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Background: Chronic Kidney Disease (CKD) patients undergoing long-term hemodialysis often experience anxiety due to therapy dependency, changes in health conditions, and uncertainty regarding the disease. Unresolved anxiety can reduce quality of life, comfort, and patient adherence to treatment. Therefore, non-pharmacological interventions are needed that are safe, easy to implement, and aligned with the patient's spiritual values. Mantram Tri Sandya has the potential to provide relaxation and psychological calm, thus helping to reduce anxiety. However, scientific evidence regarding the effectiveness of this therapy in hemodialysis patients is still limited, making this research crucial.  Purpose: The aim of this research is to determine the effect of the Tri Sandya mantra on reducing anxiety levels in CKD patients who are undergoing hemodialysis at the Buleleng Regency Regional Hospital. Methods: Pre-Experimental One Group Pre-Test & Post-Test research design with the Wilcoxon Signed Rank Test conducted at the Buleleng Regency Regional General Hospital. Data were collected using the HARS (Hamilton Anxiety Rating Scale) questionnaire sheet with Purposive Sampling technique with a sample size of 88 people. Results: The results obtained from this study were that there was a decrease in anxiety levels when given Mantra Tri Sandya therapy to CKD patients who were undergoing hemodialysis with a P value <0.001 (p<0.05). Conclusion: There is a significant effect of administering the Tri Sandy mantra on reducing anxiety levels in CKD patients who are undergoing hemodialysis at the Buleleng Regency Regional Hospital.

Chronic kidney disease is a progressive decline in kidney function that leads to fluid and electrolyte imbalance, requiring fluid restriction which often causes thirst and may result in ineffective peripheral perfusion. One non-pharmacological nursing intervention that can be applied is the ice cube sucking technique as part of fluid management. This study aimed to analyze the implementation of education the ice cube sucking technique in improving fluid management and peripheral perfusion in elderly patients with chronic kidney disease. The study used a descriptive case study design with a nursing process approach conducted over three sessions in an elderly patient with chronic kidney disease. The intervention was delivered in three sessions, each lasting approximately 15–20 minutes. The results showed a reduction in thirst complaints, improvement in peripheral perfusion indicated by capillary refill time of less than 2 seconds and warm extremities, as well as increased patient and family ability in managing fluid intake. In conclusion, the ice cube sucking technique are effective nursing interventions in fluid management and improving peripheral perfusion in patients with chronic kidney disease.

Chronic kidney disease is a progressive decline in kidney function that leads to fluid and electrolyte imbalance, requiring fluid restriction which often causes thirst and may result in ineffective peripheral perfusion. One non-pharmacological nursing intervention that can be applied is the ice cube sucking technique as part of fluid management. This study aimed to analyze the implementation of education the ice cube sucking technique in improving fluid management and peripheral perfusion in elderly patients with chronic kidney disease. The study used a descriptive case study design with a nursing process approach conducted over three sessions in an elderly patient with chronic kidney disease. The intervention was delivered in three sessions, each lasting approximately 15–20 minutes. The results showed a reduction in thirst complaints, improvement in peripheral perfusion indicated by capillary refill time of less than 2 seconds and warm extremities, as well as increased patient and family ability in managing fluid intake. In conclusion, the ice cube sucking technique are effective nursing interventions in fluid management and improving peripheral perfusion in patients with chronic kidney disease.

Chronic Kidney Disease (CKD) is a structural or functional abnormality of the kidneys that lasts ≥3 months with the criteria of eGFR <60 mL/min/1.73 m² or the presence of kidney damage such as albuminuria and urinary abnormalities (Kidney International, 2024). CKD patients, especially those treated in intensive care units, often experience gastrointestinal disorders such as increased volume of gastric residues. Giving enteral nutrition to patients with NGT can increase the volume of gastric residue which is at risk of causing complications. One of the non-pharmacological interventions that can be carried out is abdominal massage, which is a light massage technique in the abdominal area that can stimulate intestinal peristalsis and improve gastrointestinal motility. The purpose of this case study was to determine the effect of  giving abdominal massage on reducing the volume of gastric residue in CKD patients in the ICU. This scientific paper uses a case study design using abdominal mass therapy. The number of respondents was 3 people, the intervention was carried out for 3 days with a time of 10-15 minutes. The application of abdominal massage therapy in the three respondents showed a decrease in the volume of gastric residue after admixture was carried out  for three consecutive days with an average decrease in the volume of gastric residue, which was 50 cc - 75 cc. Abdominal massage is a safe and effective nonpharmacological nursing intervention to help reduce gastric residue volume and support enteral nutrient tolerance in CKD patients in the ICU.

Chronic Kidney Disease (CKD) is a growing global health concern that significantly affects patients’ quality of life. At Bhakti Asih General Hospital, Tangerang, the number of hemodialysis patients increased by 20.42% and dialysis procedures by 25.06% between 2023 and 2024. Despite this service expansion, preliminary findings revealed that 32% of patients reported poor quality of life, 31% experienced low engagement in care, 34% demonstrated low self-efficacy particularly in dietary and fluid management and 32% faced accessibility barriers. These findings indicate a gap between increased service volume and patient-centered outcomes. This study aimed to analyze the effects of patient engagement and self-efficacy on the quality of life of hemodialysis patients, with healthcare accessibility as a mediating variable. A quantitative cross-sectional design was employed. Active hemodialysis patients were selected using purposive sampling. Data were collected through structured questionnaires and analyzed using Structural Equation Modeling (SEM).The results demonstrated that patient engagement and self-efficacy had significant positive effects on quality of life, both directly and indirectly through accessibility. Accessibility also significantly influenced quality of life and strengthened the relationships between patient engagement, self-efficacy, and quality of life.These findings highlight the importance of integrating patient engagement strategies, strengthening self-efficacy through education, and improving service accessibility to enhance quality of life among hemodialysis patients

Chronic kidney disease (CKD) is a global health problem with continuously increasing prevalence and mortality. This condition is characterized by a progressive and irreversible decline in kidney function, which is clinically assessed using the estimated glomerular filtration rate (eGFR) as one of the main parameters for staging and monitoring disease progression. Red blood cell distribution width (RDW) is a hematological parameter that reflects the degree of variation in erythrocyte size. In patients with CKD, elevated RDW levels are often associated with oxidative stress and chronic inflammation, which may accelerate kidney damage and increase mortality risk. To analyze the correlation between RDW and eGFR values in patients with chronic kidney disease at ODSK Hospital, North Sulawesi Province. This study used an analytical observational design with a cross‑sectional approach. It was conducted retrospectively using secondary data from the medical records of CKD patients at ODSK Hospital, North Sulawesi Province, from February 2024 to August 2025. This study used a total sampling method with 189 CKD patients who met the inclusion and exclusion criteria.  Based on Spearman-rank correlation analysis, the p‑value obtained was 0.129 (>0.05). There was no significant relationship between RDW and eGFR values in CKD patients at ODSK Hospital, North Sulawesi.Province.

Type 2 Diabetes Mellitus (T2DM) is a global health problem with continuously increasing prevalence, covering the majority of diabetes cases worldwide. Persistent hyperglycemia in T2DM progressively damages the kidneys. Early assessment of kidney function, especially through the examination of urea levels and estimated glomerular filtration rate (eGFR) values, is important to predict CKD prognosis and guide therapeutic intervention. To discover the profile of urea levels and eGFR values in Type 2 Diabetes Mellitus patients at ODSK Hospital, North Sulawesi Province. This study is a descriptive quantitative observational study with a cross-sectional design, conducted retrospectively using secondary data from the medical records of Type 2 Diabetes Mellitus patients at ODSK Hospital, North Sulawesi Province during the period February 2024–August 2025 who met the inclusion criteria. From a total sample of 658 Type 2 Diabetes Mellitus patients, the majority of patients had high urea levels (53.3%). Based on sex, the proportion of high urea levels in males (57.2%) was higher compared to females (50.5%). Meanwhile, the distribution of eGFR values showed that the G1 category was the most frequent (23.9%). However, the majority of other patients (75.1%) were already in categories G2 to G5, which indicates a decrease in kidney function. This decrease in kidney function was slightly more detected in male patients (76.1%) compared to female patients (74.4%). Type 2 Diabetes Mellitus patients at ODSK Hospital, North Sulawesi Province, have high urea levels and the majority have decreased eGFR values.

Chronic Kidney Disease (CKD) is a global health problem with a continuously increasing prevalence and mortality rate. Global data indicates that kidney disorders have affected more than 850 million people, with CKD being one of the leading causes of death. North Sulawesi is recorded as one of the provinces with the highest prevalence of CKD. Blood creatinine is used as the primary marker of kidney function, while hypertension is a comorbidity commonly found in CKD patients and can act as both a cause and a consequence of impaired kidney function. Several studies have reported varying results regarding the relationship between creatinine levels and blood pressure. Purpose to analyze the association between serum creatinine levels and blood pressure in chronic kidney disease patients with hypertension at ODSK Hospital, North Sulawesi Province. Methods the research design used an observational analytic cross-sectional design. This study used an observational analytic cross-sectional design. It was a retrospective study utilizing secondary data from medical records for the period of June 2022 to August 2025. Total sampling method was employed with a sample size of 65 patients who met the inclusion criteria. Based on the Spearman correlation test results, the significance values between creatinine and systolic pressure was 0.685, and between creatinine and diastolic pressure was 0.787 (p-value >0.05). There is no significant correlation between serum creatinine levels and blood pressure in chronic kidney disease patients with hypertension at ODSK Hospital, North Sulawesi Province.

Chronic kidney disease (CKD) is a growing global health concern that frequently remains undiagnosed until advanced stages. Early detection through simple laboratory screening is essential to prevent disease progression and associated cardiometabolic complications. This community service program aimed to assess kidney function using serum creatinine and estimated glomerular filtration rate (eGFR), while increasing public awareness regarding CKD prevention. A total of 59 participants were included, with a mean age of 39.15 ± 15.39 years (range 16–75 years), predominantly female (74.58%). The mean serum creatinine level was 1.0 ± 0.19 mg/dL, and the mean eGFR was 91.08 ± 20.53 mL/min/1.73 m². Most participants demonstrated normal kidney function (28.8%) or mild decline (21.6%). A progressive reduction in eGFR with increasing age was observed, reflecting the physiological decline in nephron mass and renal perfusion. The program also provided education on kidney-protective practices, including optimal blood pressure control, diabetes management, adequate hydration, and avoidance of nephrotoxic agents. This intervention improved participants’ understanding of CKD risk factors and the importance of regular screening. In conclusion, serum creatinine and eGFR evaluation offer simple, accurate, and practical tools for early CKD detection, supporting promotive–preventive strategies to slow disease progression and enhance quality of life in at-risk populations.

Background: Dietary adherence is a crucial component in the management of patients with chronic kidney disease (CKD) undergoing hemodialysis. Non-adherence may lead to metabolic imbalance, increased morbidity, and reduced quality of life.Objective: To identify factors associated with dietary non-adherence among patients with CKD undergoing hemodialysis at Imelda Hospital, Medan. Methods: A cross-sectional study was conducted among patients undergoing routine hemodialysis. Data were collected using structured questionnaires assessing knowledge, attitudes, and family support related to dietary adherence. Statistical analysis was performed using chi-square tests and logistic regression with a significance level of p < 0.05. Results: Knowledge, attitudes, and family support were significantly associated with dietary non-adherence (p < 0.05). Family support was identified as the most influential factor. Conclusion: Dietary non-adherence among hemodialysis patients is influenced by knowledge, attitudes, and family support. Strengthening patient education and family-centered nursing interventions is essential to improve dietary adherence.

Chronic Kidney Disease (CKD) is a heterogeneous disorder that gradually affects the structure and function of the kidneys, is difficult to recover, and causes the body to be unable to maintain metabolism and fail to maintain fluid and electrolyte balance, leading to increased urea levels. Chronic kidney disease data was obtained from Kaggle, in this study a comparison was made between two classification algorithms, namely Naïve Bayes Classifier (NBC) and Random Forest because it is not yet known what algorithm is best in classifying chronic kidney disease (CKD). Both algorithms are evaluated based on performance metrics such as accuracy, precision, recall, and confusion matrix. The results of the evaluation showed that in a dataset of 400 samples, the performance  of the Naïve Bayes Classifier (NBC) algorithm obtained an accuracy of 94%, while Random Forest had an accuracy of 93%. Then in the small dataset (158 data), Random Forest got a better accuracy score with 87% compared to the Naïve Bayes Classifier (NBC) of 78%. Based on the results of the evaluation, Random Forest has a more stable performance on small datasets, while Naïve Bayes Classifier (NBC) provides higher performance on larger datasets in the context of chronic kidney disease classification.

Chronic kidney disease (CKD) patients undergoing hemodialysis are at risk of experiencing intradialytic complications, one of which is hypertension. Management of hypertension in hemodialysis units is generally pharmacological, although non-pharmacological interventions may serve as an effective, simple, and safe complementary option. One such technique is Benson relaxation, which combines controlled deep breathing with spiritual elements to reduce sympathetic activity and promote relaxation. This case study to determine the effect of Benson relaxation therapy on blood pressure of intradialytic hypertension patients at RSUD Batang. The case study design was a case study involving 5 CKD patients undergoing hemodialysis. The intervention was performed by guiding patients to practice Benson relaxation for about 10–15 minutes, with blood pressure measured before and after the intervention using a digital sphygmomanometer. The results showed a decrease in blood pressure in most respondents. The average systolic blood pressure decreased from 153.4 mmHg to 145.6 mmHg, while diastolic pressure decreased from 92.4 mmHg to 87.6 mmHg. In addition to physiological improvement, patients also reported subjective relief such as reduced dizziness, palpitations, and tension. In conclusion, Benson relaxation therapy proved effective in reducing blood pressure among intradialytic hypertension patients. This intervention can be recommended as a complementary non-pharmacological therapy in nursing care to improve comfort in hemodialysis patients.  

Background: Decreased kidney function is one of the serious complications of diabetes mellitus, which can develop into chronic kidney disease (CKD). This study aims to reduce kidney function in diabetic patients who are members of the Chronic Disease Management Program (Prolanis) at the Comal Pratama Clinic. Objective: The Prolanis program aims to effectively manage chronic conditions such as diabetes, these results show that most patients continue to experience significant decline in kidney function. Methods: This study involved a longitudinal analysis of Prolanis patient data, focusing on changes in creatinine and urea levels as indicators of kidney function. Clinical data used in this study included creatinine and urea levels, taken from patient medical records in 2023 and 2024. Results: The results showed a significant increase in creatinine and urea levels among the patients studied, indicating worsening kidney function during the study period. This study emphasizes the importance of closer monitoring and more specific interventions to protect kidney function in diabetic patients who are members of Prolanis. Conclusion: Most patients continue to experience significant decline in kidney function.

Patients with chronic kidney disease (CKD) often experience shortness of breath, fatigue, and a decline in quality of life due to fluid imbalance, anemia, and reduced lung capacity. These conditions highlight the need for simple, safe, and effective non-pharmacological interventions. This community service program, titled “Napas Lega Bersama” (“Breathing Relief Together”), aimed to improve the knowledge and skills of CKD patients in applying pursed-lip breathing (PLB) techniques as a strategy to enhance breathing patterns and overall well-being. The activity was conducted at a partner hospital’s hemodialysis unit through educational sessions, live demonstrations, and guided PLB practice over a two-week period. Pre- and post-program assessments were performed using standardized questionnaires to measure participants’ knowledge and perceived quality of life. The results showed an 85% increase in participants’ understanding of PLB and a 70% improvement in perceived comfort and daily activity performance after the intervention. Participants also reported reduced shortness of breath and greater relaxation during dialysis sessions. This program demonstrates that pursed-lip breathing can serve as a simple and effective complementary therapy to improve the quality of life of CKD patients. It is recommended that this initiative be continued through routine mentoring and interdisciplinary collaboration to promote therapeutic breathing exercises across healthcare settings.

Chronic diseases such as chronic kidney disease (CKD), diabetes, and heart disease remain major causes of mortality worldwide, highlighting the need for accurate and interpretable diagnostic models. However, conventional machine learning methods often face challenges of limited generalization, feature redundancy, and class imbalance in medical datasets. This study proposes an integrated classification framework that unifies three complementary feature paradigms: classical tabular attributes, deep latent features extracted through an unsupervised Long Short-Term Memory (LSTM) encoder, and quantum-inspired features derived from a five-qubit circuit implemented in PennyLane. These heterogeneous features are fused using a feature-wise attention mechanism combined with an AdaBoost classifier to dynamically weight feature contributions and enhance decision boundaries. Experiments were conducted on three benchmark medical datasets—CKD, early-stage diabetes, and heart disease—under both balanced and imbalanced configurations using stratified five-fold cross-validation. All preprocessing and feature extraction steps were carefully isolated within each fold to ensure fair evaluation. The proposed hybrid model consistently outperformed conventional and ensemble baselines, achieving peak accuracies of 99.75% (CKD), 96.73% (diabetes), and 91.40% (heart disease) with corresponding ROC AUCs up to 1.00. Ablation analyses confirmed that attention-based fusion substantially improved both accuracy and recall, particularly under imbalanced conditions, while SMOTE contributed minimally once feature-level optimization was applied. Overall, the attention-guided AdaBoost framework provides a robust and interpretable approach for clinical risk prediction, demonstrating that integrating diverse quantum, deep, and classical representations can significantly enhance feature discriminability and model reliability in structured medical data.

Chronic kidney disease (CKD) is a progressive and irreversible decline in kidney function that, if left untreated, can lead to serious complications. Ultrasonography (USG) is a widely used imaging modality for detecting CKD, yet its interpretation remains highly dependent on the radiologist’s expertise. This study aims to develop a CKD detection system using a convolutional neural network (CNN) on kidney ultrasound images based on estimated glomerular filtration rate (eGFR), and to evaluate the system’s performance. This research employed a research and development (R&D) approach with an experimental design. The dataset consisted of kidney ultrasound images from CKD and non-CKD patients with corresponding eGFR values. The methodology included image preprocessing, CNN model training, and accuracy evaluation using classification metrics. The results demonstrated that the developed CNN model achieved a total accuracy of 97% on internal test data and 95.8% on external validation. The model’s sensitivity reached 100% for the normal category, 91.67% for CKD stage 4, and 90% for CKD stage 5. Specificity exceeded 96% across all categories, with high precision and F1-scores above 94% for all classes. This system has proven to be effective as a diagnostic support tool for automatically detecting CKD through kidney ultrasound imaging. Its advantages lie not only in accurately classifying CKD from USG images but also in correlating the classification results with patients' eGFR values. This provides more precise clinical information and supports appropriate CKD staging and management planning.

Chronic Kidney Disease (CKD) is a medical condition that requires renal replacement therapy such as hemodialysis. Patient compliance with this therapy is essential to prevent complications and maintain quality of life. Patient motivation, both intrinsic and extrinsic, plays a significant role in determining the level of compliance. This study aims to examine the relationship between patient motivation and compliance with hemodialysis treatment in CKD patients at RSI PKU Muhammadiyah Pekajangan Pekalongan. This research uses a quantitative correlational design with purposive sampling, involving 67 respondents from a population of CKD patients undergoing hemodialysis, with an average of 80 patients per month. The instruments used were patient motivation questionnaires and hemodialysis compliance questionnaires. The results showed that most respondents had good motivation (74.6%) and positive compliance (76.1%). Bivariate analysis using the Spearman Rank test revealed a significant relationship between motivation and compliance (p = 0.000) with a strong correlation (r = 0.685). This study suggests nursing interventions that focus on enhancing patient motivation to support long-term therapy success. The limitations of this study include the cross-sectional design, which cannot prove causal relationships, and the potential social bias in the self-report instruments.

Patients undergoing hemodialysis require effective and adaptive coping mechanisms to manage both the physical and psychological stress experienced during treatment. Inadequate or maladaptive coping strategies may result in physiological disturbances and heightened emotional distress, ultimately reducing the quality of life of patients with chronic kidney disease (CKD). This study aims to analyze the relationship between coping mechanisms and anxiety levels among patients undergoing hemodialysis. The research employed a quantitative approach with a cross-sectional correlational design. A total of 35 respondents were recruited using purposive sampling based on specific inclusion criteria, including diagnosis of CKD and ongoing hemodialysis treatment. The study was conducted in the hemodialysis unit of RSUI Harapan Anda, Tegal, in 2025. Data collection was carried out through structured questionnaires, while statistical analysis utilized the Pearson Chi-Square test. Results indicated a p-value of 0.001 (p < 0.05), confirming a statistically significant association between coping mechanisms and anxiety levels. Patients who employed adaptive coping strategies demonstrated lower levels of anxiety, whereas those relying on maladaptive strategies experienced heightened anxiety. These findings highlight the importance of targeted nursing interventions that focus on strengthening adaptive coping skills to reduce psychological burden. Furthermore, the study emphasizes the need for comprehensive patient education and structured psychosocial support programs to promote resilience, improve coping capacity, and enhance overall psychological well-being in patients undergoing long-term hemodialysis.

Elevated blood pressure can increase intraglomerular pressure in the kidneys, potentially causing nephron damage and leading to proteinuria. In patients with chronic kidney disease (CKD), the use of supra-physiological dialysate temperatures, such as 37ºC, can elevate core body temperature (CBT), trigger vasodilation, and subsequently result in decreased blood pressure during hemodialysis. This study aimed to examine the effect of increased dialysate temperature on intradialytic blood pressure in CKD patients at the Dialysis Unit of RSI Sultan Agung. This research employed a quantitative approach with a pre-experimental one-group pre-test post-test design. The population consisted of 116 CKD patients undergoing hemodialysis. The results indicated that the average systolic blood pressure before the increase in dialysate temperature was 150.87 mmHg, with an average diastolic pressure of 85.37 mmHg. After the temperature increase, the average systolic pressure decreased to 144.00 mmHg, and the diastolic pressure dropped to 77.50 mmHg. Statistical analysis revealed a significant effect of increased dialysate temperature on intradialytic blood pressure, with a p-value of 0.000 (<0.05). These findings highlight the importance of careful regulation of dialysate temperature to enhance both the safety and effectiveness of hemodialysis therapy.

Chronic kidney disease (CKD) that is left untreated can lead to serious complications, one of which is hypertension in hemodialysis patients. Intradialytic hypertension can impair quality of life and increase mortality risk. Benson relaxation therapy, which combines breathing techniques with the repetition of positive words, has the potential to lower blood pressure. The purpose of this research is to measured blood pressure during and subsequent to Benson relaxation therapy in hemodialysis patients. This quantitative research employed a pre-experimental methodological approach with a case study approach. The subjects consisted of 3 respondents selected from a population of 24 hemodialysis patients at a hospital. Blood pressure data were collected using a digital sphygmomanometer and analyzed descriptively. After three sessions of Benson relaxation therapy lasting approximately 10 minutes each, systolic blood pressure decreased with the maximum reduction of 18 mmHg and the lowest reduction of 2 mmHg, while diastolic blood pressure decreased with the maximum reduction of 20 mmHg and the lowest reduction of 1 mmHg. Benson relaxation therapy can reduce blood pressure in patients undergoing hemodialysis. Benson relaxation therapy may be considered as a non-pharmacological intervention to help lower blood pressure in hemodialysis patients. After three sessions of Benson relaxation therapy lasting approximately 10 minutes each, systolic blood pressure decreased with the maximum reduction of 18 mmHg and the lowest reduction of 2 mmHg, while diastolic blood pressure decreased with the maximum reduction of 20 mmHg and the lowest reduction of 1 mmHg. These results indicate that Benson relaxation therapy can significantly reduce blood pressure in hemodialysis patients. The therapy’s effectiveness in reducing blood pressure may be attributed to the deep breathing exercises and the relaxation response it induces, which helps to reduce the overall stress on the cardiovascular system.