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"Pendahuluan: Penelitian ini adalah penelitian pendahuluan untuk mengetahui pengaruh tekanan darah sistolik dan diastolik terhadap maturasi arteriovenous fistula (AVF) pada pasien gagal ginjal kronis stadium akhir dengan diabetes melitus tipe 2, sehingga nantinya dapat dijadikan pertimbangan dalam pembuatan akses AVF di divisi Bedah Vaskular RSCM.Metode: Penelitian ini dilakukan dengan desain historical cohort di Divisi Vaskular Departemen Ilmu Bedah FKUI-RSCM, Jakarta. Dengan dilakukan consecutive sampling, semua penderita penyakit ginjal kronik stadium akhir dengan diabetes melitus tipe 2 yang direncanakan untuk hemodialisis dengan akses vaskular AVF brakiosefalika.Hasil: Didapatkan 64 subjek gagal ginjal kronik dengan diabetes melitus tipe 2 menjalani prosedur pemasangan akses brakiosefalika. Sebanyak 75% yang matur dari keseluruhan subjek yang diikutsertakan. Rerata tekanan sistolik pra bedah antar kedua kelompok menunjukan angka maksimal berada di 165,15 mmHg dan minimum 123.19 mmHg pada kelompok matur dan angka maksimal berada di 164,65 mmHg dan minimum 125,26 mmHg pada kelompok tidak matur dengan nilai p = 0,922. Rerata tekanan diastolik prabedah antar kedua kelompok dimana angka maksimal berada di 93,04 mmHg dan minimum 72,6 mmHg pada kelompok matur dan angka maksimal berada di 90,34 mmHg dan minimum 75,78 mmHg pada kelompok tidak matur. Sehingga secara statistik tidak memberi kemaknaan (p = 0,982).Kesimpulan: Tekanan darah sistolik-diastolik pra bedah tidak memiliki kemaknaan terhadap maturitas AVF brakiosefalika pada penderita penyakit ginjal kronik stadium akhir dengan dibetes melitus tipe 2.Kata Kunci: tekanan darah sistolik-diastolik, maturitas AV fistula, brakiosefalika, diabetes melitus.

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Introduction: This study is a preliminary study to see the effect of systolic and diastolic blood pressure on arteriovenous fistula maturation (AVF) in end-stage chronic renal failure patients with type 2 diabetes melitus, in the future this study can be considered as reference in making AVF access in the Vascular Surgery division of RSCM.

Methods: This study was conducted with a historical cohort design at the Division of Vascular Surgery Department of the Faculty of medicine University Indonesia- Cipto Mangunkusumo Hospital, Jakarta. We are using consecutive sampling, all patients with end-stage chronic kidney disease with type 2 diabetes melitus that have planned for hemodialysis with brachiocephalic AVF vascular access.

Result: There were 64 subjects with chronic renal failure with type 2 diabetes melitus undergoing brachiocephalic access insertion procedures. There are 75% of mature subjects were enrolled. The mean preoperative systolic pressure between the two groups showed the maximum number was 165.15 mmHg and minimum was 123.19 mmHg for the mature group, and we also found the maximum number is 164.65 mmHg and the minimum 125.26 mmHg for the immature group with P value 0.922 (P=0.922). The mean preoperative diastolic pressure between the two groups, where the maximum number was 93.04 mmHg and the minimum 72.6 mmHg for the mature group and the maximum number is 90.34 mmHg and the minimum 75.78 mmHg for the immature group. The result was statistically not significant with P value 0.982 (P=0.9820). Conclusion: Preoperative systolic-diastolic blood pressure has no significance meaning on the maturity of the brachiocephalic AVF in patients with end-stage chronic kidney disease with type 2 diabetes melitus.

Keywords: Systolic-diastolic blood pressure, AV fistula maturity, brachiocephalica, end-stage chronic kidney disease, diabetes melitus."

"Latar Belakang: Beberapa penelitian telah membuktikan faktor-faktor yang berpengaruh pada maturasi fistula arteriovenosa, namun pengaruh profil lipid (LDL,HDL, Trigliserida, Kolesterol total) belum terlalu jelas.Tujuan: Untuk mengetahui pengaruh profil lipid pada maturasi fistula arteriovenosa pada pasien penyakit ginjal tahap akhir dengan komorbid diabetes mellitus tipe 2.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian ini mengambil data sekunder dari penelitian dr. Dedy Pratama, SpBSubVE yang melakukan penelitian di RSUPN Dr. Cipto Mangunkusumo, RS Hermina Bekasi Barat, dan RS Hermina Depok pada pasien penyakit gagal ginjal tahap akhir dengan diabetes mellitus tipe 2 dan dilakukan operasi fistula arteriovenosa brachiocefalica.Hasil: Total sampel 67, sampel terbanyak berjenis kelamin laki-laki 34 (50,7%) sedangkan perempuan sebanyak 33 (49,3%). Sebanyak 47 (70,1%) matur, sedangkan yang tidak matur 20 (29,9%). Didapatkan nilai rerata LDL pada sampel matur FAV 110,13(32,786) dan tidak matur 135,6(39,317) P=0,008. Didapatkan diameter arteri brachialis pre operasi 4,25 mm(0,68) pada kelompok matur, 3,85(0,69) pada tidak matur P=0,029. Volume aliran pasca operasi 568,48(44,9-1451) pada kelompok matur, 347,12(43,1-1295) pada kelompok tidak matur dengan P=0,031. Usia, hipertensi, merokok, gula darah sewaktu, indeks massa tubuh, trigliserida, HDL, kolesterol total, volume aliran pre operasi, IMT feeding artery, PSV feeding artery per dan pasca operasi tidak berpengaruh pada maturasi.Simpulan: Nilai LDL lebih tinggi dari 119,5 mg/dL dapat menurunkan angka maturasi FAV pada pasien PGTA dengan DM tipe 2. Sedangkan kolesterol total, HDL, dan trigliserida pada penelitian ini tidak berpengaruh pada maturasi FAV.

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Background: Several studies have shown the factors that influence the maturation of arteriovenous fistulas, but the effect of the lipid profile (LDL, HDL, triglycerides, total cholesterol) is not clear.

Objective: To determine the effect of lipid profiles on the maturation of arteriovenous fistulas in end-stage renal disease patients with comorbid type 2 diabetes mellitus.

Method: The design used is a cross-sectional design. This study took secondary data from the research of dr. Dedy Pratama, SpBSubVE who conducted research at RSUPN Dr. Cipto Mangunkusumo, West Bekasi Hermina Hospital, and Hermina Depok Hospital in patients with end-stage renal failure with type 2 diabetes mellitus and undergoing surgery for fistula arteriovenosa brachiocefalica.

Results: The total sample was 67, the largest sample was male 34 (50.7%), while the female was 33 (49.3%). A total of 47 (70.1%) were mature, while 20 (29.9%) were not mature. The average value of LDL in the mature FAV sample was 110.13 (32.786) and the immature sample was 135.6 (39.317) P = 0.008. The preoperative brachial artery diameter was 4.25 mm (0.68) in the mature group, 3.85 (0.69) in the immature P = 0.029. Postoperative flow volume was 568.48 (44.9-1451) in the mature group, 347.12 (43.1-1295) in the immature group with P = 0.031. Age, hypertension, smoking, temporary blood sugar, body mass index, triglycerides, HDL, total cholesterol, preoperative flow volume, BMI of artery feeding, PSV feeding arteries per and postoperatively had no effect on maturation.

Conclusion: LDL values higher than 119.5 mg/dL can reduce the maturation rate of AVF in ESRD patients with type 2 diabetes. Meanwhile, total cholesterol, HDL, and triglycerides in this study had no effect on FAV maturation."

"Latar Belakang: Beberapa penelitian telah membuktikan faktor-faktor yang berpengaruh pada maturasi fistula arteriovenosa, namun pengaruh profil lipid(LDL,HDL, Trigliserida, Kolesterol total) belum terlalu jelas.Tujuan: Untuk mengetahui pengaruh profil lipid pada maturasi fistula arteriovenosapada pasien penyakit ginjal tahap akhir dengan komorbid diabetes mellitus tipe 2.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian inimengambil data sekunder dari penelitian dr. Dedy Pratama, SpBSubVE yangmelakukan penelitian di RSUPN Dr. Cipto Mangunkusumo, RS Hermina Bekasi Barat,dan RS Hermina Depok pada pasien penyakit gagal ginjal tahap akhir dengan diabetesmellitus tipe 2 dan dilakukan operasi fistula arteriovenosa brachiocefalica.Hasil: Total sampel 67, sampel terbanyak berjenis kelamin laki-laki 34 (50,7%)sedangkan perempuan sebanyak 33 (49,3%). Sebanyak 47 (70,1%) matur, sedangkanyang tidak matur 20 (29,9%). Didapatkan nilai rerata LDL pada sampel matur FAV110,13(32,786) dan tidak matur 135,6(39,317) P=0,008. Didapatkan diameter arteribrachialis pre operasi 4,25 mm(0,68) pada kelompok matur, 3,85(0,69) pada tidak maturP=0,029. Volume aliran pasca operasi 568,48(44,9-1451) pada kelompok matur,347,12(43,1-1295) pada kelompok tidak matur dengan P=0,031. Usia, hipertensi,merokok, gula darah sewaktu, indeks massa tubuh, trigliserida, HDL, kolesterol total,volume aliran pre operasi, IMT feeding artery, PSV feeding artery per dan pascaoperasi tidak berpengaruh pada maturasi.Simpulan: Nilai LDL lebih tinggi dari 119,5 mg/dL dapat menurunkan angka maturasiFAV pada pasien PGTA dengan DM tipe 2. Sedangkan kolesterol total, HDL, dantrigliserida pada penelitian ini tidak berpengaruh pada maturasi FAV.

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Background: Several studies have shown the factors that influence the maturation of

arteriovenous fistulas, but the effect of the lipid profile (LDL, HDL, triglycerides, total

cholesterol) is not clear.

Objective: To determine the effect of lipid profiles on the maturation of arteriovenous

fistulas in end-stage renal disease patients with comorbid type 2 diabetes mellitus.

Method: The design used is a cross-sectional design. This study took secondary data

from the research of dr. Dedy Pratama, SpBSubVE who conducted research at RSUPN

Dr. Cipto Mangunkusumo, West Bekasi Hermina Hospital, and Hermina Depok

Hospital in patients with end-stage renal failure with type 2 diabetes mellitus and

undergoing surgery for fistula arteriovenosa brachiocefalica.

Results: The total sample was 67, the largest sample was male 34 (50.7%), while the

female was 33 (49.3%). A total of 47 (70.1%) were mature, while 20 (29.9%) were not

mature. The average value of LDL in the mature FAV sample was 110.13 (32.786) and

the immature sample was 135.6 (39.317) P = 0.008. The preoperative brachial artery

diameter was 4.25 mm (0.68) in the mature group, 3.85 (0.69) in the immature P =

0.029. Postoperative flow volume was 568.48 (44.9-1451) in the mature group, 347.12

(43.1-1295) in the immature group with P = 0.031. Age, hypertension, smoking,

temporary blood sugar, body mass index, triglycerides, HDL, total cholesterol,

preoperative flow volume, BMI of artery feeding, PSV feeding arteries per and

postoperatively had no effect on maturation.

Conclusion: LDL values higher than 119.5 mg/dL can reduce the maturation rate of

AVF in ESRD patients with type 2 diabetes. Meanwhile, total cholesterol, HDL, and

triglycerides in this study had no effect on FAV maturation."

"Latar Belakang: Saat ini fistula arteriovenosa (FAV) masih merupakan standar baku emas akses vaskular untuk hemodialisis pada pasien PGTA. Tingginya angka diabetes melitus sebagai penyebab ataupun sebagai komorbid pasien PGTA, tingginya angka kegagalan maturasi FAV terutama pada pasien DM, dan dibutuhkan waktu lebih lama untuk maturasi pada pasien DM. Tujuan: Menganalisis ulang untuk mendapatkan anjuran batas minimal diameter arteri brakialis dan vena sefalika sebagai prediktor maturasi FAV brakiosefalika pada populasi pasien PGTA dengan diabetes melitus tipe 2 pasca pembuatan FAV 6 minggu dan 8 minggu. Metode: Desain yang digunakan adalah kohort retrospektif menggunakan data sekunder. Data sekunder yang digunakan merupakan data dari pasien penyakit ginjal tahap akhir dengan komorbid diabetes melitus tipe 2 yang menjalani operasi pembuatan fistula arteriovenosa brakiosefalika. Hasil: Dari total 72 pasien yang memenuhi kriteria inklusi dan eksklusi, terdapat 44 (61,11%) pasien yang mengalami matur pada 6 minggu post operasi dan 47 (65,28%) yang matur pada 8 minggu post operasi. Matur minggu ke 6 memiliki diameter vena sefalika yang bermakna lebih besar daripada yang tidak matur (3,20±0,94 vs 2,65±1,02, p=0,002). Pada minggu ke 8 didapatkan diameter arteri brakialis bermakna lebih besar daripada tidak matur (4,22±0,70 vs 3,78±0,60, p=0,012), dan memiliki diameter vena sefalika bermakna lebih besar daripada tidak matur (3,28±0,98 vs 2,43±0,82, p=0,000). Nilai prediksi dari diameter arteri brakialis pre operasi untuk memprediksi maturasi FAV Brakiosefalika sebesar 68% (IK 95%: 55,1%-80,9%) untuk minggu ke 8. Nilai prediksi dari diameter vena sefalika pre operasi untuk memprediksi maturasi FAV Brakiosefalika sebesar 71,7% (IK 95%: 58,7%-84,7%) untuk minggu ke 6 dan 79,8% (IK 95%: 68,2%-91,3%) untuk minggu ke 8. Kesimpulan: Nilai ambang terbaik untuk diameter arteri brakialis pre operasi memprediksi maturasi FAV minggu ke 8. adalah 3,85 mm (sensitivitas 78,7% dan spesifisitas 60%). Nilai ambang terbaik untuk diameter vena sefalika pre operasi memprediksi maturasi FAV minggu ke 6 adalah 2,45 mm (sensitivitas 79,5% dan spesifisitas 60,7%), dan nilai ambang terbaik untuk diameter vena sefalika pre operasi memprediksi maturasi FAV minggu ke 8. adalah 2,45 mm (sensitivitas 83% dan spesifisitas 72%).

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Background: Currently arteriovenous fistula (AVF) is still the gold standard for vascular access for hemodialysis in ESRD patients. The high rate of diabetes mellitus as a cause or as comorbidity in ESRD patients, the high rate of AVF maturation failure, especially in DM patients, and it takes longer time for maturation in DM patients.

Objective: To reanalyze to obtain recommendations for the minimum diameter of the bracial artery and cephalic vein as a predictor of brachiocephalic AVF maturation in the ESRD patient population with type 2 diabetes mellitus after 6 weeks and 8 weeks of creation AVF.

Method: The design used was a retrospective cohort design using secondary data. The secondary data used are data from patients with ESRD with comorbid type 2 diabetes mellitus who underwent surgery for brachiocephalic AFV.

Results: From a total of 72 patients who met the inclusion and exlusion criteria, there were 44 (61,11%) patients who were mature at 6 weeks of postoperatively 47 (65,28%) who were mature at 8 weeks of postoperatively. The 6th week of maturity had a significantly larger cephalic vein diameter than the immature (3,20±0,94 vs 2,65±1,02, p=0,002). The 8th week of maturity had a significantly larger brachial artery diameter than the immature (4,22±0,70 vs 3,78±0,60, p=0,012), and having a cephalic vein diameter significantly larger than the immature (3,28±0,98 vs 2,43±0,82, p=0,000). The predictive value of preoperative brachial artery diameter to predict brachiocephalic AVF maturation was 68% (95% CI: 55,1%-80,9%) for week 8. The predictive value of preoperative cephalic vein diameter to predict brachiocephalic AVF maturation was 71,7% (95% CI: 58,7%-84,7%) for week 6 and 79,8% (95% CI: 68,2%-91,3%) for week 8.

Conclusion: The best threshold value for preoperative brachial artery diameter predicting AVF maturation 8th week was 3,85 mm (sensitivity 78,7% and specificity 60%). The best threshold value for preoperative cephalic vein diameter predicting AVF maturation 6th week was 2,45 mm (sensitivity 79,5% dan specificity 60,7%), and the best threshold value for preoperative cephalic vein diameter predicting AVF maturation 8th week is 2,45 mm (sensitivity 83% dan specificity 72%)."

"Latar Belakang: Walaupun transplantasi ginjal merupakan pilihan tatalaksana terbaik bagi penyakit ginjal tahap akhir, hingga saat ini hemodialisis masih merupakan modalitas terapi pengganti ginjal yang paling banyak dipilih, baik di negera maju maupun negera berkembang. Akses vaskular baku emas untuk hemodialisa adalah dengan fistula arteriovenosa. Namun, untuk dapat berfungsi sebagai akses hemodialisa fistula arteriovenosa membutuhkan waktu untuk mencapai maturasi. Tujuan: Untuk menganalisa hubungan volume aliran feeding arteri pada minggu-minggu awal pasca operasi fistula arteriovenosa dan potensi volume aliran feeding arteri di minggu-minggu awal pasca operasi fistula arteriovenosa untuk dijadikan sebagai prediktor maturasi fistula arteriovenosa pada populasi pasien penyakit ginjal tahap akhir dengan diabetes melitus tipe 2. Metode: Desain yang digunakan adalah desain kohort retrospektif menggunakan data sekunder dari penelitian sebelumnya. . Data sekunder yang digunakan merupakan data dari pasien penyakit ginjal tahap akhir dengan komorbid diabetes melitus tipe 2 yang menjalani operasi konstruksi fistula arteriovenosa brachiocephalica.Hasil: Dari total 67 pasien yang memenuhi kriteria inklusi dan eksklusi, terdapat 47 (70,1%) pasien yang mengalami maturase dan sisanya tidak mengalami maturasi. Pada minggu pertama pasca operasi fistula arteriovenosa, kelompokt matur memiliki volume flow arteri feeding yang signifikan lebih tinggi daripada kelompok yang tidak matur (978.99 ±351.5 vs 555.42±215.9, p= <0.001). Sedangkan nilai prediksi dari volume flow arteri feeding untuk maturasi sebesar 84,7% (IK95%: 75,2%-94,2%) untuk minggu pertama. Simpulan: Kelompok dengan fistula arteriovenosa matur memiliki rerata flow feeding artery yang lebih tinggi secara signifikan. Nilai ambang terbaik volume flow feeding artery didapatkan padaminggu 1 untuk memprediksi maturasi fistula arteriovenosa. Nilai ambang dengan sensitivitas terbaik di mana tidak ada fistula arteriovenosa yang matur dengan volume flow di bawa nilai tersebut adalah 343,67 mL/min (sensitivitas 100% dan spesifisitas 15%)

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Background: Although kidney transplantation is the treatment of choice for end-stage renal disease, hemodialysis is still the most preferred modality for renal replacement therapy, both in developed and developing countries. The gold standard vascular access for hemodialysis is with arteriovenous fistulas. However, to be able to function for hemodialysis arteriovenous fistula takes time to reach maturation.

Objective: To analyze the relationship of volume flow feeding artery in the early weeks after surgery of arteriovenous fistulas and the potential for of volume flow feeding artery in the early weeks after surgery for arteriovenous fistulas to be used as predictors of maturation of arteriovenous fistulas in a population of patients with end-stage renal disease with type 2 diabetes mellitus.

Method: The design used is a retrospective cohort design using secondary data from previous studies. . Secondary data used were data from patients with end-stage renal disease with comorbid diabetes mellitus type 2 who underwent construction surgery for brachiocephalic arteriovenous fistula.

Results: Of the total 67 patients who met the inclusion and exclusion criteria, there were 47 (70.1%) patients who had maturation and the rest did not. In the first week postoperative arteriovenous fistula, the mature group had a significantly higher volume of feeding artery flow than the immature group (978.99 ± 351.5 vs 555.42 ± 215.9, p = <0.001). Meanwhile, the predictive value of the feeding artery flow volume for maturation was 84.7% (95% CI: 75.2% -94.2%) for the first week.

Conclusion: The mature group of arteriovenous fistulas had a significantly higher rate of artery feeding flow. The best threshold value for artery flow feeding volume was obtained at week 1 to predict maturation of arteriovenous fistulas. The threshold value with the best sensitivity where there are no mature arteriovenous fistulas with a volume flow below this value is 343.67 mL / min (sensitivity 100% and specificity 15%)."

"Latar belakang: Penyakit ginjal tahap akhir (PGTA) terusmeningkat jumlahnya di dunia maupun di Indonesia. Fistula arterio-venosa (FAV) masih menjadi standard emas aksesvaskular untuk hemodialisa dan untuk pasien diabetes melitusdirekomendasikan untuk membuat FAV di brakiosefalika. Steal Syndrome merupakan salah satu komplikasi FAV. Telah adapenelitian basal digital pressure (BDP), saturasi oksigen, dan change digital pressure (CDP) untuk diagnosa Steal Syndrome, namun belum pada pasien dengan diabetes melitus. Penelitianini bertujuan untuk mengukur akurasi BDP, saturasi oksigen, dan CDP untuk diagnosa Steal Syndrome pada pasien PGTA dengandiabetes melitus.Metode: Penelitian ini merupakan kohort prospektif yang melibatkan 69 pasien PGTA dengan diabetes melitus tipe 2 yang melakukan kontruksi FAV brakiosefalika pada 3 senter vaskulardi Jakarta. Pemeriksaan BDP, CDP, dan saturasi oksigendilakukan minimal 4 minggu setelah proses pembuatan FAV dan setelah FAV dinyatakan matur serta telah digunakan untukhemodialisa. Analisis statistic menggunakan SPSS versi 25.Hasil: Terdapat perbedaan bermakna pada CDP, BDP, maupun saturasi oksigen antara pasien Steal Syndrome dan tidak Steal Syndrome (p<0,001). Nilai area under curve (AUC) BDP, CDP, dan Saturasi oksigen untuk memprediksi Steal Syndrome adalah 95,9% (IK95%: 90,1%-100%), 93,8% (IK95%: 87,6%-99,9%), dan 97,5% (IK95%: 93,8%-100%). Dan nilai ambang batasBDP, CDP, dan saturasi oksigen yang optimal untukmemprediksi Steal Syndrome adalah <85 mmHg (sensitivitas: 80%, Spesifisitas 100%) untuk BDP, >35 mmHg (sensitivitas: 80%, Spesifisitas 90,74%) untuk CDP, dan 94,5% (sensitivitas80%, spesifisitas 100%) untuk saturasi oksigen.Kesimpulan: BDP, CDP, dan saturasi oksigen meski dengansensitivitas dan spesifisitas yang masih terbatas terbukti dapatdigunakan untuk mendiagnosa Steal Syndrome pada pasienPGTA dengan diabetes melitus.

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Background: The number of end-stage renal disease patient keep increasing globally. Arteriovenous Fistula (AVF) is still the golden standard vascular access for hemodialysis and the recommended site for AVF construction in diabetic patient is at brachiocephalic. Steal Syndrome is one of AVF complication.There have been studies that used basal digital pressure (BDP), oxygen saturation, and change digital pressure (CDP) for Steal Syndrome diagnosis. However, there is no study in diabetic patient. This study aims to measure the accuracy of BDP, CDP, and oxygen saturation to diagnose Steal Syndrome in end-stage renal disease patient with type 2 diabeters mellitus.

Methods: This is a prospective cohort study with 69 end-stage renal disease patient with type 2 diabetes mellitus that have braciocephalic AVF construction in 3 vascular centers in Jakarta. BDP, CDP, and oxygen saturation examination was performed after AVF was considered mature and being use for hemodialysis, the earliest being 4 weeks after AVF construction.SPSS version 25 was used for statictical analysis.

Result: There was significant association between CDP, BDP,and oxygen saturation with Steal Syndrome (p<0,001). Area Under Curve (AUC) value of BDP, CDP, and oxygen saturation to predict Steal Syndrome was 95,9% (90,1%-100%), 93,8% (87,6%-99,9%), and 97,5% (93,8%-100%) consecutively. The optimal threshold of BDP, CDP, and oxygen saturation for predicting steal syndrome was <85 mmHg (sensitivity: 80%, Spesificity 100%) for BDP, >35 mmHg (sensitivity: 80%, Spesificity 90,74%) for CDP, dan 94,5% (sensitivity 80%, spesificity 100%) for oxygen saturation.

Conclusion: BDP, CDP, and oxygen saturation can be used to diagnose Steal Syndrome in end-stage renal disease patient with diabetes mellitus. However, BDP, CDP, and oxygen saturation still have limited sensitivity and specificity."

"Latar belakang: Penyakit ginjal tahap akhir (PGTA) masih menjadi permasalahan nasional dan internasional, salah satu faktor penyebabnya adalah Diabetes Melitus tipe 2 (DM). Hemodialisa menjadi pilihan terbanyak terapi pengganti ginjal bagi para pasien PGTA, dengan fistula arteriovenosa autogen (FAV) menjadi pilihan terbaik akses karena rendah angka komplikasi dan intervensi. Penentuan maturasi dan waktu kanulasi FAV masih bervariasi dan masih banyak dipelajari. Salah satu faktor utama keberhasilan maturasi FAV adalah feeding arteri. Rekomendasi KDOQI penggunaan FAV yaitu “rule of 6”, dan rekonstruksi FAV bracchiocephalica untuk kasus PGTA dengan komorbid DM. Penelitian ini diharapkan bahwa parameter arteri brachialis sebagai feeding artery menggunakan USG linear dapat menjadi prediktor maturasi FAV. Subjek dan metode: seluruh pasien PGTA dengan DM tipe 2 yang menjalani operasi FAV brachiocephalica. Dengan menggunakan data sekunder dilihat parameter sebelum operasi berupa diameter, peak systole (PS), volume flow (VF), dan Intimal Medial Thickness (IMT) arteri brachialis yang akan dilakukan anastomosis, dan penilaian maturasi pada minggu 1,2,4,6,8 pasca operasi.  Penilitian ini menggunakan analisis komparatif kategorik 2 kelompok tidak berpasangan dengan uji hipotesis T test. Nilai perbedaan rerata (mean difference) dan p dipresentasikan. nilai p=0.05 menunjukkan terdapat hubungan bermakna secara statistik. Hasil: 64 pasien masuk dalam penelitian, jumlah maturasi pada minggu 1,2,4,6,8 pasca operasi: 6 (9,37%), 12 (18,75%), 20 (31,25%), 37 (57,81%), dan 47 (73,43%). Dari keseluruhan variabel bebas yang di teliti tidak ada yang menunjukan hubungan bermakna terhadap maturasi FAV. Ditemukan VF dan PS yang selalu konsisten lebih tinggi pada kelompok matur di setiap waktu pemeriksaan. Kesimpulan: parameter VF, PS dan IMT arteri brachialis sebelum operasi belum dapat menjadi prediktor untuk keberhasilan maturasi pada pasien PGTA dengan DM tipe 2. Diperlukan penelitian lanjut menilai parameter lain termasuk faktor outflow dan faktor lainnya dengan sampel lebih besar.

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Background; End stage renal disease is an increasing national and global health problem, with diabetic type 2 as one of its most common cause. Hemodialysis is still the most frequent choice for renal substitution therapy. And native arteriovenous fistula is still the best option for hemodialysis access because of the lowest number of complication and intervention. But the method for determining AVF maturation and time for cannulation still varies and need to be studied more.  One of the main factors for AVF maturation is feeding artery. KDOQI had recommend “rule of 6” as maturation condition, other recommendation stated that brachiocephalic AVF should be constructed for end renal stage disease with diabetes mellitus.  This study aim to know whether preoperative feeding artery linear duplex scan parameters can be used as a predictor for the AVF maturation.  

Subject and Methods: Subjects were patient with end stage renal disease with diabetic type 2, who had brachiocephalic AVF surgery. Subject were taken from secondary data and diameters, peak systole (PS), volume flow (VF), and intimal medial thickness (IMT) of brachial artery were collected before surgery. Maturation time was determined with draining vein examination at 1^st, 2^nd, 4^th, 6^th and 8^th weeks after surgery. Data analysis was done using unpaired t-test. P value below 0.05 were considered significant.

Results: 64 patients were included in this study. The number of patients with mature AVF in 1, 2, 4, 6, and 8 weeks were 6 (9,37%), 12 (18,75%), 20 (31,25%), 37 (57,81%), and 47 (73,43%) consecutively. All independent variables showed no statistically significant difference between mature and non-mature group. We found VF and PS scores to be consistently higher at mature group compared to non-mature group in all examination time.

Conclusion: Preoperative VF, PS, IMT of the feeding artery could not predict the maturation and time to mature of brachiocephalic AVF in end stage renal disease with diabetic type 2 patients. Further research is required, especially to study other paramaters include outflow and other factors with larger sampel size.

 

Keywords: AVF maturation, feeding artery, duplex scan

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"Latar Belakang : Arteriovenous fistula telah menjadi akses hemodialisis yang direkomendasikan. Namun tidak semua arteriovenous fistula dapat digunakan dengan baik, National kidney disease outcome quality initiative (NKDOQI) telah merekomendasikan pasien pascaoperasi arteriovenous fistula untuk melakukan latihan tangan, saat ini belum adanya evaluasi serta bentuk program latihan ekstremitas atas terhadap pasien gagal ginjal dengan diabetes melitus yang telah menjalani arteriovenous fistula radiochepalica di RSCM. Metode : Penelitian ini adalah penelitian kuasi eksperimental yang membandingkan data yang memiliki karakteristik sama, subjek yang menjalani arteriovenous fistula radiochepalica pada rentang waktu Februari 2020 – Februari 2021 telah diikutsertakan. Hasil : 23 subjek yang menjalani operasi arteriovenous fistula radiochepalica dilakukan pengamatan, program latihan dapat meningkatkan ukuran diameter draining vein secara bermakna dengan nilai p = 0,006 pada minggu keenam setelah operasi. Dan secara bermakna dapat meningkatkan blood flow rate di minggu keenam setelah menjalani operasi arteriovenous fistula sebesar 210% dengan rerata 616,56 ± 88,80 mL/menit dengan p = 0,002. Selanjutnya dapat menurunkan jarak draining vein dengan kulit pada minggu keempat (p = 0,015), namun hasil menjadi tidak bermakna pada minggu keenam setelah operasi. Kesimpulan: Program latihan isotonik, isometrik dan restriksi parsial ekstermitas atas pascaoperasi dapat meningkatan diameter draining vein, mempengaruhi jarak draining vein dengan kulit, dan meningkatan blood flow rate arteriovenous fistula radiochepalica.

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Background : Arteriovenous fistulas have become the recommended access for hemodialysis. However, not all arteriovenous fistulas can be functional. National kidney disease outcome quality initiative (NKDOQI) has recommended hand exercises for patients following arteriovenous fistula surgery. To date, there has been no evaluation and exercise program for the upper extremity in diabetic patients with kidney failure who have undergone radiocephalic arteriovenous fistula surgery in RSCM. Methods : This study had a quasi-experimental design, comparing the data which had the same characteristics. Subjects who underwent radiocephalic arteriovenous fistula surgery in February 2020 to February 2021 were included. Results : Twenty-three subjects who underwent radiocephalic arteriovenous fistula surgery were observed. The exercise program could increase the diameter of the draining veins significantly (p = 0.006) in the 6th week following the surgery. There was also a significant increase in the rate of blood flow as much as 210% with an average of 616.56 ± 88.80 mL/minute (p = 0.002), observed in the 6th week after the operation. Subsequently, there was a decrease in the draining vein-to-skin distance in the 4th week (p = 0.015), however the result was not significant in the 6th week following the surgery. Conclusion : The upper extremity isotonic, isometric, and partial restriction exercise program following the surgery could increase the diameter of the draining veins, affect the draining vein-to-skin distance, and increase the rate of blood flow in the radiocephalic arteriovenous fistula."

"Latar Belakang: Arteriovenous fistula telah menjadi akses hemodialisis yang direkomendasikan. Namun tidak semua arteriovenous fistula dapat digunakan dengan baik, National kidney disease outcome quality initiative (NKDOQI) telah merekomendasikan pasien pascaoperasi arteriovenous fistula untuk melakukan latihan tangan, saat ini belum adanya evaluasi serta bentuk program latihan ekstremitas atas terhadap pasien gagal ginjal dengan diabetes melitus yang telah menjalani arteriovenous fistula radiochepalica di RSCM. Metode: Penelitian ini adalah penelitian kuasi eksperimental yang membandingkan data yang memiliki karakteristik sama, subjek yang menjalani arteriovenous fistula radiochepalica pada rentang waktu Februari 2020 – Februari 2021 telah diikutsertakan. Hasil: 23 subjek yang menjalani operasi arteriovenous fistula radiochepalica dilakukan pengamatan, program latihan dapat meningkatkan ukuran diameter draining vein secara bermakna dengan nilai p = 0,006 pada minggu keenam setelah operasi. Dan secara bermakna dapat meningkatkan blood flow rate di minggu keenam setelah menjalani operasi arteriovenous fistula sebesar 210% dengan rerata 616,56 ± 88,80 mL/menit dengan p = 0,002. Selanjutnya dapat menurunkan jarak draining vein dengan kulit pada minggu keempat (p = 0,015), namun hasil menjadi tidak bermakna pada minggu keenam setelah operasi.Kesimpulan: Program latihan isotonik, isometrik dan restriksi parsial ekstermitas atas pascaoperasi dapat meningkatan diameter draining vein, mempengaruhi jarak draining vein dengan kulit, dan meningkatan blood flow rate arteriovenous fistula radiochepalica.

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Background: Arteriovenous fistulas have become the recommended access for hemodialysis. However, not all arteriovenous fistulas can be functional. National kidney disease outcome quality initiative (NKDOQI) has recommended hand exercises for patients following arteriovenous fistula surgery. To date, there has been no evaluation and exercise program for the upper extremity in diabetic patients with kidney failure who have undergone radiocephalic arteriovenous fistula surgery in RSCM.

Methods: This study had a quasi-experimental design, comparing the data which had the same characteristics. Subjects who underwent radiocephalic arteriovenous fistula surgery in February 2020 to February 2021 were included.

Results: Twenty-three subjects who underwent radiocephalic arteriovenous fistula surgery were observed. The exercise program could increase the diameter of the draining veins significantly (p = 0.006) in the 6th week following the surgery. There was also a significant increase in the rate of blood flow as much as 210% with an average of 616.56 ± 88.80 mL/minute (p = 0.002), observed in the 6th week after the operation. Subsequently, there was a decrease in the draining vein-to-skin distance in the 4th week (p = 0.015), however the result was not significant in the 6th week following the surgery.

Conclusion: The upper extremity isotonic, isometric, and partial restriction exercise program following the surgery could increase the diameter of the draining veins, affect the draining vein-to-skin distance, and increase the rate of blood flow in the radiocephalic arteriovenous fistula."

"[ABSTRAK Pendahuluan Masalah utama pada ArterioVenous Fistula AVF adalah kegagalan maturasi Deteksi dini bahwa AVF akan mengalami gagal maturasi dibutuhkan sehingga memungkinkan untuk melakukan revisi atau membuat akses vaskular yang baru sesegera mungkin Diameter vena pra operasi adalah faktor prediktor independen dalam maturasi Tujuan penelitian ini adalah untuk mengetahui prediksi dini maturasi AVF berdasarkan peningkatan ukuran diameter draining vein pasca operasi minggu pertama Metode Penelitian dilakukan secara kohort retrospektif dengan mengambil data rekam medis pasien yang menjalani operasi pembuatan AVF di RSCM tahun 2013 2014 Diameter vena pra operasi dan diameter draining vein pasca operasi minggu pertama diukur dengan USG Doppler Peningkatan diameter draining vein pasca operasi minggu pertama dihubungkan dengan maturasi AVF Hasil Didapatkan 38 pasien dengan angka maturasi 81 6 Tidak didapatkan perbedaan maturasi yang bermakna pada usia jenis kelamin diabetes melitus hipertensi CHF CAD stroke hepatitis hiperlipidemia riwayat dilakukan AVF operator dan diameter arteri pra operasi Terdapat perbedaan yang bermakna pada AVF jenis radiosefalika dan brakiosefalika p 0 022 Didapatkan perbedaan maturasi yang bermakna pada diameter draining vein pasca operasi minggu pertama dan peningkatannya pada AVF tipe brakiosefalika p 0 034 dan p 0 041 dan radiosefalika p 0 012 dan p 0 011 Nilai cut off peningkatan diameter draining vein pasca operasi minggu pertama untuk batasan prediksi maturasi adalah 0 65 mm dengan sensitifitas sebesar 90 3 spesifisitas sebesar 85 7 Pada AVF tipe brakiosefalika nilai cut off adalah 0 45 mm dengan sensitifitas sebesar 95 8 spesifisitas sebesar 100 Pada AVF tipe radiosefalika nilai cut off adalah 1 00 mm dengan sensitifitas sebesar 85 7 spesifisitas sebesar 100 Simpulan Peningkatan diameter draining vein pasca operasi minggu pertama dapat dijadikan sebagai prediktor maturasi AVF ABSTRACT Introduction The main problem in ArterioVenous Fistula AVF is the failure of maturation Early detection for non mature AVF is needed making it possible to revise or create a new vascular access as soon as possible Preoperative vein diameter is considered to be an independent predictor factor in the maturation The purpose of this study was determining the early prediction of AVF maturation using the enlargement of draining vein diameter in the first week postoperative Methods Design of this study was cohort retrospective by taking patients medical records who underwent AVF surgery Vein diameter were measured preoperative and first week postoperative with Doppler ultrasound The enlargement of the first week draining vein diameter was associated with AVF maturation Results There was 38 patients with maturation rate was 81 6 There were no significant maturation differences on age sex diabetes mellitus hypertension CHF CAD stroke hepatitis hyperlipidemia AVF history operator and preoperative arterial diameter There was significant maturation difference in the radiocephalica and brachiocephalica AVF type p 0 022 There were significant maturation difference in first week postoperative draining vein diameter and it s increasement in brachiocephalica type p 0 034 and p 0 041 and radiocephalica type p 0 012 and p 0 011 Cut off value for first week postoperative draining vein diameter increasement in maturation prediction limitation is 0 65 mm with a sensitivity of 90 3 specificity of 85 7 For brachiocephalica type cut off value is 0 45 mm with a sensitivity of 95 8 specificity of 100 For radiocephalica type cut off value is 1 00 mm with a sensitivity of 85 7 specificity of 100 Conclusion First week postoperative draining vein diameter increasement can be used as predictors of AVF maturation ;Introduction The main problem in ArterioVenous Fistula AVF is the failure of maturation Early detection for non mature AVF is needed making it possible to revise or create a new vascular access as soon as possible Preoperative vein diameter is considered to be an independent predictor factor in the maturation The purpose of this study was determining the early prediction of AVF maturation using the enlargement of draining vein diameter in the first week postoperative Methods Design of this study was cohort retrospective by taking patients medical records who underwent AVF surgery Vein diameter were measured preoperative and first week postoperative with Doppler ultrasound The enlargement of the first week draining vein diameter was associated with AVF maturation Results There was 38 patients with maturation rate was 81 6 There were no significant maturation differences on age sex diabetes mellitus hypertension CHF CAD stroke hepatitis hyperlipidemia AVF history operator and preoperative arterial diameter There was significant maturation difference in the radiocephalica and brachiocephalica AVF type p 0 022 There were significant maturation difference in first week postoperative draining vein diameter and it s increasement in brachiocephalica type p 0 034 and p 0 041 and radiocephalica type p 0 012 and p 0 011 Cut off value for first week postoperative draining vein diameter increasement in maturation prediction limitation is 0 65 mm with a sensitivity of 90 3 specificity of 85 7 For brachiocephalica type cut off value is 0 45 mm with a sensitivity of 95 8 specificity of 100 For radiocephalica type cut off value is 1 00 mm with a sensitivity of 85 7 specificity of 100 Conclusion First week postoperative draining vein diameter increasement can be used as predictors of AVF maturation , Introduction The main problem in ArterioVenous Fistula AVF is the failure of maturation Early detection for non mature AVF is needed making it possible to revise or create a new vascular access as soon as possible Preoperative vein diameter is considered to be an independent predictor factor in the maturation The purpose of this study was determining the early prediction of AVF maturation using the enlargement of draining vein diameter in the first week postoperative Methods Design of this study was cohort retrospective by taking patients medical records who underwent AVF surgery Vein diameter were measured preoperative and first week postoperative with Doppler ultrasound The enlargement of the first week draining vein diameter was associated with AVF maturation Results There was 38 patients with maturation rate was 81 6 There were no significant maturation differences on age sex diabetes mellitus hypertension CHF CAD stroke hepatitis hyperlipidemia AVF history operator and preoperative arterial diameter There was significant maturation difference in the radiocephalica and brachiocephalica AVF type p 0 022 There were significant maturation difference in first week postoperative draining vein diameter and it s increasement in brachiocephalica type p 0 034 and p 0 041 and radiocephalica type p 0 012 and p 0 011 Cut off value for first week postoperative draining vein diameter increasement in maturation prediction limitation is 0 65 mm with a sensitivity of 90 3 specificity of 85 7 For brachiocephalica type cut off value is 0 45 mm with a sensitivity of 95 8 specificity of 100 For radiocephalica type cut off value is 1 00 mm with a sensitivity of 85 7 specificity of 100 Conclusion First week postoperative draining vein diameter increasement can be used as predictors of AVF maturation ]"