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All Journal Faletehan Health Journal Jurnal Keperawatan (JKEP) Journal of Telenursing (JOTING) Malahayati International Journal of Nursing and Health Science
Krisna Yetti
Universitas Indonesia
Health Professions Nursing Public Health

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Use of medium cut-off membrane dialyzer compared to high flux membrane dialyzer in improving the clearance of middle to large molecule uremic toxins: A Systematic Review Wasal Desrial Siregar; Krisna Yetti; Agung Waluyo; yulia yulia
Malahayati International Journal of Nursing and Health Science Vol. 8 No. 3 (2025): Volume 8 Number 3
Publisher : Program Studi Ilmu Keperawatan-fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/minh.v8i3.934

Abstract

Background: The loss of kidney function in patients with kidney disease leads to the accumulation of dissolved substances known as uremic toxins, which can negatively impact patient health. Membranes with a high number of pores, such as those in high-flux dialyzers, allow some medium-sized molecules like beta-2 microglobulin to pass through. However, these membranes are less effective at filtering out larger dissolved substances. Larger medium-sized molecules (>25 kD) need to be removed either by convection or through the use of highly permeable membranes such as Medium Cut-Off (MCO) membranes. Therefore, it is important to understand the improvement in uremic toxin clearance when using MCO dialyzers compared to high-flux dialyzers. Purpose: To evaluate and compare the effectiveness of using medium cut-off (MCO) membrane dialyzer with high flux membrane dialyzer. Method: A systematic review with article selection guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review process begins with the formulation of clinical questions relevant to the topic. Before this, the authors establish PICOS criteria, which stand for: P (problem, patient, or population), I (intervention, prognostic factor, or exposure), C (comparison or control), O (outcome), and S (study design). For this article, P: Patients with chronic kidney disease undergoing hemodialysis, I: Use of dialyzers with medium cut-off (MCO) membrane, C: Use of dialyzer with high flux membrane, O: Increased clearance of uremic toxins of middle to large molecules, such as β2-microglobulin, kappa and lambda free light chains, S: Randomized controlled trials. The article search was conducted systematically using the keywords: "Medium cut-off dialyzer" AND "High flux dialyzer" AND "Uremic toxins" AND "Middle molecules" AND "Large molecules" AND "Clearance Hemodialysis". Results: The use of MCO membranes was more effective in eliminating medium-to-large uremic toxins while maintaining safety and regulation comparable to conventional hemodialysis with high-flux dialyzers. MCO membranes were also more effective even with low blood flow, without significantly increasing albumin loss. Additionally, MCO membranes contributed to reducing inflammation and allowed for shorter recovery times post-hemodialysis treatment. Conclusion: Given its comparable safety to high-flux dialyzers, the use of MCO membranes can be expanded in clinical practice at hemodialysis centers, including those in resource-limited settings.
Komunikasi End of Life dengan Penyusunan Dokumen Wasiat Hidup: Qualitative Evidence Synthesis Jathu Dwi Wahyuni; Krisna Yetti; Dewi Gayatri; Imami Nur Rachmawati; Ati Surya Meidiawati
Faletehan Health Journal Vol 10 No 03 (2023): Faletehan Health Journal, November 2023
Publisher : Universitas Faletehan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33746/fhj.v10i03.640

Abstract

End of Life (EoL) communication is carried out when the patient's condition is palliative and documented in an advance Directives (ADs) document which contains of patient's preferences of treatment options. ADs are highly important documents for patients, families and health worker, but have not been applied in Indonesia. This study aimed to identify the stages of preparing ADs with qualitative evidence synthesis research design. The Data sources used several data bases, namely Sage Journals, ProQuest, Scopus, Taylor & Francis, ScienceDirect, and ClinicalKey Nursing from 2003 to 2023. The article selection was based on the category of qualitative research on EoL communication and ADs drafting. The results of the study obtained 6 out of 38,185 articles. The articles contained of the stages of preparing ADs starting with the initiation of patients or health workers, providing an explanation of ADs and the course of patient's disease, discussion or EoL communication between families and health workers, reviewing the decisions in ADs according to patient's condition, and making ADs according to local regulations. The researchers concluded that ADs document as the result of EoL communication should be made by health workers and patients. ADs document is important for patients, families and health workers and can help patients become calmer to face a follow-up care and end-of-life care.
Co-Authors Ade Suhendri Ade Suhendri Agung Waluyo Ahsan Ahsan Anik Maryunani Anik Maryunani Ati Surya Meidiawati Cori Tri Suryani Deby Zulkarnain Rahadian Syah, Deby Zulkarnain Rahadian Dewi Gayatri Dudi Mashudi Dyah Fitri Wulandari Endang Sudjiati Eva Oktaviarini Hadi, Muhammad Hanny Handiyani Imami Nur Rachmawati Jathu Dwi Wahyuni Junaiti Sahar Khairul Nasri Khairul Nasri Kristina Ana La Ode A. Rahman Lia Dwi Jayanti Masfuri - Mastia Wiraya Megawati Tabroni Mery Anglelia Sirait Mu'minah Mu'minah Nurdiana Nurdiana Tuti Afriani Wasal Desrial Siregar Yulia Yulia Yunisar Gultom