JKEP (Jurnal Keperawata.
Vol 9.
No 2.
November 2024 ISSN: 2354-6042 (Prin.
ISSN: 2354-6050 .
Compliance of Patients Undergoing Hemodialisis with Recovery Time PostDialysis Fitriani Agustina*.
Ainil Yusra.
Said Taufiq Poltekkes Kemenkes Aceh.
Indonesia *email: fitriani.
agustina@poltekkesaceh.
Article history Posted.
Apr 04th , 2024 Reviewed.
Sept 30th , 2024 Received.
Nov 18th , 2024 Copyright A 2024 Authors This work is licensed under a Creative Commons Attribution-ShareAlike 4.
International License.
ABSTRACT
Post-hemodialysis, patients frequently experience symptoms that disrupt their comfort during daily activities, ranging from simple to strenuous tasks.
Many hemodialysis patients do not feel well after dialysis sessions and require time to recover before resuming their usual activities at home or work.
This study aims to determine the influence of fluid compliance, dietary compliance, and hemodialysis dose compliance on post-dialysis recovery time.
A crosectional design with consecutive sampling was employed, involving 76 respondents.
Data were collected by distributing questionnaires to patients undergoing hemodialysis during each Data analysis was conducted using the Mann-Whitney test with a 95% confidence Post-dialysis recovery time ranged from a minimum of 15 minutes to a maximum of 1,800 minutes, with the majority of patients recovering within 240 minutes.
There was a significant difference between post-dialysis recovery time and fluid restriction adherence .
value = 0.
000, p-value < 0.
, with respondents who adhered to fluid restrictions having a predominantly 45-minute recovery time.
Similarly, a significant difference was observed between post-dialysis recovery time and dietary compliance .
-value = 0.
000, p-value < 0.
with respondents who adhered to their diet also having a 45-minute recovery time.
Additionally, a significant difference was found between post-dialysis recovery time and hemodialysis dose compliance .
-value = 0.
007, p-value < 0.
, with the majority of respondents adhering to the hemodialysis dose exhibiting a 120-minute recovery time.
Postdialysis recovery time is influenced by compliance to fluid restrictions, dietary management, and hemodialysis dosing in hemodialysis patients.
Maintaining compliance to fluid restrictions, diet, and hemodialysis dosing can shorten post-dialysis recovery time.
Keywords: Dietary Compliance.
Fluid Restriction Compliance.
Hemodialysis Dose Compliance.
Post-Dialysis Recovery Time.
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ABSTRAK
Pasca hemodialisis pasien sering megalami keluhan yang mengganggu kenyamanan pasien ketika melakukan aktifitas sehari- hari mulai dari aktifitas sederhana sampai dengan aktifitas Banyak pasien hemodialisis tidak merasa baik setelah sesi dialisis dan membutuhkan waktu untuk pulih dan melanjutkan aktifitas mereka seperti biasa dirumah atau ditempat kerja.
Tujuan penelitian untuk mengetahui pengaruh kepatuhan cairan, kepatuhan diet dan kepatuhan dosis hemodialisis terhadap waktu pemulihan paska dialisis.
Desain penelitian cross sectional design dengan Concecutive Sampling.
Jumlah responden yang dilibatkan 76 responden.
Pengumpulan data dilakukan dengan menyebarkan kuesioner pada pasien yang menjalani hemodialisis disetiap sesuai dengan sesi hemodialisis.
Analisis data menggunakan uji MannWhitney dengan interval kepercayaan 95%.
Waktu pemulihan hemodialisis didapat sebagian besar selama 240 menit dengan batas waktu minimal 15 menit dan maksimal 1800 menit.
terdapat perbedaan yang bermakna antara waktu pemulihan paska hemodialisis dengan kepatuhan pembatasan cairan p value 0.
000 (Pvalue < 0.
Responden yang patuh membatasi cairan memiliki waktu pemulihan paska hemodialisis sebagian besar 45 menit.
Terdapat perbedaan bermakna antara waktu pemulihan paska hemodialisis dengan kepatuhan diet dengan p value 0.
000 (Pvalue < 0.
dan sebagian besar waktu pemulihan paska hemodialysis responden yang patuh selama 45 menit.
Terdapat perbedaan bermakna antara waktu pemulihan paska hemodialisis dengan dosis hemodialisis dengan p value 0.
007 (Pvalue < 0.
, sebagian besar responden yang patuh menunjukan waktu pemulihan paska hemodialisis selama 120 Kepatuhan pada pasien hemodialysis berpengaruh pada waktu pemulihan hemodialisis.
Mempertahan kepatuhan pembatasan cairan, diet dan dosis terapi dialisis memperpendek waktu pemulihan pasca dialisis.
Kata Kunci: Diet.
Dosis hemodialisis.
Hemodialisis.
Pembatasan cairan.
Kepatuhan.
Waktu Pemulihan.
INTRODUCTION
Post-hemodialysis, recovery, 27.
3% require 60-120 minutes, experience symptoms such as numbness, 5% require more than 240 minutes fatigue, weakness, tiredness, and lethargy.
for recovery (Rayner et al.
, 2.
These complaints disrupt patients' comfort Numerous factors influence recovery time, during daily activities, ranging from simple including patient demographics, comorbid Many hemodialysis (HD) patients do not feel well after dialysis sessions and require time to recover before resuming their usual activities at home or work.
The need for post-dialysis recovery time is more common in patients undergoing HD three times a week compared to those undergoing HD daily (Bossola et al.
According to Lopes et al.
, 49.
2% of HD patients require less than 60 minutes for Post-dialysis recovery time refers to the duration patients need to regain the ability to perform their normal daily activities following a hemodialysis (HD) session (Lindsay et al.
, 2.
Studies have shown that dialysis recovery is influenced by several unmodifiable factors, including JKEP (Jurnal Keperawata.
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, 2.
among patients with end-stage renal Another factor influencing HD recovery challenges, with approximately 50% of treatment protocols.
The primary objectives patients missing their dialysis sessions.
of HD therapy, which include fluid removal Additionally, 11% of patients require extra and solute clearance, may contribute to a care, and 12% have shortened their dialysis reduction in post-dialysis recovery time sessions (Duong et al.
, 2.
Negative (Lindsay et al.
, 2.
patient outcomes, increased healthcare (ESRD) costs, and an elevated workload in Compliance to treatment is essential in HD, a complex therapeutic process.
Treatment administration, and participation in dialysis Among HD patients, numerous complications can arise from noncompliance to treatment protocols.
This is further Ibrahim hemodialysis units are consequences of noncompliance behaviors among patients with end-stage renal disease (ESRD) (Chironda and Bhengu, 2.
Several studies have also identified non-adherence as a cause of mortality, increased hospital hemodialysis (HD) patients (Duong et al.
, (Chironda and Bhengu, 2.
manifested as missed HD sessions, ranges Research from 7% to 32% among patients with end- relationship or impact of compliance on stage renal disease (ESRD) (Ibrahim, post-HD recovery time has not been Hossam and Belal, 2.
Similarly, a study identified by the author.
Most primary conducted in Zimbabwe revealed that over studies illustrate that physical factors, 50% of patients did not compliance to their clinical chemistry, psychosocial aspects scheduled HD plans.
In fact, 93% of (Ayu et al.
, 2.
HD dose management respondents had missed at least one HD (Bolton et al.
, 2.
, (Ippoliti.
Santarelli session, with 61% missing the majority of and Nebiolo, 2.
, and HD adequacy their scheduled sessions.
Only seven percent (Guedes et al.
, 2.
influence post- dialysis recovery time.
sixty-seven rescheduled their designated HD sessions more than once.
(Chironda et al.
, 2.
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 172- 186 The ethical review of this study was METHOD This study utilized a quantitative analytic approach with a cross-sectional design to compliance, dietary compliance, and HD dose compliance and the dependent variable post-dialysis recovery time.
The sample was selected using a Consecutive Sampling Technique, distributed during HD sessions.
The sample size was determined using the Slovin sampling formula based on a population of 90 patients, resulting in 76 respondents.
questionnaires, which included the Fluid Compliance Dietary Compliance Hemodialysis compliance was measured using nurse conducted by the Health Research Ethics Committee of the University of Sumatera Utara, 2989/X/SP/2023.
The Faculty of Nursing at USU received approval from the Health Research Ethics Committee with the statement: AuThe research proposal has been reviewed and determined not to conflict with human values and normsAy.
Data analysis will be conducted using both The types of data utilized in this study include categorical data, which will Data were collected by distributing research comprised the dates of dialysis sessions, start and end times of HD sessions, and notes regarding any instances of shortened or missed HD sessions.
Reports from the three months preceding data collection were Post-dialysis recovery time was assessed using Patient Reported Outcome Measures (PROM.
The specific question numerical data, which will be summarized using medians along with minimum and maximum values due to the non-normal distribution of the data.
Bivariate statistical measurement scales of the variables and Consequently, the Mann-Whitney U test, which is appropriate for non-normally distributed numerical data, was utilized to independent groups.
posed to patients was, "How long does it take for you to return to normal after dialysis?" Post-dialysis recovery time was calculated in RESULTS AND DISCUSSION The characteristics of the respondents are as follows: out of 76 participants, 54 JKEP (Jurnal Keperawata.
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1%) were aged above 55 had been undergoing HD for 1 to 5 years.
The majority of respondents were with 37 respondents .
7%).
Additionally, male, comprising 47 individuals .
8%).
a significant proportion of respondents had terms of educational attainment, most respondents had a secondary education level, individuals .
2%).
Furthermore, 43 totaling 33 participants .
0%).
Regarding the duration of HD treatment, the majority complications during the HD sessions.
Tabel 1.
Distribution of Respondents Based on Fluid Compliance.
Dietary Compliance, and Hemodialysis Dose Compliance (N=.
Variable and Category Fluid Compliance Complied Noncomplied Frequency .
Percentage (%) Dietary Compliance Complied Noncomplied HD Dose Compliance Complied Non-complied Tabel 2.
Distribution of Post-Dialysis Recovery Time at RSUD Cut Meutia North Aceh, 2023 (N=.
Variable Median Recovery Time
Minimum Ae
Maximum
15 Ae 1800
95% CI
21 Ae The post-dialysis recovery time data were minutes and 596.
60 minutes.
A normality found to be non-normally distributed.
test conducted on the HD recovery time shown in Table 2, the median post-dialysis recovery time was 240 minutes.
The shortest therefore, bivariate analysis recovery time recorded was 15 minutes, was performed using the Mann-Whitney U while the longest was 1,800 minutes.
Based The analysis of the relationship on the confidence interval estimation, it can be concluded that the average post-dialysis compliance, and HD dose compliance with recovery time ranges between 362.
non-normal JKEP (Jurnal Keperawata.
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Tabel 3.
Relationship Between Post-Dialysis Recovery Time and Fluid Restriction compliance (N=.
Variable Fluid Compliance Complied Noncomplied Median .
Ae 1.
Ae 1.
P Value The Mann-Whitney U test yielded a p-value dialysis recovery time of 45 minutes, with a 000 .
< 0.
, indicating a statistically minimum of 15 minutes and a maximum of post-dialysis 1,440 minutes.
In contrast, respondents recovery time between respondents who who did not adhere to fluid restriction had a complied to fluid restriction and those who predominant post-dialysis recovery time of did not.
Among respondents who adhered 780 minutes, ranging from a minimum of to fluid restriction, the majority had a post- 15 minutes to a maximum of 1,800 minutes.
Tabel 4.
Relationship Between Post-Dialysis Recovery Time and Dietary compliance (N=.
Variable Dietary Compliance Complied Noncomplied Median .
P Value 45 .
Ae 1.
Ae 1.
The Mann-Whitney U test yielded a p-value post-dialysis recovery time was 45 minutes, of <0.
< 0.
, indicating a ranging from 15 to 1,440 minutes.
statistically significant difference in post- contrast, respondents who did not complied dialysis recovery time between respondents to diet management had a median post- who complied to diet management and dialysis recovery time of 720 minutes, with those who did not.
Among respondents who a range of 15 to 1,800 minutes.
complied to diet management, the median JKEP (Jurnal Keperawata.
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Relationship between Post-Dialysis Recovery Time and Hemodialysis Dose Compliance (N=.
Variable Median .
inimum-maximu.
P Value 120 .
Ae 1.
Ae 1.
Fluid Compliance Complied Noncomplied The Mann-Whitney U test yielded a p-value who constitute only 13.
5% (Indonesian 007 .
< 0.
, indicating a statistically Renal Registry, 2.
post-dialysis recovery time between respondents who adhered to the hemodialysis (HD) dosage regimen and those who did not.
Among respondents who adhered to the HD dosage regimen, the median post-dialysis recovery time was 120 minutes, with a minimum of 15 minutes and a maximum of 1,800 In contrast, respondents who did not adhere to the HD dosage regimen had a median post-dialysis recovery time of 720 minutes, ranging from a minimum of 15 Several studies have demonstrated that age influencing the risks individuals encounter.
This implies that as individuals age, they are more likely to adopt strategies to manage or mitigate identified risks.
A study conducted in England by Woerden .
found that individuals over 75 years old do not undergoing HD due to considerations of psychosocial conditions.
minutes to a maximum of 1,440 minutes.
Consequently, elderly patients do not receive routine The dialysis therapy.
proportion of respondents based on age grouping shows that the majority of respondents are under 55 years old .
1%).
According to IRR .
, the age grouping of end-stage renal disease (ESRD) patients Indonesia .
Ae54 compared to older individuals (Ou56 year.
The findings of this study indicate that the majority of respondents are male .
compared to females.
This aligns with other research, which reports that the majority of respondents are male, ranging around Several studies have demonstrated that gender influences compliance to treatment protocols.
Males consistently tend to be noncompliance, whereas females JKEP (Jurnal Keperawata.
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2 November 2024 hlm 172- 186 are more likely to consistently adhere to compliance to HD protocols (Chan.
Zalilah Additionally, this study found that and Hii, 2.
Conversely, other research females have a lower mortality rate related to patient education in end-stage compared to males, possibly due to higher renal disease (ESRD) patients has shown health consciousness among females.
It can that patients tend to be more complied after be concluded that both males and females receiving health education related to health have equal opportunities to develop end- management (Deif et al.
, 2.
stage renal disease (ESRD).
However, the inconsistent health behaviors exhibited by males may predispose them to ESRD In this study, the majority of ESRD patients undergoing HD have been on HD for 1-5 years, followed by those on HD for less (Chan.
Zalilah and Hii, 2.
than 1 year.
Similar characteristics have In this study, the educational level of ESRD been observed in several other studies, patients undergoing HD revealed that the where the majority of respondents have majority possess a secondary education undergone HD for 2-5 years (Ba and level .
igh school or equivalen.
0%).
Mollaolu, 2.
A comparable study Similarly, a study conducted in Banda Aceh conducted by Chironda et al.
found reported that the majority of patients have a that the majority of HD durations were high school education, accounting for 5 and 5 years (Chironda et al.
0% (Agustina.
Yetti and Sukmarini.
Data reported by the Indonesian Furthermore, health status and Renal Registry (IRR) in 2015 indicate that adherence data indicate that ESRD patients most patients undergoing HD have been on treatment for less than 1 year .
4%),
undergoing HD constitute the majority whereas durations of 1-3 years account for compared to those with other education 6%, and those exceeding 3 years levels (Chironda et al.
, 2.
Additionally, the IRR reported that the longest duration of HD Several studies have investigated the relationship between educational level and (Indonesian Renal Registry, 2.
adherence to hemodialysis (HD) treatment.
The data indicate that there is no significant Post-dialysis recovery time was evaluated using the question, "How long do you adherence to HD, where higher knowledge require to recover after a dialysis session?" levels are not associated with better Some JKEP (Jurnal Keperawata.
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9 No.
2 November 2024 hlm 172- 186 interpretations, wherein they compared required between 2 and 6 hours, 17% their condition during acute kidney failure needed 7 to 12 hours, and 10% took more than 12 hours to fully recover (Rayner et hemodialysis (HD) and after undergoing , 2.
Another study reported an HD.
To reduce potential misinterpretations, average recovery time of 246 A 451 minutes researchers first asked whether respondents (Awuah et al.
, 2.
Various study results understood the question related to this indicate significant differences in post- hemodialysis .
ost-HD) recovery times.
The researchers clarified that Different research has identified the median the referenced time pertains to the number recovery time after HD as 180 minutes of hours necessary for respondents to .
anging from 60 to 420 minute.
, with 95 engage in physical activities and feel patients .
%) experiencing recovery times below the median value.
Patients with conclusion of the HD session.
In a study shorter recovery times exhibited a lower context, this question should be easily ultrafiltration rates (UFR), and lower response stability through retesting, exhibit frequencies of dialysis (Bossola et al.
both convergent and divergent validity, and Conversely, another study found be sensitive to changes (Lindsay et al.
that recovery time after an HD session was not related to various demographic and clinical factors (Awuah et al.
, 2.
The The majority of respondents reported recovering within 240 minutes post-dialysis with the recovery time ranging from a minimum of 15 minutes to a maximum of 1800 minutes.
These findings are consistent with other studies, which reported an lack of association between post-HD complicates the prediction of recovery time after HD based on demographic profiles and standard clinical parameters (Awuah et , 2.
average recovery time of 246 A 451 minutes (Awuah et al.
, 2.
A study conducted in Hemodialysis (HD) Bali identified an average post-dialysis post-dialysis recovery time of 878.
41 A 402.
27 minutes recovery time.
Specifically, afternoon HD (Ayu et al.
, 2.
Furthermore.
Rayner et .
reported that 32% of respondents periods compared to those conducted in the recovered in less than 2 hours, 41% This JKEP (Jurnal Keperawata.
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2 November 2024 hlm 172- 186 recovery duration is primarily attributed to composition (Safitri.
Pahria and Rahayu, a nearly twofold increase in the prevalence intra-dialytic patients with afternoon HD schedules.
Intradialytic Additionally.
HD sessions impact patient determines the volume of fluid to be filtered drowsiness during the procedure, likely during dialysis.
The relationship between Patients Ultrafiltration Rate (UFR) and post-dialysis undergoing afternoon HD who attempt to recovery time is inversely proportional, sleep during dialysis frequently report with longer recovery times observed in difficulties in maintaining sleep, increased patients with UFR below the average.
The restlessness, and heightened nocturnal underlying mechanism for this inverse stiffness (Ayu et al.
, 2.
Research findings indicate that respondents adhering to fluid restriction .
Weight
Gain
(IDWG)
UFR
clearance (Ippoliti.
Santarelli and Nebiolo, primarily had post-dialysis recovery times of 45 minutes, with a minimum of 15 The pathophysiology of the recovery minutes and a maximum of 1800 minutes.
process remains incompletely understood.
Statistically.
HD induces the movement of salts and relationship between compliance to fluid restriction and post-dialysis recovery time .
-value < 0.
Fluid compliance is intracellular fluids, crossing of the blood- related to appropriate health Yetti Fluid electrolytes across cell membranes.
These restriction is influenced by intradialytic alterations may be more pronounced weight gain (IDWG), which is the increase following a dialysis session, resulting in in body weight serving as an indicator of prolonged recovery times.
Recovery time fluid intake during the interdialytic period.
may be expedited following treatments Increased IDWG is associated with fluid characterized by slower fluid shifts and intake, thirst, and xerostomia, as well as smaller volumes.
This allows patients who factors related to the implementation of HD maintain urine output to experience lower therapy, such as longer HD durations, intradialytic weight loss and a slower Sukmarini, dialysis time and frequency, and dialysate education and family support (Al Husna.
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 172- 186 ultrafiltration rate, thereby achieving faster provided, and this dietary compliance also recovery times (Rayner et al.
, 2.
contributed to fluid compliance (Mersal and El-Sedawy, 2.
Among respondents, 51.
3% adhered to their exhibiting post-dialysis recovery times of 45 minutes, ranging from a minimum of 15 minutes to a maximum of 1440 minutes.
Statistically, adherence to dietary regimens post-dialysis recovery time .
-value < 0.
Compliance to dietary regimens among hemodialysis (HD) patients tended to be low.
one study nutritional intake, and these patients were prone to experiencing disturbances in nutritional status that affect quality of life (Siagian, 2.
, including a decline in health following dialysis.
In alignment with previous research, 57.
7% of respondents Improving dietary compliance is and education, which can motivate patients to change and comply with dietary recommendations.
(Widiany, diets experience increased nutrient loss, leading to biochemical alterations and reduced nutrient levels in the blood.
Continuous changes result in altered body functions, such as neurological signs including weakness, dizziness, fatigue, shortness of breath, and others (Siagian.
Dietary compliance affects body biochemistry and has additional side effects on the body.
These functional changes impact quality of life and correlate with post-dialysis recovery time (Lindsay et al.
Compliance to Hemodialysis (HD) dosing among respondents was 61.
8%, with the majority exhibiting post-dialysis recovery times of 120 minutes, ranging from a minimum of 15 minutes to a maximum of 1800 minutes.
Statistically, there is a compliance to HD dosing and post-dialysis recovery time .
-value < 0.
Compliance The majority of HD patients do not strictly complied to their dietary patterns.
In a study, compliance to dietary regimens concerning the intake of protein, sodium.
Patients who are noncompliance to their increased when nursing interventions were to HD dosing within the Aceh community at RSU dr.
Zainoel Abidin Aceh mirrors the overall respondent adherence rate, with 60% of respondents complying with their HD dosing regimen.
This reflects the general compliance behavior of the Aceh JKEP (Jurnal Keperawata.
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A rapid filtration rate and shorter dialysis the same study, compliance to HD dosing treatment times have been reported to was influenced by factors such as self- efficacy, acceptance, and social support Conversely, patients who recover slowly (Agustina.
Yetti and Sukmarini, 2.
One of the factors affecting post-dialysis experience lower salt and fluid intake and recovery time is the ultrafiltration rate.
HD increased treatment durations, thereby schedule.
Kt/V ratio, and dialysate sodium concentration (Ayu et al.
, 2.
, as well as recover more quickly into the higher the duration of dialysis sessions (Rayner et filtration rate group (Rayner et al.
, 2.
post-dialysis , 2.
Altering HD dosing frequency to 5Ae7 times Afternoon Hemodialysis (HD) schedules per week has been proven to significantly require longer recovery times compared to reduce the total weekly recovery time (Rayner et al.
, 2.
Therefore, further Additionally, studies are necessary to investigate methods durations and lower dialysate sodium for reducing recovery time and improving concentrations are associated with extended treatment quality within dialysis units, as recovery times (Rayner et al.
, 2.
well as the potential to enhance clinical trial study investigated the modification of post- outcomes, such as increasing dialysate dialysis recovery time through alterations in HD regimens.
The findings reported that essential to conduct randomized controlled recovery time was associated with the use trials to substantiate these approaches.
of hemofiltration/hemodiafiltration and a Kt/V Specifically, recovery times were correlated with lower
IDWG
Conversely, these factors were found to contribute to shorter recovery times, parameters may enhance patient recovery post-HD (Rayner et al.
, 2.
The limitations identified in this study include the presence of several secondary data required for the research that were not well-documented in the medical records of RSU dr.
Zainoel Abidin Aceh, such as comorbidity data, early complications during HD, and adherence to HD dosing.
Consequently, some respondents were excluded from the analysis.
Another limitation pertains to the questions related JKEP (Jurnal Keperawata.
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2 November 2024 hlm 172- 186 to the post-dialysis recovery time variable, which require further clarification to ensure Available https://doi.
org/10.
1016/j.
respondents fully understand them.
CONCLUSION
Post-dialysis recovery time is influenced by compliance to fluid restriction, compliance to dietary regulations, and the hemodialysis (HD) dosing regimen administered to EndStage Renal Disease (ESRD) patients.
It is comfort and allowing patients to resume activities after the HD session is completed.
ACKNOWLEDGMENTS
I would like to extend my sincere gratitude to Poltekkes Kemenkes Aceh for their financial support, utilizing the Poltekkes Kemenkes Aceh DIPA budget for 2023.
REFERENCES