The present study showed a high prevalence of CKD in representative urban and semi-urban areas and argues for screening and treatment of all Indonesians, particularly those at an increased risk of CKD.

Hemodialysis patients are at an increased risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. However, the prevalence of hepatitis viral infection and its genotype distribution among hemodialysis patients in Indonesia are unclear. In order to investigate these issues and the possibility of nosocomial transmission, 161 hemodialysis patients and 35 staff members at one of the hemodialysis unit in Yogyakarta, Indonesia, were tested for serological and virological markers of both viruses. HBV surface antigen (HBsAg) was detected in 18 patients (11.2%) and in two staff members (5.7%). Anti-HCV was detected in 130 patients (80.7%) but not in any staff members. Occult HBV and HCV infection were detected in 21 (14.7%) and 4 (12.9%) patients, respectively. The overall prevalence rates of HBV and HCV infection among patients were 24.2% and 83.2%, respectively. HCV infection was independently associated with hemodialysis duration and the number of blood transfusions. Phylogenetic analysis revealed that 23 of 39 tested HBV strains (59%) were genotype B, 11 (28.2%) were genotype C, and 5 (12.8%) were genotype A. HCV genotype 1a was dominant (95%) among 100 tested HCV strains. Nosocomial transmission was suspected because the genotype distribution differed from that of the general population in Indonesia, and because the viral genomes of several strains were identical. These findings suggest that HBV and HCV infection is common among hemodialysis patients in Yogyakarta, and probably occurs through nosocomial infection. Implementation of strict infection-control programs is necessary in hemodialysis units in Indonesia.

Patients undergoing hemodialysis are at increased risk of infection with blood-borne viruses, including GB virus C (GBV-C) and torque teno virus (TTV). However, the prevalence and genotypic distribution of these viruses in the assessed patients undergoing hemodialysis remains unclear. The present study investigated these issues and the possibility of nosocomial transmission among patients undergoing hemodialysis in a unit in Yogyakarta, Indonesia. GBV-C RNA was detected in 92/161 patients (57.1%) by nested reverse-transcription polymerase chain reaction. Phylogenetic analysis of the 5'-untranslated region (UTR) classified the GBV-C isolates into genotypes 6 (85%), 2 (8%), 4 (6%), and 3 (1%). TTV DNA was detected in all patients by the amplification of the 5'-UTR and open reading frame-1 (ORF1) by nested and semi-nested polymerase chain reaction. Phylogenetic analysis based on the ORF1 revealed that genotype 1 was dominant (84%), followed by genotypes 2 (10%) and 3 (6%). The greater prevalence of GBV-C genotype 6 in patients undergoing hemodialysis compared with the general population and the identical sequences observed in multiple isolates provided strong evidence of patient-to-patient transmission. The prevalence of TTV in hemodialysis patients was similar to that observed in the general population, and only one pair of TTV isolates was identical. These results indicated that nosocomial infection was not the main cause of the high prevalence of TTV in patients undergoing hemodialysis. In conclusion, GBV-C and TTV infections are common in patients undergoing hemodialysis in Yogyakarta, Indonesia, and transmission is likely to be nosocomial in the case of GBV-C infection.

Dietary assessment is absolutely necessary to meet the dietary requirements of hemodialysis (HD) patients. A food record is the most commonly used method; however, it is not routinely performed. The weakness of this method is that it is burdensome for some respondents and requires more time to complete data entry. Meanwhile, the brief food frequency questionnaire (BFFQ) is a quicker and simpler method to assess individual dietary intake. We aimed to compare the BFFQ and food records as assessment methods of energy and protein intake for HD patient in Dr. Sardjito Hospital in Indonesia. This study was conducted on March to April 2015 in HD Unit of Dr. Sardjito Hospital, Indonesia, as an observational study. This was a cross-sectional study. Data were collected from 103 patients, who were selected using a purposive sampling method. All participants' dietary intakes were assessed using a food record and the BFFQ to obtain total protein and energy intakes. Wilcoxon test was used for the statistical analysis. There was a significant difference (P <0.0001) between the methods used to assess energy intake in HD patients at Dr. Sardjito Hospital. However, there was no significant difference (P = 0.732) between the two methods used to assess protein intake among patients. This difference was caused by a missing list in the BFFQ about snacks that were usually consumed by patients as energy sources. The BFFQ can be used as a protein intake assessment tool in HD patients. However, the BFFQ is not suitable to assess energy intake in patients.

The incidence and prevalence of chronic kidney disease (CKD) has increased worldwide and in Indonesia. There were about 53,940 people with stage 5 CKD based on data from the Indonesian Renal Registry (IRR) in 2018. Incidence crude rate is 251 per million population and prevalence crude rate is 499 per million population for the entire population1. The prevalence of CKD has almost doubled in 5 years, from 2‰ in 2013 to 3.8‰ in 2018. Hemodialysis (HD) is a renal replacement therapy modality that is in great demand by the public compared to the other two modalities, namely peritoneal dialysis and kidney grafts. In 2018, there was a consistent increase in the number of new patients and active HD patients. Active patients is the total number of patients (either new or old patients) who are still undergoing routine HD. The number of new patients has doubled compared to 2017. This also resulted in a sharp increase in the number of active patients compared to the previous year.