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Abstrak :
Stenosis atau oklusi vena sentral merupakan komplikasi serius pada pasien hemodialisis yang secara signifikan menurunkan kwalitas hemodialisis yang efektif patensi semua komponen akses vascular dialisis, termasuk arteri beserta cabangnya, AV anastomosis, vena perifer, dan vena sentral, sangat penting untuk penyediaan dialisis yang konsisten, kuat, nyaman, dan tidak rumit. Etiologi utama  stenosis vena sentral (SVS) sebagian besar adalah sekunder akibat penempatan kateter dialisis yang sementara ataupun menetap pada vena subclavia, vena  jugular internal, dan vena femoralis. Terapi endovascular standar stenosis vena sentral adalah angioplasty dengan balon konvensional. Analisis deskriptif dilakukan untuk menilai karakteristik serta sebaran data masing-masing variabel yang kemudian disajikan dalam bentuk tabuler atau grafik. Data kategorik disajikan dalam bentuk persentase dan dilakukan uji statistik dengan Chi-square atauFisher (univariat dan bivariat). Data yang akan dibandingkan adalah keberhasilan setelah tindakan Endo Vaskular dibandingkan antara riwayat pemasangan kateter vena sentral di vena subclavia dan vena jugularis interna, dengan tipe kateter, onset gejala, dan durasi pemasangan kateter sebagai variabel perancu. Dari hasil analisis data di temukan faktor-faktor bermakna yang berhubungan dengan keberhasilan tindakan Endo Vaskular pada pasien stenosis vena sentraldengan POBA (p>0.005) adalah ; onset gejalaklinis (<3 bulan), durasipemasangankateter (<2,5 bulan), riwayat pemasangan kateter sebelumnya (baru 1 kali), Initial stenosis (kurangdari 80), serta diameter POBA (> 10 mm). Diperlukan SOP untuk pemasangan KVS yang sesuai standar KADOQi untuk mengurangi resiko kejadian SVS. Diperlukan strategi screening yg lebih baik untuk mendeteksi  kasusSVS. Perlu edukasi kepada tenaga medis dan pasien mengenai durasi pemasangan KDL akut. Mengoptimalkan akses vaskuler permanen AVF sebagai Akses vaskular idaman penderita GGK yg menjalani HD.Perlu perhatian yang lebih dari pemerintah atau pihak penjamin kesehatan, karena keterbatasan biaya yang membuat tindakan Endo Vaskuler pada kasus SVS menjadi kurang optimal, terutama pada kasus re-Intervensi dan inisial stenosis yg berat (>80%).

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Central venous stenosis or occlusion is a serious complication in hemodialysis patients that significantly decreases effective hemodialysis quality The patency of all components of dialysis vascular access, including arteries and branches, AV anastomosis, peripheral veins and central veins, is essential for the provision of consistent, adequate dialysis, comfortable, and not complicated. The main etiologies of central venous stenosis (SVS) are mostly secondary to temporary or persistent dialysis / chemoteraphycatheter placement in the subclavian vein, internal jugular vein, and femoral vein. Standard endovascular therapy of central venous stenosis is angioplasty with conventional balloons. Descriptive analysis is done to assess the characteristics and distribution of data for each variable which is then presented in tabular or graphical form. Categorical data is presented in the form of a percentage and statistical tests are performed by Chi-square or Fisheries (univariate and bivariate). Data to be compared is the success after endovascular action compared between the history of central venous catheter placement in the subclavian vein and internal jugular vein, with, catheter type, symptom onset, and duration of catheter placement as confounding variables. The results of data analysis found significant factors related to the success of endovascular action in patients with central venous stenosis with POBA (p> 0.005) are; onset of clinical symptoms (<3 months), duration of catheter placement (<2.5 months), history of catheter placement (only 1 time), initial stenosis (less than 80), and diameter of POBA (> 10 mm). According with KADOQi standards is needed to reduce the risk of SVS events. A better screening strategy is needed to detect SVS cases. Need education to medical staff and patients regarding the duration of the installation of acute KDL. Optimizing AVF permanent vascular access as ideal vascular access for people with CRF who undergo HD. More attention is needed from the government or health guarantor, because of the limited costs that make endovascular actions in SVS cases less optimal, especially in cases of re-intervention and severe initial stenosis (> 80%).

Abstrak :
Latar belakang: Ulkus Kaki diabetik atau Diabetic Foot Ulcer merupakan salah satu komplikasi yang berat, karena sering kali ulkus kaki diabetik berakhir dengan amputasi kecacatan dan kematian. USG Doppler merupakan modalitas yang mudah tersedia dan non invasif untuk evaluasi arteri ekstremitas inferior dan dapat mendeteksi tingkat keparahan gangguan aliran darah atau Penyakit Arteri Perifer (PAP) dengan sensitivitas 42,8% dan spesifisitas 97,5%. WHO merekomendasikan klasifikasi Perfusion, Extent/Size, Depth/Tissue Loss, Infection, Sensation (PEDIS) sebagai sarana penegakan diagnosis dan membantu menentukan tatalaksana kaki diabetik. Penelitian ini dilakukan untuk melihat korelasi skor PEDIS dalam menilai gangguan aliran arteri tungkai berdasarkan spektral USG Doppler pada penderita ulkus kaki diabetik di RS Cipto Mangunkusumo Jakarta. Subjek dan Metode: Subjek penelitian adalah pasien ulkus kaki diabetes yang dirawat di Divisi Bedah Vaskular dan Endovaskular FKUI-RS Cipto Mangunkusumo Jakarta dan memenuhi kriteria inklusi dan eksklusi. Penelitian ini dilakukan dengan perhitungan menggunakan sensitivitas estimasi sebesar 80%, error absolut (d=5%), prevalensi estimasi 51,8% maka besar sampel minimal adalah 76. Setelah itu diperoleh data berupa skor PEDIS dan hasil spektral USG pada arteri femoralis, arteri poplitea, arteri dorsalis pedis dan arteri tibialis posterior. Penelitian ini mengumpulkan 81 orang subjek dengan 52 orang (64%) jenis kelamin laki-laki, 29 orang (36%) perempuan dan rata-rata usia 59,8+10,5 tahun. Profil gula darah sewaktu subjek median 265 mg/dl dengan kisaran antara 105-571 mg/dl. Pada tabel 3 dalam menentukan Cut Off skor PEDIS menggunakan kurva ROC (Receiver Operating Characteristic), didapatkan Cut Off arteri poplitea >10, sedangkan arteri dorsalis pedis dan arteri tibialis posterior >8.

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Main topics: Diabetic Foot Ulcer or Diabetic Foot Ulcer is one form that is severe, because often diabetic foot ulcers end with disability amputation and death. Doppler ultrasound is an easily available and unlimited modality for lower limb risk and can detect the severity of arterial disease or peripheral arterial sensitivity (PAP) with a sensitivity of 42.8% and specificity of 97.5%. WHO that performs Data Perfusion, Area/Size, Depth/Tissue Loss, Infection, Sensation (PEDIS) as a means of enforcing the diagnosis and helps determine the management of diabetic foot. This study was conducted to look at the PEDIS score in assessing the disturbance of limb arterial flow based on Doppler ultrasound in patients with diabetic foot ulcer at Cipto Mangunkusumo Hospital, Jakarta. Subjects were patients with diabetic foot ulcers performed in the Division of Vascular and Endovascular Surgery of the Faculty of Medicine-Cipto Mangunkusumo Hospital Jakarta and fulfilled the inclusion and exclusion criteria. This research was conducted by calculating using an estimation sensitivity of 80%, absolute error (d = 5%), the largest prevalence of 51.8%, then the minimum sample size was 76. After that data was obtained in the form of PEDIS scores and spectral results of ultrasound in the femoral artery, arteries poplitea, dorsalis pedis artery and posterior tibial artery. This study collected 81 subjects with 52 people (64%) male gender, 29 people (36%) women and an average of 59.8 + 10.5 years. The blood sugar profile was median 265 mg/dl with a range of 105-571 mg/dl. In table 3 in determining the PEDIS score Cut-Off using the Receiver Operating Characteristic curve, obtained Cut-ff popliteal artery> 10, while the dorsalis pedis artery and posterior tibial artery> 8.

Abstrak :
Pada tahun 2010 American Venous Forum mengembangkan sebuah sistem skoring Venous Clinical Severity Score (VCSS) untuk menilai tingkat keparahan Insufisiensi Vena Kronik, dimana system ini dikatakan lebih lengkap daripada system CEAP. Tetapi validasi VCSS terhadap uji obyektif masih kurang. Tujuan Penelitian ini adalah untuk menguji VCSS terhadap refluks dan diameter vena tungkai berdasarkan ultrasonografi. Penelitian ini merupakan suatu uji diagnostik potong lintang pada pekerja wanita dengan posisi kerja berdiri sebnyak 114 orang (228 tungkai). Dilakukan penilaian VCSS dan pemeriksaan USG pada semua subjek. Hubungan antara VCSS dengan refluks dan diameter vena tungkai dianalisis menggunakan odd rasio dengan interval kepercayaan 95%. Dari 228 tungkai yang diperiksa didapatkan skor VCSS 0-3 sebanyak 18,4%, skor ≥4sebanyak 81,6%. Refluks didapatkan pada 21,9% tungkai. Terdapat hubungan yang signifikan antara VCSS dengan refluks pada vena tungkai. Sedangkan diameter vena safena magna antara 2,1-12,2mm, vena femoral 7,1-17mm, vena popliteal 3-11,4 dan vena safena parva 1,7-7mm. Ketika VCSS dihubungkan dengan diameter vena, didapatkan hubungan yang signifikan. Sensistivitas VCSS dibandingkan dengan refluks berdasarkan USG didapatkan 78%, spesivitas 98,31%, nilai prediksi positif 92,86% dan nilai prediksi negatif 93,86%. Dari hasil penelitian ini disimpulkan skoring VCSS dapat dipakai sebagi metode untuk menilai insufisiensi vena kronik. Meskipun VCSS dirancang untuk menilai keparahan penyakit vena kronis,  VCSS dapat juga dipaki untuk melakukan skrining karena menujukkan hubungan yang baik dengan refluks dan diameter vena tungkai berdasarkan USG.

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In 2010 the American Venous Forum developed a scoring system for the Venous Clinical Severity Score (VCSS) to assess the severity of chronic venous insufficiency, where the system is said to be more complete than the CEAP system. But the VCSS validation of the objective test is still lacking. The aim of this study was to test VCSS for reflux and diameter of leg veins based on ultrasonography. This study is a cross-sectional diagnostic test on female workers with a working position standing at 114 people (228 limbs). VCSS assessment and ultrasound examination were performed on all subjects. The relationship between VCSS and reflux and limb vein diameter was analyzed using odds ratios with a 95% confidence interval. From the 228 limbs examined, the VCSS score of 0-3 was 18.4%, the score ≥4 was 81.6%. Reflux is obtained at 21.9% of the legs. There is a significant relationship between VCSS and reflux in the leg veins. Whereas the diameter of the safena magna vein is between 2.1-12.2mm, 7.1-17mm femoral vein, popliteal vein 3-11.4 and safena parva vein 1.7-7mm. When VCSS is associated with vein diameter, a significant relationship is obtained. The sensitivity of VCSS compared with reflux based on USG was 78%, the specificity was 98.31%, the positive predictive value was 92.86% and the negative predictive value was 93.86%. From the results of this study concluded VCSS scoring can be used as a method to assess chronic venous insufficiency. Although VCSS is designed to assess the severity of chronic venous disease, VCSS can also be cited for screening because it shows a good relationship with reflux and diameter of leg veins based on ultrasound.

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. Maturitas fistula arteriovena tergantung dengan persiapan pre operasi pembuatan fistula arteriovena. Penelitian ini diharapkan pemeriksaan peak systolic velocity pada arteri radialis preoperatif dan intraoperatif dapat memprediksi keberhasilan maturasi dari fistula arteriovena radisefalika. Subjek dan Metode: Subjek adalah pasien-pasien yang akan dibuat FAV radiosefalika dengan USG mapping sesuai standar. Sesaat setelah anastomosis diukur peak systolic velocity dengan USG Doppler probe linear. Penelitian ini menggunakan desain potong lintang analitik untuk mendapatkan hubungan maturasi FAV dengan peak systolic velocity preoperatif dan intraoperatif. Hasil: FAV radiosefalika (n=71) pada 71 pasien dibuat dan dievaluasi dalam 6 minggu. Rerata PSV preoperatif pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (54,6+11,7 cm/s dan 26,7+7,7 cm/s; P<0,001). Rerata PSV intraoperatif pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (57,9+12,6 cm/s dan 27,1+8,1 cm/s; P<0,001). Rerata selisih PSV pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (3 cm/s dan 0 cm/s; P<0,001).  PSV preoperatif dengan nilai cut-off sebesar 40 cm/s memiliki sensitifitas 91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. PSV intraoperatif dengan nilai cut-off sebesar 42 cm/s memiliki sensitifitas 91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. Selisih PSV dengan nilai cut-off sebesar 42 cm/s memiliki sensitifitas  91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. Kesimpulan: PSV preoperatif >40 cm/s dan PSV intraoperatif >42 cm/s memiliki nilai prediktor yang baik untuk maturasi FAV radiosefalika,sehingga dapat menjadi acuan menentukan perlu tidaknya penilaian lebih lanjut dan tindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angka kegagalan maturasi fistula arteriovenous.

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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. This study is expected to examine the peak systolic velocity of radial arteries in the preoperative and intraoperative to predict the successful maturation of radiocephalic arteriovene fistulas. Subjects and Methods: Subjects are patients who will be made radiocephalic FAV with ultrasound mapping according to the standard. Shortly after anastomosis, a peak systolic velocity is measured with a linear ultrasound Doppler probe. This study uses a cross-sectional analytic design to obtain the relationship of FAV maturation with preoperative and intraoperative peak systolic velocity. Results: Radiosefalic FAV (n = 71) in 71 patients was made and evaluated in 6 weeks. The mean of preoperative PSV in mature fistulas was significantly higher than those who were immature (54.6 + 11.7 cm / s and 26.7 + 7.7 cm / s; P <0.001). The mean intraoperative PSV in mature fistulas was significantly higher than that which was immature (57.9 + 12.6 cm / s and 27.1 + 8.1 cm / s; P <0.001). The mean difference in PSV in mature fistulas was significantly higher than that of immature (3 cm / s and 0 cm / s; P <0.001). Preoperative PSV with a cut-off value of 40 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. The intraoperative PSV with a cut-off value of 42 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. The difference in PSV with a cut-off value of 42 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. Conclusions: Preoperative PSV> 40 cm / s and intraoperative PSV> 42 cm / s have a good predictor value for radiocephalic FAV maturation, so that it can be a reference in determining whether or not further assessment and revision actions are intraoperative, which is ultimately expected to reduce the number failure of maturation of arteriovenous fistulas.

Abstrak :
ABSTRAK
Keberhasilan proses haemodialisis ditentukan oleh terpenuhinya dosis HD sesuai dengan kebutuhan pasien. Pemberian dosis HD yang sesuai dengan kebutuhan pasien dapat dinilai dari adekuasi atau kecukupan haemodialisis yang dicapai pasien HD. Dengan nilai Qb yang berbeda memberi pengaruh terhadap bersihan ureum yang dicapai. Penelitian ini diharapkan berguna dalam pengaturan dan pemantauan terhadap Qb sehingga dapat mengoptimalkan kecukupan dialisis pasien dan terciptanya kualitas hidup pasien yang lebih baik.

Tujuan :
Penelitian ini diharapkan dapat memberikan gambaran bagaimana korelasi antara Qb dengan adekuasi haemodialisis pada pasien dengan Arterovenous Fistula (AVF) yang matur. Selain itu mengidentifikasi karakteristik pasien (umur, jenis kelamin dan berat badan interdialisis), Qb pasien dengan AVF yang matur, mengidentifikasi adekuasi haemodialisis yang dicapai oleh pasien dengan AVF yang matur, menganalisa korelasi antara Qb dengan adekuasi haemodialisis pada pasien AVF yang matur dan menganalisa korelasi antara faktor perancu dengan adekuasi haemodialisis pada pasien dengan AVF yang matur.

Metode :
Penelitian ini merupakan penelitian kuantitatif dengan pendekatan studi cross-sectional. Hasil tersebut ditulis dalam lembar pengumpulan data. Selanjutnya dilakukan pengolahan data hasil observasi dengan menggunakan penghitungan secara statistik melalui SPSS 20.0. Pengambilan sampel dengan tehnik total sampling yang memenuhi kriteria inklusi. Penelitian dilakukan di Divisi Vaskular & Endovaskular FKUI-RSCM Jakarta dan ruang haemodialisa RSCM dan dilakukan pada bulan September sampai November 2015.

Hasil :
Hasil analisis hubungan antara Qb dengan adekuasi haemodialisis (nilai Kt/V) menunjukkan hasil yang tidak signifikan, dimana p value sebesar 0,227 (p > 0,05). Hasil penelitian ini menyimpulkan bahwa tidak ada hubungan yang bermakna antara Qb dengan adekuasi haemodialisis (p = 0,227).

Kesimpulan :
Tidak ada hubungan yang bermakna antara Qb dengan adekuasi haemodialis (nilai Kt/V). Pada penelitian ini terdapat banyak kekurangan diantaranya penilaian adekuasi haemodialisis hanya dengan melihat hasil Kt/V tanpa dilakukan pengukuran URR. Keterbatan lain yaitu ruang HD RSCM menggunakan membran dialyzer jenis low flux, hal ini tentunya mempengaruhi pencapaian bersihan ureum yang pada akhirnya berpengaruh terhadap pencapaian adekuasi haemodialisis.ABSTRACT
Background: The success of the process is determined by the fulfillment hemodialysis HD dose according to the patient's needs. HD dosing according to patient needs can be assessed from the adequacy or adequacy of hemodialysis patients who achieved HD. Qb different with giving effect to the urea clearance is achieved. This study is expected to be useful in setting up and monitoring of the Qb so as to optimize the adequacy of dialysis patients and the creation of quality of life of patients better. Aim: This study is expected to provide an overview of how the correlation between Qb and adequacy of hemodialysis in patients with Arterovenous Fistula (AVF) that mature. Besides identifying patient characteristics (age, sex and weight interdialisis), Qb patients with AVF were mature, identify the adequacy of hemodialysis achieved by patients with AVF were mature, analyzing the correlation between Qb and adequacy of hemodialysis in patients with AVF were mature and analyzing the correlation Among the factors confounding the adequacy of hemodialysis in patients with AVF were mature. Method: This research is a quantitative approach cross-sectional study. The result is written in the data collection sheets. Furthermore, the data processing of observation results using statistical calculation by SPSS 20.0. Sampling with total sampling technique that met the inclusion criteria. The study was conducted at the Division of Vascular & Endovascular Faculty of medicine-RSCM Jakarta and space Haemodialisa RSCM and conducted from September to November 2015. Results: The results of the analysis of the relationship between Qb and adequacy of hemodialysis (value Kt / V) showed significant results, where the p value of 0.227 (p> 0.05). Results of this study concluded that there was no significant relationship between Qb and adequacy of hemodialysis(p=0.227). Conclusion: There is no significant relationship between Qb and adequacy haemodialis (value Kt / V). In this study, there are many shortcomings including hemodialysis adequacy assessment just by looking at the Kt / V without a measurement of URR. Another Keterbatan namely HD space RSCM use dialyzer membrane type of a low flux, it is certainly affect the achievement of urea clearance which ultimately affect the achievement of the adequacy of hemodialysis.;Background: The success of the process is determined by the fulfillment hemodialysis HD dose according to the patient's needs. HD dosing according to patient needs can be assessed from the adequacy or adequacy of hemodialysis patients who achieved HD. Qb different with giving effect to the urea clearance is achieved. This study is expected to be useful in setting up and monitoring of the Qb so as to optimize the adequacy of dialysis patients and the creation of quality of life of patients better. Aim: This study is expected to provide an overview of how the correlation between Qb and adequacy of hemodialysis in patients with Arterovenous Fistula (AVF) that mature. Besides identifying patient characteristics (age, sex and weight interdialisis), Qb patients with AVF were mature, identify the adequacy of hemodialysis achieved by patients with AVF were mature, analyzing the correlation between Qb and adequacy of hemodialysis in patients with AVF were mature and analyzing the correlation Among the factors confounding the adequacy of hemodialysis in patients with AVF were mature. Method: This research is a quantitative approach cross-sectional study. The result is written in the data collection sheets. Furthermore, the data processing of observation results using statistical calculation by SPSS 20.0. Sampling with total sampling technique that met the inclusion criteria. The study was conducted at the Division of Vascular & Endovascular Faculty of medicine-RSCM Jakarta and space Haemodialisa RSCM and conducted from September to November 2015. Results: The results of the analysis of the relationship between Qb and adequacy of hemodialysis (value Kt / V) showed significant results, where the p value of 0.227 (p> 0.05). Results of this study concluded that there was no significant relationship between Qb and adequacy of hemodialysis(p=0.227). Conclusion: There is no significant relationship between Qb and adequacy haemodialis (value Kt / V). In this study, there are many shortcomings including hemodialysis adequacy assessment just by looking at the Kt / V without a measurement of URR. Another Keterbatan namely HD space RSCM use dialyzer membrane type of a low flux, it is certainly affect the achievement of urea clearance which ultimately affect the achievement of the adequacy of hemodialysis.