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Simanjuntak, Charley Dokma Tua
"Latar belakang dan objektif: Keberhasilan hemodialisis ditentukan oleh kesuksesan akses vaskular, baik dicapai melalui arteriovenous fistula AVF , arteriovenous graft AVG , atau central venous catether CVC . Dari berbagai pilihan akses vaskular lainnya, AVF adalah akses vaskular hemodialisis yang paling disarankan untuk jangka panjang karena memiliki patensi yang lebih panjang dan tingkat komplikasi yang rendah. Meskipun demikian, AVF memiliki tingkat kegagalan maturasi tinggi, dengan angka sekitar 43-63 . Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo RSCM , rumah sakit tersier terbesar di Indonesia, tidak memiliki data mengenai tingkat patensi AVF. Penelitian ini bertujuan untuk mengetahui tingkat patensi primer AVF di RSCM. Metode: Penelitian kohort retrospektif dilakukan pada seluruh pasien yang menjalani pemasangan AVF di RSCM pada periode Januari 2011 sampai Desember 2013. Hasil: Dari 269 pasien rerata umur 53.1 13.9 , 190 70.6 pasien menjalani pemasangan fistula brakiosefalika, 71 26.4 pasien menjalani pemasangan fistula radiosefalika, dan 7 2.6 pasien menjalani pemasangan fistula jenis lainnya. Tingkat patensi tahun pertama adalah 71.4 . Kesimpulan: Tingkat patensi primer AVF pada pasien end-stage renal disease ESRD memenuhi standar target yang ditentukan oleh pedoman National Kidney Foundation Dialysis Outcomes Quality Initiative NKF/DOQI . Penelitian ini menunjukkan bahwa diameter vena memiliki korelasi yang signifikan dengan tingkat patensi primer AVF. Faktor-faktor lainnya tidak berkaitan dengan patensi primer.

Background and objectives The success of haemodialysis relies on the success of the vascular access, whether achieved with an arteriovenous fistula AVF , an arteriovenous graft AVG , or a central venous catether CVC . Among other access options, arteriovenous fistula is the preferred long term haeemodialysis vascular access due to longer patency and low complication rate. However, AVF maturation failure rates are high, ranging from 43 to 63 . Cipto Mangunkusumo Hospital, the largest tertiary referral hospital in Indonesia, lacks data on AVF patency rates. This study is aimed to determine the primary patency rates of AVF in Cipto Mangunkusumo Hospital. Methods A single centre retrospective study was performed in all patients who had primary arteriovenous fistulas created at Cipto Mangunkusumo Hospital during the period between January 2011 and December 2013. Results Of 269 patients mean age 53.1 13.9 , 190 70.6 patients underwent brachiocephalic fistula creation, 71 26.4 patients underwent radiocephalic fistula creation, and 7 2.6 patients underwent other fistula types creation during the two year study period. The first year patency rate was 71.4 . Conclusions In this setting, the rate of AVF creation for end stage renal disease patients meets the standard of the target goals set forward by the National Kidney Foundation published updated Dialysis Outcomes Quality Initiative NKF DOQI Guidelines. Our study suggested that venous diameter was significantly correlated with primary patency rates of AVF. Other factors were not associated with primary patency. "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Simanjuntak, Charley Dokma Tua
"Latar belakang dan objektif: Keberhasilan hemodialisis ditentukan oleh kesuksesan akses vaskular, baik dicapai melalui arteriovenous fistula AVF , arteriovenous graft AVG , atau central venous catether CVC . Dari berbagai pilihan akses vaskular lainnya, AVF adalah akses vaskular hemodialisis yang paling disarankan untuk jangka panjang karena memiliki patensi yang lebih panjang dan tingkat komplikasi yang rendah. Meskipun demikian, AVF memiliki tingkat kegagalan maturasi tinggi, dengan angka sekitar 43-63 . Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo RSCM , rumah sakit tersier terbesar di Indonesia, tidak memiliki data mengenai tingkat patensi AVF. Penelitian ini bertujuan untuk mengetahui tingkat patensi primer AVF di RSCM. Metode: Penelitian kohort retrospektif dilakukan pada seluruh pasien yang menjalani pemasangan AVF di RSCM pada periode Januari 2011 sampai Desember 2013. Hasil: Dari 269 pasien rerata umur 53.1 13.9 , 190 70.6 pasien menjalani pemasangan fistula brakiosefalika, 71 26.4 pasien menjalani pemasangan fistula radiosefalika, dan 7 2.6 pasien menjalani pemasangan fistula jenis lainnya. Tingkat patensi tahun pertama adalah 71.4 . Kesimpulan: Tingkat patensi primer AVF pada pasien end-stage renal disease ESRD memenuhi standar target yang ditentukan oleh pedoman National Kidney Foundation Dialysis Outcomes Quality Initiative NKF/DOQI . Penelitian ini menunjukkan bahwa diameter vena memiliki korelasi yang signifikan dengan tingkat patensi primer AVF. Faktor-faktor lainnya tidak berkaitan dengan patensi primer.

Background and objectives The success of haemodialysis relies on the success of the vascular access, whether achieved with an arteriovenous fistula AVF , an arteriovenous graft AVG , or a central venous catether CVC . Among other access options, arteriovenous fistula is the preferred long term haeemodialysis vascular access due to longer patency and low complication rate. However, AVF maturation failure rates are high, ranging from 43 to 63 . Cipto Mangunkusumo Hospital, the largest tertiary referral hospital in Indonesia, lacks data on AVF patency rates. This study is aimed to determine the primary patency rates of AVF in Cipto Mangunkusumo Hospital. Methods A single centre retrospective study was performed in all patients who had primary arteriovenous fistulas created at Cipto Mangunkusumo Hospital during the period between January 2011 and December 2013. Results Of 269 patients mean age 53.1 13.9 , 190 70.6 patients underwent brachiocephalic fistula creation, 71 26.4 patients underwent radiocephalic fistula creation, and 7 2.6 patients underwent other fistula types creation during the two year study period. The first year patency rate was 71.4 . Conclusions In this setting, the rate of AVF creation for end stage renal disease patients meets the standard of the target goals set forward by the National Kidney Foundation published updated Dialysis Outcomes Quality Initiative NKF DOQI Guidelines. Our study suggested that venous diameter was significantly correlated with primary patency rates of AVF. Other factors were not associated with primary patency. "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Ahan Gifhari
"Tujuan: Pemeriksaan ultrasonography doppler pra operasi pada arteri dan vena sudah menjadi standar untuk membantu pembuatan fistula arteriovena (FAV) sebagai akses hemodialisis, tetapi pengukuran indeks rasio arteriovenous (RAV) yang diperoleh dari  diameter arteri dibagi dengan diameter vena hanya dengan ultrasonography biasa serta penerapannya melalui hukum Bernoulli belum banyak diteliti. Penelitian ini berusaha  mengetahui hubungan antara variabel rasio diameter arteri dan vena dengan prediktif pematangan FAV.

Metode: Sebuah studi kohort prospektif pada 144 pasien yang menjalani FAV dalam periode 6 bulan. Variabel demografi, komorbiditas dan indeks RAV dinilai melalui analisis regresi logistik bivariat pada evaluasi akhir kematangan. RAV dibuat tiga titik desimal untuk mendapatkan akurasi maksimal pada sensitivitas terbaik dan spesifisitas pada kurva karakteristik. Uji probabilitas (nilai P) dianggap signifikan dengan P <0,05. Hasil dilaporkan sebagai odds-rasio dengan interval kepercayaan 95%.

Hasil: Didapatkan maturitas FAV pada 92 (63,89%) dari 144 pasien (P = 0,05; Interval kepercayaan 95%; 59,8%-78,6%). Pada Index RAV 0,93 - 1,14 didapatkan 86,90% FAV yang matur (P <0,001) sedangkan lebih sempit lagi pada Index RAV 1,01 - 1,06 didapatkan 100% FAV yang matur (P <0,002). Penurunan atau kenaikan indeks ini berhubungan dengan penurunan tingkat maturitas.  

Kesimpulan: Teknik pengukuran ini (indeks RAV) sebagai prediktor maturitas dalam FAV disarankan untuk diteliti lebih lanjut. Studi ini menyiratkan bahwa rasio diameter antara arteri dan vena berhubungan maturitas, terlepas dari variabel lain tetap berpengaruh pada faktor mekanik dan biologis terhadap hemodinamik yang optimal (tekanan dan kecepatan) pada pematangan FAV

 

 

Kata kunci: Fistula Arterivenous, Indeks Rasio Arterivenous, Pematangan fungsional.

Objective: Preoperative doppler ultrasonography  examination has become a standard to assist in making arteriovenous fistulas (AVF) as access to hemodialysis, but measurements of arteriovenous ratio index (AVR) obtained from arterial diameter and venous diameter and its application through Bernoulli's law have not been widely studied. This study to determine the relationship between the variable ratio of blood vessel diameter and predictive maturation of AVF.

Method: A prospective cohort study with a view to recording 144 patients underwent AVF in period of 6 months. Demographic, comorbid and RAV index variables were assessed through bivariate logistic regression analysis at the final evaluation of maturity. AVR is made of three decimal points in order to obtain maximum accuracy for the best sensitivity and specificity on the characteristic curve. The probability test (P value) is considered significant with P <0.05. Results are reported as odds ratios with 95% confidence intervals.

Results: AVF maturity was obtained in 92 (63.89%) of 144 patients (P = 0.05; 95% confidence interval; 59.8%-78.6%). In the AVR Index 0,93-1,14 obtained 86,90% mature AVF (P <0.001) and more sharp AVR Index 1.01 to 1.06 obtained 100% mature AVF (P <0.002). This decrease or increase in index is related to a decrease in the level of maturity.

Conclusion: This measurement technique (AVR index) as a predictor of AVF maturity is strongly suggested for further investigation. This study implies that the minimum ratio of diameter between arteries and veins relates to maturity rate, regardless of other variables that still have an important influence on mechanical and biological factors with optimal hemodynamics (pressure and speed) in AVF maturation

 

 

 

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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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UI - Tugas Akhir  Universitas Indonesia Library
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Yang, Andrew Jackson
"Latar belakang: Fistula arteriovenous (FA V) merupakan akses terbaik untuk melakukan hemodialisis. Kegagalan maturasi fistula arteriovenous merupakan hambatan utama penggunaannya. Penelitian ini bertujuan menilai dapatkah bloodjlow rateyang diukur intraoperatif menggunakan ultrasonografi Doppler dapat menjadi prediktor maturitas F A V radiosefalika. Subjek dan Metode: Subjek adalah pasien-pasien yang akan dibuat F A V radiosefalika dengan usa mapping sesuai standar. Sesaat setelah anastonosis diukur bloodjlow ratedengan usa Doppler probe linear. Penelitian ini menggunakan desain potong lintanganalitik untuk mendapatkan hubungan maturasi FA V dengan bloodjlow rateintraoperatif.Hasil:FA V radiosefalika (n=71) pada 71 pasien dibuat dan dievaluasi dalam 6 minggu. Reratabloodjlow rateintraoperatif pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (201,85 dan 141,96 mllmenit; P 165,5 ml/menit memiliki nilai prediktor yang baik untuk maturasi FA V radiosefalika,sehingga dapat menjadi acuan menentukan perlu tidaknya penilaian lebih lanjut dan tindakan revisi saat intraoperatif, yang pada akhimya diharapkan dapat menurunkan angka kegagalan maturasi fistula arteriovenous.

Background: Arteriovenous fistula (A VF) is the best access to hemodialysis. The failure of arteriovenous fistula maturation is a major obstacle to its use. This study aims to assess whether an intraoperative bloodflow rate measured with Doppler ultrasound can be a predictor of the maturity ofradiocephalicA VF.Subjects and Methods: Subjects were patients to be made radiocephalic A VF with USG mapping according to the standard. Shortly after anastonosis bloodflow rate was measured with a linear probeDoppler ultrasound. This study used cross sectional analytic design to obtain radiocephalic A VF maturation relationship with intraoperative blood flow rate. Results: Radiocephalic A VF(n = 71) in 71 patients were made and evaluated in 6 weeks. The mean intraoperative blood flow rate in mature fistulas was significantly higher than those not mature (201.85 and 141.96 mLimin; P <0.001). Bloodflow rate with a cut-off value of 165.5 mLimin has a sensitivity of 93.8%, specificity 95.7%, positve predictive value 97.8% and negative predictive value 88.5%.Conclusion: Bloodflow rate> 165.5 mLimin has a good predictor value for radiocephalic A VF maturation, so it can be a reference to detem1inewhether the need for further assessment and revision action intraoperatively, which in tum is expected to decrease the maturation failure rate of arteriovenous fistula."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
T56014
UI - Tesis Membership  Universitas Indonesia Library
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Oktaviati
"[ABSTRAK
Pendahuluan Masalah utama pada ArterioVenous Fistula AVF adalah kegagalan maturasi Deteksi dini bahwa AVF akan mengalami gagal maturasi dibutuhkan sehingga memungkinkan untuk melakukan revisi atau membuat akses vaskular yang baru sesegera mungkin Diameter vena pra operasi adalah faktor prediktor independen dalam maturasi Tujuan penelitian ini adalah untuk mengetahui prediksi dini maturasi AVF berdasarkan peningkatan ukuran diameter draining vein pasca operasi minggu pertama Metode Penelitian dilakukan secara kohort retrospektif dengan mengambil data rekam medis pasien yang menjalani operasi pembuatan AVF di RSCM tahun 2013 2014 Diameter vena pra operasi dan diameter draining vein pasca operasi minggu pertama diukur dengan USG Doppler Peningkatan diameter draining vein pasca operasi minggu pertama dihubungkan dengan maturasi AVF Hasil Didapatkan 38 pasien dengan angka maturasi 81 6 Tidak didapatkan perbedaan maturasi yang bermakna pada usia jenis kelamin diabetes melitus hipertensi CHF CAD stroke hepatitis hiperlipidemia riwayat dilakukan AVF operator dan diameter arteri pra operasi Terdapat perbedaan yang bermakna pada AVF jenis radiosefalika dan brakiosefalika p 0 022 Didapatkan perbedaan maturasi yang bermakna pada diameter draining vein pasca operasi minggu pertama dan peningkatannya pada AVF tipe brakiosefalika p 0 034 dan p 0 041 dan radiosefalika p 0 012 dan p 0 011 Nilai cut off peningkatan diameter draining vein pasca operasi minggu pertama untuk batasan prediksi maturasi adalah 0 65 mm dengan sensitifitas sebesar 90 3 spesifisitas sebesar 85 7 Pada AVF tipe brakiosefalika nilai cut off adalah 0 45 mm dengan sensitifitas sebesar 95 8 spesifisitas sebesar 100 Pada AVF tipe radiosefalika nilai cut off adalah 1 00 mm dengan sensitifitas sebesar 85 7 spesifisitas sebesar 100 Simpulan Peningkatan diameter draining vein pasca operasi minggu pertama dapat dijadikan sebagai prediktor maturasi AVF ABSTRACT Introduction The main problem in ArterioVenous Fistula AVF is the failure of maturation Early detection for non mature AVF is needed making it possible to revise or create a new vascular access as soon as possible Preoperative vein diameter is considered to be an independent predictor factor in the maturation The purpose of this study was determining the early prediction of AVF maturation using the enlargement of draining vein diameter in the first week postoperative Methods Design of this study was cohort retrospective by taking patients medical records who underwent AVF surgery Vein diameter were measured preoperative and first week postoperative with Doppler ultrasound The enlargement of the first week draining vein diameter was associated with AVF maturation Results There was 38 patients with maturation rate was 81 6 There were no significant maturation differences on age sex diabetes mellitus hypertension CHF CAD stroke hepatitis hyperlipidemia AVF history operator and preoperative arterial diameter There was significant maturation difference in the radiocephalica and brachiocephalica AVF type p 0 022 There were significant maturation difference in first week postoperative draining vein diameter and it s increasement in brachiocephalica type p 0 034 and p 0 041 and radiocephalica type p 0 012 and p 0 011 Cut off value for first week postoperative draining vein diameter increasement in maturation prediction limitation is 0 65 mm with a sensitivity of 90 3 specificity of 85 7 For brachiocephalica type cut off value is 0 45 mm with a sensitivity of 95 8 specificity of 100 For radiocephalica type cut off value is 1 00 mm with a sensitivity of 85 7 specificity of 100 Conclusion First week postoperative draining vein diameter increasement can be used as predictors of AVF maturation ;Introduction The main problem in ArterioVenous Fistula AVF is the failure of maturation Early detection for non mature AVF is needed making it possible to revise or create a new vascular access as soon as possible Preoperative vein diameter is considered to be an independent predictor factor in the maturation The purpose of this study was determining the early prediction of AVF maturation using the enlargement of draining vein diameter in the first week postoperative Methods Design of this study was cohort retrospective by taking patients medical records who underwent AVF surgery Vein diameter were measured preoperative and first week postoperative with Doppler ultrasound The enlargement of the first week draining vein diameter was associated with AVF maturation Results There was 38 patients with maturation rate was 81 6 There were no significant maturation differences on age sex diabetes mellitus hypertension CHF CAD stroke hepatitis hyperlipidemia AVF history operator and preoperative arterial diameter There was significant maturation difference in the radiocephalica and brachiocephalica AVF type p 0 022 There were significant maturation difference in first week postoperative draining vein diameter and it s increasement in brachiocephalica type p 0 034 and p 0 041 and radiocephalica type p 0 012 and p 0 011 Cut off value for first week postoperative draining vein diameter increasement in maturation prediction limitation is 0 65 mm with a sensitivity of 90 3 specificity of 85 7 For brachiocephalica type cut off value is 0 45 mm with a sensitivity of 95 8 specificity of 100 For radiocephalica type cut off value is 1 00 mm with a sensitivity of 85 7 specificity of 100 Conclusion First week postoperative draining vein diameter increasement can be used as predictors of AVF maturation , Introduction The main problem in ArterioVenous Fistula AVF is the failure of maturation Early detection for non mature AVF is needed making it possible to revise or create a new vascular access as soon as possible Preoperative vein diameter is considered to be an independent predictor factor in the maturation The purpose of this study was determining the early prediction of AVF maturation using the enlargement of draining vein diameter in the first week postoperative Methods Design of this study was cohort retrospective by taking patients medical records who underwent AVF surgery Vein diameter were measured preoperative and first week postoperative with Doppler ultrasound The enlargement of the first week draining vein diameter was associated with AVF maturation Results There was 38 patients with maturation rate was 81 6 There were no significant maturation differences on age sex diabetes mellitus hypertension CHF CAD stroke hepatitis hyperlipidemia AVF history operator and preoperative arterial diameter There was significant maturation difference in the radiocephalica and brachiocephalica AVF type p 0 022 There were significant maturation difference in first week postoperative draining vein diameter and it s increasement in brachiocephalica type p 0 034 and p 0 041 and radiocephalica type p 0 012 and p 0 011 Cut off value for first week postoperative draining vein diameter increasement in maturation prediction limitation is 0 65 mm with a sensitivity of 90 3 specificity of 85 7 For brachiocephalica type cut off value is 0 45 mm with a sensitivity of 95 8 specificity of 100 For radiocephalica type cut off value is 1 00 mm with a sensitivity of 85 7 specificity of 100 Conclusion First week postoperative draining vein diameter increasement can be used as predictors of AVF maturation ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Danny Pratama
"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.

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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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Raden Suhartono
"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."
Jakarta: PESBEVI, 2020
616 JINASVS 1:1 (2020)
Artikel Jurnal  Universitas Indonesia Library
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