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"Latar belakang : Steal Syndrome, adalah salah satu komplikasi pembuatan akses vena untuk hemodialisis, Insidensi steal syndrome yang berat diperkirakan 0,5-5%.11Belum ada pemeriksaan secara baku emas, terdapat berbagai prediktor noninvasif yang dapat menilai derajat steal salah satunya dengan nilai Digital Brachial Indices (DBI). Pada penelitian ini, subjek dengan AVF brachiocephalic dinilai Hand Ischemic Questioner (HIQ) untuk melihat manifestasi yang dikeluhkan berupa rasa dingin nyeri. Berkurangnya sensasi dan kekuatan, serta keram yang dinilai derajat keparahan dan frekuensinya dikorelasikan dengan nilai DBI yang dianggap bermakna sebagai steal syndrome adalah nilai DBI <0,6. Korelasi dari kedua parameter tersebut diharapkan dapat menunjukkan hal yang bermakna dalam praktek dan dalam penanganan pasien-pasien steal syndrome. Subyek dan Metode: Subyek penelitian ini adalah semua pasien yang menjalani hemodialisis dengan akses AVF lengan atas di RSUPN Cipto Mangunkusumo dalam periode bulan Mei-Juni 2019. Pasien akan ditanyakan mengenai berbagai gejala mengenai steal syndrome sesuai dengan HIQ, dan dihitung skor nya, dilanjutkan dengan pengukuran Systolic Digital Pressure menggunakan alat phletysmograph, disisi lengan dengan AVF/AVG dan Systolic Brachial Pressure untuk menentukan DBI pada pasien tersebut. Hasil: Dari data demografik, profil pasien gagal ginjal yang menjalani hemodialisis berdasarkan jenis kelamin laki-laki 37(46,2%) pasien dan perempuan 43(53,8%) dengan rata-rata usia pasien 53 tahun. Skor HIQ nilai minimum adalah 0 dan nilai maksimum adalah 70 dengan nilai median 3. Uji korelasi antara nilai total skor kuesioner HIQ dan nilai DBI didapatkan adanya korelasi dengan nilai p<0.001. uji diagnostik antara Skor HIQ menggunakan nilai cut-off ≥50 dengan nilai DBI <0.6. Dari hasil uji diagnostik antara skor HIQ dan DBI didapatkan nilai sensitivitas 15.3% dan nilai spesifisitas 100%, dengan akurasi diagnostik 58.75%. Kesimpulan: terdapat korelasi yang baik antara skor HIQ dengan DBI pada subyek penelitian ini, menunjukkan HIQ dan DBI ini dapat digunakan sebagai alat diagnostik yang cukup akurat sebagai salah satu metode awal untuk mendeteksi gejala-gejala awal dari Steal Syndrome sebelum dilakukan pemeriksaan tambahan lainnya untuk mengurangi pemeriksaan lanjutan yang tidak perlu.

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Background: Steal Syndrome is a complication after a native Arteriovenous Fistule(AVF), there were symtomps of cold sensations, pain, cramps, loss of strength and diminishes of sensibility. A severe steal syndrome incidences was 0.5 - 5%. And there are no gold standard non inavasive examination to predict a steal syndrome, there is Digital Brachial Indices (DBI). In this study all patients on Hemodialysis with brahiocepalic (BC) AVF were questioned and valued for Hand Ischemic Questionaire (HIQ) related symptomps. All those symptomps were valued for its severity and frequencies to correlate with DBI values, DBI <0.6 as a cut-off to consider a steal syndrome. Correlation between those parameter were expected to be significant in evaluate patients suspected steal syndrome in our daily practice. Methods: subjects in this study were all patients on hemodialysis with BC AVF at Cipto Mangunkusumo Hospital within May-June 2019 periods. They were questioned and valued for HIQ (no symptoms of ischemia, 0 points; maximal ischemia, 500 points), and then systolic digital pressure were measured with a phletysmograph, ipsilateral of AVF, continued to measure systolic brachial pressure, and we found DBI values. Results: a demographic profile data, male patients 37(46.2%), female patients 43(53.8%) with mean age 53y.o. Minimum HIQ score was 0 and maximum 70, mean score 3. Correlation between HIQ and DBI was good with p<0.001. Diagnostic test between HIQ and DBI were sensitivity 15.3% and specivity 100% with diagnostic accuracy 58.7%. Conclusions: there were a good correlation between HIQ score and DBI on hemodialysis patients with BC AVF to early detection of steal syndrome symptomps, as diagnostic tools HIQ and DBI shows a good accuracy, to avoid more invasive and expensive examinations."

"Introduction: Steal syndrome is one of the most feared complications in maintaining arteriovenous fistula (AVF) for hemodialysis. The incidence of steal syndrome in worldwide is estimated to be 0.5-5%. There are various non-invasive examinations to assess the degree of stealing, one of which is the digital brachial index (DBI). In this study, subjects with brachiocephalic AVF were assessed by the hand ischemic questionnaire (HIQ) to assess the manifestations of steal syndrome complained by the patient, which are the sensation of cold, pain, the decrease in sensation and strength, and cramps. The literature about the correlation of DBI with other assessment is still limited. Method: The subjects of this study were all patients undergoing hemodialysis with upper arm AVF at Cipto Mangunkusumo Hospital in the period May – June 2019. Patients will be asked about various symptoms of stealing syndrome, the severity, and also frequency, according to HIQ. The scores were then calculated, followed by scores of DBI measurements using a plethysmograph. The DBI values that considered to be meaningful as stealing syndrome were <0.6. The correlation between the two parameters was then analyzed. Results: From demographic data, characteristics of patients with native AVF by sex were 37 (46.2%) men and 43 (53.8%) women with an average age of 53 years. The minimum value of the HIQ score was 0, and the maximum value was 70, with a median value of 3. The correlation test between the total value of the HIQ questionnaire score and the DBI value found a significant correlation (r = -0.0798, p <0.001). A diagnostic tests was performed between HIQ scores using a cut-off value ≥50 with a DBI value <0.6 as a reference. It was obtained a sensitivity value of 15.3% and a specificity value of 100%, with a diagnostic accuracy of 58.75%. Conclusion: There was a good correlation between HIQ and DBI in patients undergoing hemodialysis using upper arm native AVF. The use of HIQ as a screening tool in native upper arm AVF patients is less recommended, but its use for patients who are suggestive of stealing syndrome has good specificity results."