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"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.

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"Dewasa ini akses vaskular hemodialisis dan segala permasalahannya masih menjadi penyebab perawatan di rumah sakit dan morbiditas pada pasien gagal ginjal kronik. Dibalik keutamaan dan superioritas penggunaan fistula arteriovenous (AVF) sebagai akses vaskular hemodialisis, kegagalan maturasi merupakan hambatan utama penggunaannya. Penelitian ini bertujuan mengkaji dapatkah bloodflow rate (BFR) yang diukur intraoperatif menggunakan ultrasonografi Doppler memprediksi maturasi AVF. Metode penelitian adalah potong lintang. Hasil didapatkan BFR intraoperatif menggunakan ultrasonografi Doppler sesaat setelah kreasi AVF brakiosefalika dapat memprediksi maturasi dengan nilai titik potong sebesar 245,5 mL/menit, didapatkan nilai sensitifitas sebesar 76,7% , spesifisitas 92,9%, nilai duga positif 95,8% dan nilai duga negatif 65% sehingga dapat menjadi acuan menentukan perlu tidaknya tindakan revisi saat intraoperatif yang pada akhirnya diharapkan dapat menurunkan angka kegagalan maturasi AVF.

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Currently, vaskular access for haemodialysis and its assocoiated problems is the leading cause for hospital admission and morbidity in patients with chronic kidney failure. Arteriovenous fistula (AVF) is the preferred vaskular access for haemodialysis, however its use is impeded by issues of maturation. This cross sectional study aims to evaluate whether bloodflow rate (BFR), measured intraoperatively using Doppler ultrasonography, can predict AVF maturation. The result from this study showed that intraoperative BFR measured using Doppler ultrasonography right after the creation of the brachiocephalic fistula can predict the fistula’s maturation. The intraoperative BFR cut-off value was 245,5 mL/min, with sensititivity of 76,7%, specificity 92,9%, positive predictive value of 95,8% and negative predictive value 65%. Therefore, the intraoperative BFR may be used as a guide to decide whether or not a corrective procedure was needed to repair the brachiocephalic AVF, and consequently, help in reducing the rate of AVF maturation failure.

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"ABSTRAK Hemodialisis merupakan tatalaksana renal replacement yang tersering pada pasien gagal ginjal kronik stadium 5, Akses vaskular dan morbiditas sebagai akibat komplikasi akses merupakanpenyebab utama perawatan di rumah sakit. Kegagalan maturitas merupakan hambatan utamapenggunaan arteriovenous fistula. Tujuan dari penelitian ini adalah untuk mengkaji korelasi peaksistolik velocity arteri brakialis dan volume flow draining vein intraoperatif denganmenggunakan ultrasonografi doppler untuk memprediksi maturasi AVF. Uji statistik yangdigunakan adalah uji Mann Whitney dan uji Chi Squere. Hasil yang didapatkan tidak ditemukankorelasi antara PSV arteri brakialis dengan maturitas. Rerata nilai titik potong volume flowdraining vein intraoperatif 259,43 ml/min dan paska operatif 679,22 ± 65,36 ml/mindihubungkan dengan maturitas, ini dapat menjadi acuan menetukan perlu tidaknya melakukantindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angkakegagalan 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 hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation 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 hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation 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 hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation 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 hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation 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 hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation 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 hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation 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 hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure."