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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."

"Pendahuluan. Penelitian ini merupakan penelitian lanjutan untuk melakukan pengkajian nilai batasan bloodflow rate BFR intraoperatif menggunakan ultrasonografi Doppler dalam memprediksi maturitas fistula brakiosefalika dengan sampel yang lebih besar dan lebih spesifik untuk mendapatkan nilai dengan tingkat error dan bias lebih rendah, sehingga nantinya dapat dijadikan referensi di divisi Bedah Vaskular RSCM. Metode. Dilakukan studi potong lintang analitik di Divisi Vaskular Departemen Ilmu Bedah FKUI-RSCM, Jakarta yang melibatkan semua penderita gagal ginjal stadium 4-5 akibat nefropati diabetik yang akan dihemodialisis dengan akses vaskular fistula brakiosefalika. Hasil. Terdapat 71 subjek dengan rerata BFR 249,15 86,86 mL/menit, rerata diameter arteri 3,3 mm 2,0-7,4 mm dan rerata diameter vena 3 mm 2,1-5,6 mm. Analisis statistik menunjukkan bahwa hanya BFR yang berhubungan bermakna dengan maturitas AVF p80.

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Introduction. This research is a follow-up study to determine the value limits of bloodflow rate BFR intraoperative using Doppler ultrasound to predict maturity of brachiocephalic fistula with a larger sample and to obtain lower level of error and bias, so it can be used as a reference in the Vascular Surgery division, Cipto Mangunkusumo Hospital.

Methods. Cross-sectional design with analytic fashion conducted at Division of Vascular Surgery Department of the Faculty of medicine - Cipto Mangunkusumo Hospital, Jakarta with all patients with stage IV-V CKD, due to diabetic nephropathy who planned to get vascular access for hemodialysis brachiocephalic fistula.

Result. Total subject are 71 with mean bloodflow rate is 249.15 86.86 mL / min, mean arterial diameter is 3.3 mm 2.0 to 7.4 mm and the mean diameter of the vein is 3 mm 2.1 to 5.6 mm . Only BFR associated significantly with maturity AVF p

BFR intraoperatif, maturitas AV fistula, brakiosefalika, sensitivitas, spesifisitas"

"Latar Belakang : Hemodialisis merupakan terapi pengganti ginjal yang paling banyak digunakan di dunia. Fistula Arteriovenosa (FAV) merupakan pilihan akses vaskular terbaik bagi penderita Penyakit Ginjal Tahap Akhir (PGTA) yang menjalani hemodialisis. Akan tetapi, kegagalan maturasi FAV masihrelatif tinggi akibat gangguan dari înflow dan/atau outflow. Pengukuran peningkatan Blood Flow Rate (BFR) dan Peak Systolic Velocity (PSV) intraoperasi pada arteri brakialis diharapkan dapat mengidentifikasi masalah inflow sekaligus outflow sebagai penyebab kegagalan maturasi FAV.Tujuan : Mengetahui hubungan peningkatan BFR dan PSV arteri brakialis intraoperasi serta nilai batasannya yang dapat dijadikan prediktor maturasi FAV Brakiosefalika.Subjek dan Metode : PGTA yang menjalani operasi FAV brakiosefalika di lima Rumah Sakit (RSCM, RSUP Fatmawati, RSUD Kab. Tangerang, RS Hermina Depok dan RS Hermina Bekasi) pada periode Juli 2019 – Februari 2022. Desain penelitian kohort retrospektif menggunakan data sekunder dari penelitian sebelumnya Data yang diteliti meliputi: usia, jenis kelamin, tekanan darah, merokok, diabetes melitus, dan hasil pengukuran USG doppler berupa diameter arteri brakialis dan vena sefalika preoperasi serta peningkatan BFR dan PSV arteri brakialis intraoperasi, kemudian data subjek dengan FAV brakiosefalika yang mengalami maturasi dalam 6 minggu sesuai kriteria rule of 6 dari NKF-KDOQI. Selanjutnya dilakukan analisa statistik adanya korelasi peningkatan BFR dan PSV arteri brakialis intraoperasi terhadap maturitas FAV brakiosefalika serta ditetapkannya nilai batasan sebagai prediktor maturasi. dengan memakai uji diagnostik grafik Receiver Operator Curve (ROC). Hasil : Dari total 83 subjek yang memenuhi kriteria inklusi dan eksklusi, terdapat 50 (60,24%) subjek yang mengalami maturasi dalam 6 minggu pascaoperasi. Dengan menggunakan analisis multivariat dengan uji regresi logistik, peningkatan BFR arteri brakialis intraoperasi (p<0,001) merupakan faktor yang paling berhubungan dengan maturasi FAV brakiosefalika setelah 6 minggu pascaoperasi dengan nilai batasan 184,58 ml/menit, sensitivitas 100%, spesifisitas 84,8%, Nilai Duga Positif 90,9%, Nilai Duga Negatif 100%, Akurasi 93,98%Kesimpulan : Peningkatan BFR arteri brakialis intraoperasi dapat dipakai sebagai prediktor maturasi FAV brakiosefalika 6 minggu pascaoperasi

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Background : Hemodialysis is the most widely used renal replacement therapy in the world. Arteriovenous fistula (AVF) is the best vascular access option for patients with End Stage Kidney Disease (ESKD) undergoing hemodialysis. However, the AVF maturation failure rate is still high due to inflow and/or outflow problem. Measurement of intraoperative increase in Blood Flow Rate (BFR) and Peak Systolic Velocity (PSV) in the brachial artery is expected to identify inflow and outflow problems as the cause of AVF maturation failure.

Objective: To determine the relationship between intraoperative increase in BFR and PSV of the brachial artery and the cut off point that can be used as a predictor of Brachiocephalic AVF maturation.

Subjects and Methods : ESKD who underwent AVF brachiocephalic surgery in five hospitals (RSCM, Fatmawati Hospital, Tangerang Hospital, Hermina Hospital Depok and Hermina Hospital Bekasi) in the period July 2019 – February 2022. The retrospective cohort study design used secondary data from the study previously. The data studied included: age, sex, blood pressure, smoking, diabetes mellitus, and the results of Doppler ultrasound measurements of preoperative brachial artery and cephalic vein diameters and an increase in intraoperative BFR and PSV brachial artery, then data on subjects with maturation of brachiocephalic AVF within 6 weeks according to the rule of 6 criteria of the NKF-KDOQI. Furthermore, statistical analysis was carried out on the correlation between increased intraoperative brachial artery BFR and PSV on brachiocephalic FAV maturity and the determination of cut off value as a predictor of maturation using the Receiver Operator Curve (ROC) graphic diagnostic test.

Results: From a total of 83 subjects who met the inclusion and exclusion criteria, there were 50 (60.24%) subjects who matured within 6 weeks postoperatively. Using multivariate analysis with logistic regression, the increase in intraoperative brachial artery BFR (p<0.001) was the most associated factor of brachiocephalic FAV maturation after 6 weeks postoperatively with a cut off value of 184.58 ml/min, sensitivity 100%, specificity 84.8%, Positive Predictive Value 90.9%, Negative Predictive Value 100%, Accuracy 93.98%

Conclusion: Increased intraoperative brachial artery BFR can be used as a predictor of brachiocephalic FAV maturation 6 weeks postoperatively."

"Penyakit ginjal tahap akhir (PGTA) merupakan masalah kesehatan masyarakat yang memerlukan terapi pengganti ginjal (TPG) seperti Hemodialisis. Fistula Arteriovenosa (FAV) merupakan pilihan akses vaskular terbaik bagi penderita yang menjalani hemodialisis. Akan tetapi, kegagalan maturasi FAV relatif tinggi akibat gangguan dari înflow dan/atau outflow. Pengukuran peningkatan Blood Flow Rate (BFR) pada arteri brakialis proksimal anastomosis, distal anastomosis dan vena outflow dapat mengidentifikasi penyebab kegagalan maturasi FAV. Penelitian dilakukan di RSCM, RS Hermina Depok dan RS Hermina Bekasi pada periode Februari 2024 – Mei 2024. Desain penelitian kohort prospektif menggunakan data primer meliputi: usia, jenis kelamin, hipertensi, merokok, diabetes melitus, aterosklerosis, riwayat pemasangan catheter double lumen (CDL) dan hasil pengukuran USG doppler berupa diameter arteri brakialis, vena sefalika dan BFR arteri brakialis preoperasi serta BFR arteri brakialis proksimal anastomosis, distal anastomosis dan vena outflow (OV) segera setelah tindakan AVF, hari ke 7, hari ke 14 sampai minggu ke 6. Dari total 45 subjek yang memenuhi kriteria inklusi dan eksklusi, terdapat 36 subjek yang mengalami maturasi dalam 6 minggu pascaoperasi. Dengan analisis multivariat uji t-tidak berpasangan, didapatkan diameter arteri brakialis dan vena sefalika nilai rerata >2,5 mm serta nilai BFR arteri brakialis preoperasi 66,22 ± 22,60 (p<0,001). Didapatkan batasan nilai persentase peningkatan BFR arteri brakialis proksimal 167,23% pada hari ke-7 yang memprediksi  keberhasilan maturitas FAV brakiosefalika setelah 6 minggu pascaoperasi dengan sensitivitas 58,3%, spesifisitas 87,5%, interval kepercayaan 97,3%. Nilai persentase peningkatan OV diatas 186,92% pada hari ke-7 dan diatas 468,0% pada hari ke-14 dapat memprediksi keberhasilan maturitas FAV pada minggu ke-6 dengan sensitifitas dan spesifisistas sebesar 61,1% dan 100% untuk hari ke-7 dan 80,6% dan 100% untuk hari ke-14. Sebagai kesimpulan Peningkatan persentase BFR arteri brakialis proksimal anastomosis dan vein outflow hari ke-7 pasca tindakan FAV dapat dipakai sebagai prediktor maturitas FAV brakiosefalika.

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End-stage kidney disease (ESKD) is a public health problem that requires kEnd-stage kidney disease (ESKD) is a public health problem that requires Kidney replacement therapy (KRT) such as hemodialysis. Arteriovenosa fistula (AVF) is the best vascular access option for patients undergoing hemodialysis. However, AVF maturation failure is relatively high due to interruption of inflow and/or outflow. Measurement of increased Blood Flow Rate (BFR) in the brachial arteries of the proximal anastomosis, distal anastomosis and venous outflow can identify the cause of AVF maturation failure. The study was conducted at Ciptomangunkusumo Hospital, Hermina Depok Hospital and Hermina Bekasi Hospital in the period February 2024 – May 2024. The design of the prospective cohort study using primary data includes: age, gender, hypertension, smoking, diabetes mellitus, atherosclerosis, a history of installation of a double lumen catheter and doppler ultrasound measurements of the diameter brachial artery, cephalic vein and BFR of the preoperative brachialis artery as well as BFR proximal anastomosis, distal anastomosis and outflow vein immediately after the AVF operation, day 7, day 14 to week 6. A total of 45 subjects met the inclusion and exclusion criteria. Of these, 36 had matured within six weeks of the operation. A multivariate analysis of the non-pairing t-test revealed that a percentage increase of 167.23% in brachial artery BFR on the 7th day can predict the successful maturation of brachiocephalic AVF after 6 weeks of postoperative treatment. This model demonstrated a sensitivity of 58.3% and a specificity of 87.5%, with a confidence interval of 97.3%. The percentage value of OV increase above 186.92% on day 7 and above 468.0% on the 14th day can be used to predict the success of AVF maturity on week 6. This approach has a sensitivity and specificity of 61.1% and 100% for day 7th and 806% and 100% for day 14th. As a conclusion Increased percentage of BFR of proximal brachial artery anastomosis and venous outflow on day 7 after AVF can be used as a predictor of brachiocephalic FAV maturity."