Tesis

Akurasi Basal Digital Pressure, Saturasi Oksigen, dan Change Digital Pressure dalam Mendiagnosa Chronic Steal Syndrome Pasca Operasi Fistula Aterio-venosa Brachiocephalica pada Pasien Penyakit Ginjal Tahap Akhir Dengan Diabetes Melitus Tipe 2 = Accuracy of Basal Digital Pressure, Saturasi Oksigen, dan Change Digital Pressure for the Diagnosis of Chronic Steal Syndrome after Brachiocephalic Arteriovenous Fistula Surgery in End Stage Renal Disease Patient with Type 2 Diabetes Mellitus.

Latar belakang: Penyakit ginjal tahap akhir (PGTA) terus meningkat jumlahnya di dunia maupun di Indonesia. Fistula arterio-venosa (FAV) masih menjadi standard emas akses vaskular untuk hemodialisa dan untuk pasien diabetes melitus direkomendasikan untuk membuat FAV di brakiosefalika. Terdapat beberapa komplikasi FAV, salah satunya yaitu Steal Syndrome yang lebih sering dijumpai pada pasien dengan diabetes melitus. Penelitian ini bertujuan untuk mengukur akurasi basal digital pressure (BDP), saturasi oksigen, dan change digital pressure (CDP) untuk diagnosa Steal Syndrome pada pasien PGTA dengan diabetes melitus. Metode: Penelitian ini merupakan kohort prospektif yang melibatkan 69 pasien PGTA dengan diabetes melitus tipe 2 yang melakukan kontruksi FAV brakiosefalika pada 3 senter vaskular di Jakarta. Pemeriksaan BDP, CDP, dan saturasi oksigen dilakukan minimal 4 minggu setelah proses pembuatan FAV dan setelah FAV dinyatakan matur serta telah digunakan untuk hemodialisa. Analisis statistic menggunakan SPSS versi 25. Hasil: Terdapat perbedaan bermakna pada CDP, BDP, maupun saturasi oksigen antara pasien Steal Syndrome dan tidak Steal Syndrome (p 35 mmHg (sensitivity: 80%, specificity 90,74%) for CDP and 94,5% (sensitivity 80%, specificity 100%) for oxygen saturation. Conclusion: BDP, CDP and oxygen saturation can be used to diagnose steal syndrome in end stage renal disease patient with type 2 diabetes mellitus. However, BDP, CDP and oxygen saturation still have limited sensitivity and specificity.
Kata Kunci: Basal Digital Pressure, Saturasi Oksigen, Change Digital Pressure, Steal Syndrome, Fistula Arterio-Venosa, Type 2 Diabetes Mellitus.


Background: The number of end stage renal disease patient keep increasing globally. Arteriovenous fistula (AVF) is still the golden standard vascular access for hemodialysis and the recommended site for AVF reconstruction in diabetic patient is at brachiocephalic. Steal syndrome is one of AVF complication. There have been studies that used basal digital pressure (BDP), oxygen saturation and change digital pressure (CDP) for steal syndrome diagnosis. However, there is no study in diabetic patient. This study aims to measure the accuracy of BDP, CDP and oxygen saturation to diagnose steal syndrome in end stage renal disease patient with type 2 diabetes mellitus. Methods: This is a prospective cohort study with 69 end stage renal disease patient with type 2 diabetes mellitus that have brachiocephalic AVF construction in 3 vascular centres in Jakarta. BDP, CDP and oxygen saturation examination was performed after AVF was considered mature and being use for hemodialysis, the earliest being 4 weeks after AVF construction. SPSS version 25 was used for statistical analysis. Results: There was significant association between BDP, CDP and oxygen saturation with steal syndrome (p < 0,001). Area Under Curve (AUC) value of BDP, CDP and oxygen saturation to predict steal syndrome was 95,9% (90,1%-100%), 93,8% (87,6%-99,9%) and 97,5% (93,8%100%) consecutively. The threshold of BDP, CDP and oxygen saturation for predicting steal syndrome was < 85 mmHg (sensitivitay: 80%, specificity 100%) for BDP, > 35 mmHg (sensitivity: 80%, specificity 90,74%) for CDP and 94,5% (sensitivity 80%, specificity 100%) for oxygen saturation. Conclusion: BDP, CDP and oxygen saturation can be used to diagnose steal syndrome in end stage renal disease patient with type 2 diabetes mellitus. However, BDP, CDP and oxygen saturation still have limited sensitivity and specificity.
Kata Kunci: Basal Digital Pressure, Saturasi Oksigen, Change Digital Pressure, Steal Syndrome, Fistula Arterio-Venosa, Type 2 Diabetes Mellitus.