the hemodialysis unit of Avisena General Hospital from 30
respondents, almost all of the 21 respondents (87.5%) had good family support and
were obedient in limiting their intake. fluid intake, almost all of them, namely 5
respondents ( 83.3%) had poor family support and were not compliant in limiting
fluid intake, a small portion, namely 1 person (16.7%) had poor family support but
were obedient in limiting fluid intake and a small portion of as many as namely 3
respondents ( 12.5%) have good family support but do not comply in limiting fluid
intake.
The results of the statistical test used in this study is the Fisher's Exact Test
because there is an expected count value that is less than 5. The results of the
Fisher's Exact Test obtained a p value = 0.002 with a value of = 0.05 then p = 0.002
< 0.05 so it can be concluded that Ha is accepted and Ho is rejected, meaning that
there is a relationship between family support and compliance with fluid intake
restrictions in patients with chronic kidney failure in the hemodialysis unit of Avisena
General Hospital.

Discussion

Based on the results of the study in table 1, it was found that 24 respondents (80.0%) had good
family support and 6 respondents (20.0%) had poor family support. This means that it can be
assumed that the family has carried out the function of family health duties. Similar results from
Wijaya's research (2019), entitled "The Relationship of Family Support, Education Level and
Age With Hemodialysis Client Compliance in Restricting Fluid Intake at Dr M Yunus Bengkulu

5
Regional General Hospital" stated that respondents with good family support were 86
respondents ( 79.6%) while respondents who have poor family support are 22 respondents
(20.4%). (Wijaya and Padila, 2019)
Family support according to Friedman (2014) is an attitude, an act of family
acceptance of family members, in the form of informational support, assessment
support, instrumental support and emotional support. (Friedman, Bowden and Jones,
2014) In this study, 24 respondents (80.0%) had good family support. This may be due
to several factors that influence it, including; f actor predisposition (pusher): trust or
religion which embraced , factor geography , attitude individual which want to heal and
knowledge ; factor reinforcing (booster): Support family and enabling factors (enabling):
facility health . (Soekidjo, 2012)
Good family support is very influential in determining beliefs and has a great
motivation to comply with limiting fluid intake. As many as 6 respondents (20.0%) stated
that they did not get family support, this had an impact on compliance with the
management of CKD disease management including fluid intake restrictions.
Family support has a very important role in supporting compliance with fluid intake
restrictions in CKD patients undergoing hemodialysis. In addition to acting as a
supporter, the family also acts as a supervisor at home who will remind CKD patients to
limit the fluid intake they consume. Patients need support from the closest people to
provide motivation, information and attention in undergoing compliance with fluid intake
restrictions experienced by CKD patients.
Chronic kidney failure patients undergoing hemodialysis will experience various
problems that can cause changes or imbalances that include biological, psychological,
social and spiritual. Therefore, the researcher argues that family support is an important
risk factor in creating obedient behavior towards fluid intake restrictions because families
can affect individual compliance in undergoing the treatment process by providing direct
attention from the family, giving love and respect so that it fosters confidence and
motivation. of adherence to the healing process and the care that the patient is
undergoing.
Based on the results of the study in table 2 regarding the description of compliance
with fluid intake restrictions in patients with chronic kidney failure in the hemodialysis unit
of Avisena RSU from 30 respondents, the results obtained were 22 respondents (73.3%)
were obedient in limiting fluid intake and as many as 8 respondents (26.7 %) did not
comply in limiting fluid intake. This shows that most of the patients are obedient to one of
the hemodialysis therapies, namely fluid intake restriction.
Compliance is a form of behavior that arises because of the interaction between
health workers and families with patients so that patients know the plan and implement it
properly. According to Osterberg & Blaschke (2012), there are several kinds of
terminology commonly used in the literature to describe patient compliance, including
compliance, adherence, and persistence. Compliance is passively following the doctor's
advice and orders to carry out the therapy being carried out. Adherence is the extent to
which medication is taken as prescribed by a healthcare provider. The level of
adherence ( adherence ) for patients is usually reported as a percentage of the
prescription drug dose actually taken by the patient during the specified period. In terms
of persistence , the patient shows behavior that regularly consumes drugs, starting from
the first prescription to the next prescription and so on. (Nurina, 2012)
The results of the study are in line with research conducted by Umayah (2016),
entitled "The Correlation of Education Level, Knowledge and Family Support With
Compliance In Restricting Fluid Intake in Chronic Kidney Failure Patients Undergoing
Outpatient Hemodialysis at Sukoharjo District Hospital" showed that 17 respondents

6
 ( 54.8%) were obedient in limiting fluid intake and 14 respondents (45.2%) were not
compliant in limiting fluid intake. (Umayah, 2016)
In the research conducted by the researcher, 22 respondents (73.3%) were obedient
in limiting fluid intake. This may be due to several influencing factors, namely; the
patient's motivation to recover, the level of lifestyle changes needed, the support of the
family and the surrounding environment, the value of efforts to reduce the threat of
disease, the belief that the therapy carried out will help or not help and the side effects
after therapy. (Soekidjo, 2012)
Based on table 3, the results of the study regarding the relationship between family
support and compliance with fluid intake restrictions in patients with chronic renal failure
in the hemodialysis unit of Avisena Hospital, the results of the Fisher's Exact Test
statistic test, p value = 0.002 with = 0.05, thus p -value 0.002 < 0, 05, it can be
concluded that there is a relationship between family support and compliance with fluid
intake restrictions in patients with chronic kidney failure in the hemodialysis unit of
Avisena General Hospital.
The results of this study are in line with the research conducted by Puji Astuti (2017)
entitled "Family Support with Compliance with Fluid Intake Restrictions in Chronic
Kidney Failure Patients With Hemodialysis" shows the percentage of respondents who
have good support as many as 42 respondents (80.8%) and family support bad as many
as 10 respondents (19.2%). The percentage of respondents who comply with limiting
fluid intake are 44 respondents (84.6%) and those who are not compliant to limit fluid
intake are 8 respondents (15.4%). The results of the spearman rank test with a
significance level of < 0.05, the p value = 0.00. Then the p value 0.00 < 0.005, it can be
concluded that there is a relationship between family support and adherence to fluid
intake in patients with chronic kidney failure with hemodialysis at the Jember Plantation
Hospital Clinic. (Astuti, Ghofar and Suwandi, 2018)
This study is also in line with the results of research conducted by Yulinda (2014)
entitled "Compliance of patients with chronic kidney failure in dieting fluid intake in terms
of family social support" shows that there is a significant positive relationship between
family social support and compliance with chronic kidney failure patients. in dieting fluid
intake. The greater the family support felt by the patient, the more obedient the patient is
in limiting fluid intake and conversely the smaller the family support felt by the patient,
the less compliant in limiting fluid intake. (Savitri and Parmitasari, 2015)
In the research conducted by the researcher, there were respondents with poor family
support but obedient in limiting fluid intake, then there were also respondents with good
family support but did not comply in limiting fluid intake, it is also possible that this could
be influenced by several factors, namely; the patient's motivation to recover, the level of
lifestyle changes needed, family and environmental support, perceptions of the severity
of health problems, the value of efforts to reduce the threat of disease, the belief that the
therapy carried out will help or not help and side effects after therapy, education or level
knowledge, age, attitude and behavior, emotional and spiritual, family practice, socio-
economic and cultural background. (Soekidjo, 2012)
This is supported by the research of Ahrari, Moshki & Bahrami (2014) entitled "The
Relationship Between Social Support and Adherence of Dietary and Fluids Restrictions
Among Hemodialysis Patients in Iran " which states that the highest support is felt by
patients to maintain patient compliance in dietary restrictions. fluids are family support.
(Ahrari, Moshki and Bahrami, 2014) This is reinforced by Efe & Kocaoz (2015) in their
research entitled “Adherence to diet and fluid restriction of individuals on hemodialysis
treatment and affecting factors in Turkey” which states that the presence of a person in
the family will give assistance in treatment and exchange opinions in overcoming
problems in CKD patients related to the disease they are suffering from. (Efe and

7
 Kocaöz, 2015) It can be assumed that family support can be a risk factor that greatly
influences patient compliance in undergoing their treatment program. Family can be a
very influential factor and determine individual health beliefs and values in determining
the treatment program that will be received by their family members.

Conclusions and suggestions

Based on the results of research that has been carried out at the Hemodialysis Unit of Avisena
RSU, the results show that the frequency distribution of the description of family support in
patients with chronic kidney failure from 30 respondents obtained results as many as 24
respondents (80.0%) had good family support, the frequency distribution depicted compliance
with dietary restrictions. fluid intake in patients with chronic kidney failure from 30 respondents
obtained results as many as 22 respondents (73.3%) were obedient in limiting fluid intake. The
results of statistical tests using the Fisher's Exact Test obtained p value = 0.002 < (0.05) so it
can be concluded that there is a relationship between family support and compliance with fluid
intake restrictions in patients with chronic kidney failure in the hemodialysis unit of Avisena
General Hospital.
For Avisena RSU, the results of this study are expected to be used as a reference
and basis for improving patient health status and improving health services, especially
for CKD patients to carry out hemodialysis therapy on a regular basis as well as adding
insight and information to researchers in improving education for patients and families in
preventing restrictions. fluid intake due to the fact that good family support is a risk factor
that can affect patient compliance in the process of limiting fluid intake.

Bibliography

Ahrari, S., Moshki, M. and Bahrami, M. (2014) 'The Relationship Between Social Support and
Adherence of Dietary and Fluids Restrictions among Hemodialysis Patients in Iran.',
Journal of caring sciences , 3(1), pp. 11–9. doi: 10.5681/jcs.2014.002.
Aini, N. (2018) 'Theory of Nursing Models and Its Applications in Nursing', UMM Press , p. 158.
Available at: http;//ummpress.umm.ac.id.
Angga, B., Aminah, N. and Wahyudin, A. (2020) 'The Relationship of Length of Hemodialysis
Treatment with Anxiety Levels in Chronic Kidney Failure Patients at the Hemodialysis
Installation of RS Mitra Kasih Cimahi', JKBL , 13(243), pp. 337–343.
Astuti, P., Ghofar, A. and Suwandi, EW (2018) 'Family Support With Fluid Restriction Adherence
in Chronic Kidney Failure Patients With Hemodialysis', EDUNursing Journal , 1(2), pp.
89–99. Available at: http://www.journal.unipdu.ac.id/index.php/edunursing/article/view/
1093.
Budianto, A., Khodijah, K. and ... (2019) 'The Relationship of Family Support With Diet
Compliance of Chronic Kidney Disease Patients During Hemodialysis At Mitra Siaga
Hospital …', … : Jurnal Ilmu dan … , pp. 1–8. Available at:
http://ojs.stikesbhamadaslawi.ac.id/index.php/jik/article/view/165.
Efe, D. and Kocaöz, S. (2015) 'Adherence to diet and fluid restriction of individuals on
hemodialysis treatment and affecting factors in Turkey', Japan Journal of Nursing
Science , 12(2), pp. 113–123. doi: 10.1111/jjns.12055.
Friedman, MM, Bowden, VR and Jones, EG (2014) Textbook of Family Nursing Research,
Theory & Practice (5th Edition) . Jakarta: EGC.
Idarahyuni, Erna, LS and Haryanto, E. (2019) 'Quality of Life of Chronic Kidney Failure (CKD)
Patients Undergoing Hemodialysis Therapy at the Hemodialysis Unit of RSAU dr. M.
Salamun Bandung', Journal of Aeromedical Health , V(I), pp. 17–23. Available at:
https://jurnal.poltekestniau.ac.id/jka/article/download/17/13.

8
Indonesian, P. et al. (2017) '9 th Report Of Indonesian Renal Registry 2016', pp. 1–46.
Intan Saraswati, NLG, Sri Antari, NLY and Suwartini, NLG (2019) 'The Relationship between
Family Support and Compliance with Fluid Restrictions in Chronic Kidney Disease
Patients Undergoing Hemodialysis', Journal of Health Sciences Bhakti Husada: Health
Sciences Journal , 10(1), pp . 45–53. doi:10.34305/jikbh.v10i1.84.
Karyati, S., Sukarmin, S. and Listyaninsih, S. (2019) 'The Relationship of Family Support With
Fluid Restriction Compliance in Ckd Patients At Raa Soewondo Hospital Pati',
Proceedings of The URECOL , pp. 633–638. Available at:
http://repository.urecol.org/index.php/proceeding/article/view/410.
Naryati, N. and Nugrahandari, ME (2021) 'Factors Associated with Dietary Adherence in
Chronic Kidney Failure Patients Through Hemodialysis Therapy', Scientific Journal of
Nursing , 7(2), pp. 256–265. doi:10.33023/jikep.v7i2.799.
Nurina (2012) 'The Relationship of Spouse Support and Health Locus Of Control with
Compliance in undergoing the treatment process for Type 2 Diabetes Mellitus',
University of Surabaya Student Scientific Journal , 1.
Rachmawati, N., Wahyuni, D. and Idriansari, A. (2019) 'Relationship of family support on dietary
adherence to fluid intake in chronic kidney failure patients undergoing hemodialysis',
Sriwijaya Nursing Journal , 6(1), pp. 50–58.
Savitri, YA and Parmitasari, DLN (2015) 'Compliance of Chronic Kidney Failure Patients in
Dieting from Family Social Support', Psychodimensia , 14(1), pp. 1–10. Available at:
http://journal.unika.ac.id/index.php/psi/article/view/369.
Soekidjo, N. (2012) Health Promotion and Health Behavior . Jakarta: Sagung Sento.
Srianti, NM et al. (2021) 'DIFFERENCES IN INTRADIALYSIS BLOOD PRESSURE IN
CHRONIC KIDNEY FAILURE PATIENTS WITH INTERDIALYTIC WEIGHT GAINS
>5% AND <5% IN THE HEMODIALYSIS ROOM OF MANGUSADA Hospital, Badung
Ni', Journal of Nursing Update , 12, pp. 25–32. Available at: http://jurnal.aiska-
university.ac.id/index.php/gaster/article/view/139.
Supriadi, D. (2019) 'The Relationship of Long Time Undergoing Hemodialysis And Anemia With
Quality Of Life In CRF Patients Undergoing Hemodialysis In Hemodialysis Unit Tk. II
03.05.01 Dustira', Journal of Scholastic Nursing , 4(1), pp. 10–19.
doi:10.35974/jsk.v4i1.728.
Umayah, E. (2016) 'Relationship of Education Level, Knowledge, and Family Support with
Compliance with Restriction of Fluid Intake in Chronic Kidney Failure (CKD) Patients
Undergoing Outpatient Hemodialysis (HD) at Sukoharjo District Hospital', Faculty of
Health Sciences Ummi Surakarta , 53(9), pp. 1689–1699. Available at:
http://v2.eprints.ums.ac.id/archive/etd/40506/11/1.
Wijaya, AK and Padila, P. (2019) 'Relationship of Family Support, Education Level and Age with
Compliance with Fluid Intake Restriction in ESRD Clients Undergoing Hemodialysis
Therapy', Silampari Nursing Journal , 3(1), pp. 393–404.