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Abstrak :

Latar belakang: Hemodialisis merupakan salah satu tatalaksana penting yang dilakukan pada pasien dengan penyakit ginjal kronik (PGK) stadium 5 atau penyakit ginjal stadium akhir. Komplikasi akses hemodialisis lebih rendah pada penggunaan akses hemodialisis autogen dibandingkan dengan penggunaan akses prostetik. Maturitas fistula arteriovena sangat menentukan keberhasilan suatu akses vaskular untuk hemodialisis. Pemeriksaan  Volume flow pada draining vein yang sesuai dengan kriteria K/DOQI dapat menentukan maturitas suatu akses fistula arteriovena (FAV) . Pada penelitian ini diharapkan volume flow pada arteri brachialis dapat mewakili volume flow pada draining vein dalam menentukan maturitas suatu FAV. Subjek dan Metode : subjek adalah pasien pasien dengan PGK stadium 5,  sudah menjalani pembuatan FAV brachiosefalika usia 6 minggu dan sudah menjalani hemodialisa. Pada pasien diukur volume flow arteri brachialis dan draining vein dengan usg Doppler probe linier. Penelitian ini menggunakan desain potong lintang  untuk mendapatkan hubungan volume flow arteri brachialis dengan maturitas FAV brachiosefalika. Hasil : FAV brachiosefalika (n=80) usia 6 minggu dievaluasi. Pada FAV brachiosefalika matur, didapatkan rerata volume flow arteri brachialis (1901±1030) sedangakan yang tidak matur didapatkan rerata volume flow arteri brachialis (563±152). Sedangkan rerata volume flow draining vein pada FAV brachiosefalika matur (2707±1717) lebih tinggi dari tidak matur (500±73). Pada arteri brachialis didapatkan cut-off sebesar 700 ml/mnt dengan sensitifitas 98,44 %, spesifisitas 87,5 %, positive predictive value 96,92 %, negative predictive value 93,33 % dan akurasi 96,25 %. Kesimpulan : volume flow arteri brachialis > 700 ml/mnt, memiliki nilai predictor yang baik untuk menilai maturasi FAV brachiosefalika, sehingga didapatkan nilai yang lebih akurat dan cepat dalam menilai maturasi suatu FAV.

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Background: Hemodialysis is one of the important treatments in patients with stage 5 chronic kidney disease (CKD) or end-stage renal disease. Complications of hemodialysis access are lower in the use of access to autogenous hemodialysis compared to the use of prosthetic access. The maturity of arteriovenous fistula greatly determines the success of a vascular access to hemodialysis. The maturity of arteriovenous fistula depends on the preoperative preparation of arteriovenous fistula making. Examination of volume flow in draining veins that are in accordance with K / DOQI criteria can determine the maturity of an arteriovene fistula access (FAV). In this study it is expected that the volume flow in the brachial artery can represent volume flow in the draining vein in determining the maturity of an FAV. Subjects and Methods: Subjects were patients with stage 5 CKD, who had  brachiosefalic FAV 6 weeks of age and had hemodialysis. The patient measured brachial artery flow volume and draining vein with linear ultrasound Doppler probes. This study used a cross-sectional design to obtain a relationship between the volume flow of the brachial artery and the brachiosefalic FAV maturity. Result : Brachiocephalic FAV (n = 80) 6 weeks of age were evaluated. In the mature brachiosefalic FAV, the mean volume flow of brachial artery was (1901 ± 1030) while the non-mature FAV, the volume flow was (563 ± 152). While the mean volume flow of draining vein in mature brachiocephalic FAV (2707 ± 1717) is higher than immature (500 ± 73). The brachial artery obtained a cut-off of 700 ml / min with sensitivity of 98.44%, specificity of 87.5%, positive predictive value of 96.92%, negative predictive value of 93.33% and accuracy of 96.25%. Conclusion: Brachial artery flow volume> 700 ml / min, has a good predictor value for assessing brachiosefalic FAV maturation, so that a more accurate and faster value is obtained in assessing the maturation of a FAV.

Abstrak :
Tujuan: Pemeriksaan ultrasonography doppler pra operasi pada arteri dan vena sudah menjadi standar untuk membantu pembuatan fistula arteriovena (FAV) sebagai akses hemodialisis, tetapi pengukuran indeks rasio arteriovenous (RAV) yang diperoleh dari  diameter arteri dibagi dengan diameter vena hanya dengan ultrasonography biasa serta penerapannya melalui hukum Bernoulli belum banyak diteliti. Penelitian ini berusaha  mengetahui hubungan antara variabel rasio diameter arteri dan vena dengan prediktif pematangan FAV.

Metode: Sebuah studi kohort prospektif pada 144 pasien yang menjalani FAV dalam periode 6 bulan. Variabel demografi, komorbiditas dan indeks RAV dinilai melalui analisis regresi logistik bivariat pada evaluasi akhir kematangan. RAV dibuat tiga titik desimal untuk mendapatkan akurasi maksimal pada sensitivitas terbaik dan spesifisitas pada kurva karakteristik. Uji probabilitas (nilai P) dianggap signifikan dengan P <0,05. Hasil dilaporkan sebagai odds-rasio dengan interval kepercayaan 95%.

Hasil: Didapatkan maturitas FAV pada 92 (63,89%) dari 144 pasien (P = 0,05; Interval kepercayaan 95%; 59,8%-78,6%). Pada Index RAV 0,93 - 1,14 didapatkan 86,90% FAV yang matur (P <0,001) sedangkan lebih sempit lagi pada Index RAV 1,01 - 1,06 didapatkan 100% FAV yang matur (P <0,002). Penurunan atau kenaikan indeks ini berhubungan dengan penurunan tingkat maturitas.  

Kesimpulan: Teknik pengukuran ini (indeks RAV) sebagai prediktor maturitas dalam FAV disarankan untuk diteliti lebih lanjut. Studi ini menyiratkan bahwa rasio diameter antara arteri dan vena berhubungan maturitas, terlepas dari variabel lain tetap berpengaruh pada faktor mekanik dan biologis terhadap hemodinamik yang optimal (tekanan dan kecepatan) pada pematangan FAV

 

 

Kata kunci: Fistula Arterivenous, Indeks Rasio Arterivenous, Pematangan fungsional. Objective: Preoperative doppler ultrasonography  examination has become a standard to assist in making arteriovenous fistulas (AVF) as access to hemodialysis, but measurements of arteriovenous ratio index (AVR) obtained from arterial diameter and venous diameter and its application through Bernoulli's law have not been widely studied. This study to determine the relationship between the variable ratio of blood vessel diameter and predictive maturation of AVF.

Method: A prospective cohort study with a view to recording 144 patients underwent AVF in period of 6 months. Demographic, comorbid and RAV index variables were assessed through bivariate logistic regression analysis at the final evaluation of maturity. AVR is made of three decimal points in order to obtain maximum accuracy for the best sensitivity and specificity on the characteristic curve. The probability test (P value) is considered significant with P <0.05. Results are reported as odds ratios with 95% confidence intervals.

Results: AVF maturity was obtained in 92 (63.89%) of 144 patients (P = 0.05; 95% confidence interval; 59.8%-78.6%). In the AVR Index 0,93-1,14 obtained 86,90% mature AVF (P <0.001) and more sharp AVR Index 1.01 to 1.06 obtained 100% mature AVF (P <0.002). This decrease or increase in index is related to a decrease in the level of maturity.

Conclusion: This measurement technique (AVR index) as a predictor of AVF maturity is strongly suggested for further investigation. This study implies that the minimum ratio of diameter between arteries and veins relates to maturity rate, regardless of other variables that still have an important influence on mechanical and biological factors with optimal hemodynamics (pressure and speed) in AVF maturation

 

 

 

Abstrak :
ABSTRAK
Hemodialisis merupakan tatalaksana renal replacement yang tersering pada pasien gagal ginjal kronik stadium 5, Akses vaskular dan morbiditas sebagai akibat komplikasi akses merupakan penyebab utama perawatan di rumah sakit. Kegagalan maturitas merupakan hambatan utama penggunaan arteriovenous fistula. Tujuan dari penelitian ini adalah untuk mengkaji korelasi peak sistolik velocity arteri brakialis dan volume flow draining vein intraoperatif dengan menggunakan ultrasonografi doppler untuk memprediksi maturasi AVF. Uji statistik yang digunakan adalah uji Mann Whitney dan uji Chi Squere. Hasil yang didapatkan tidak ditemukan korelasi antara PSV arteri brakialis dengan maturitas. Rerata nilai titik potong volume flow draining vein intraoperatif 259,43 ml/min dan paska operatif 679,22 ± 65,36 ml/min dihubungkan dengan maturitas, ini dapat menjadi acuan menetukan perlu tidaknya melakukan tindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angka kegagalan maturasi AVF. ABSTRACT
Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5. Vascular access for hemodialysis its associated problems is the leading cause for hospital admission and morbidity.Maturation failure is impeded by issues of maturation. The result from this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week 679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF maturation failure. ;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5. Vascular access for hemodialysis its associated problems is the leading cause for hospital admission and morbidity.Maturation failure is impeded by issues of maturation. The result from this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week 679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF maturation failure. ;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5. Vascular access for hemodialysis its associated problems is the leading cause for hospital admission and morbidity.Maturation failure is impeded by issues of maturation. The result from this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week 679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF maturation failure. ;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5. Vascular access for hemodialysis its associated problems is the leading cause for hospital admission and morbidity.Maturation failure is impeded by issues of maturation. The result from this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week 679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF maturation failure. ;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5. Vascular access for hemodialysis its associated problems is the leading cause for hospital admission and morbidity.Maturation failure is impeded by issues of maturation. The result from this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week 679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF maturation failure. ;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5. Vascular access for hemodialysis its associated problems is the leading cause for hospital admission and morbidity.Maturation failure is impeded by issues of maturation. The result from this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week 679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF maturation failure. ;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5. Vascular access for hemodialysis its associated problems is the leading cause for hospital admission and morbidity.Maturation failure is impeded by issues of maturation. The result from this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict AVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSV with maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week 679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF maturation failure.

Abstrak :
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%). ......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%).