Peranan Sistem Penilaian CAVeA2T2 dalam Memprediksi Maturasi Fistula Radiosefalika

Abstract

Background: Based on National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF/KDOQI) guidelines, radiochepalic arteriovenous fistula (AVF) is a primary selection of vascular access in patients undergoing hemodialysis. AVF is said to be mature in accordance with the rule of six (blood flow of more than 600mL/minute, diameter greater than 6mm and vein distance to skin surface ≤6 mm). CAVeA2T2 scoring system (ipsilateral CVC access, age >73 years, vein <2,2mm, history of lower limb angioplasty, non-perioperative thrill) have capacity in assessing maturation of radiochepalic fistula.

Method: Prospective cohort analytical study with consecutive sampling were performed to assess CAVeA2T2 scoring system role in predicting radiochepalic fistula maturation in end-stage renal disease (ESRD) patients who came to vascular surgery outpatients clinic at Dr. Hasan Sadikin Bandung hospital and Ny.RAHabibie hospital who will undergo radiocephalic AVF surgery. Univariate examination for descriptive analysis was performed. The samples was grouped by CAVeA2T2 score (score <2 and ≥2) and fistula maturation (mature/non mature), then analyzed through comparison between groups in bivariate model. Hypothetical analysis were done through Chi-square with significance of 0.05.

Results: Twenty four samples were collected (men and women ratio is 1:1) which carried out the analysis by age range 21-76 years and the average systolic blood pressure 149,2 (±28,4)mmHg. The CAVeA2T2 scoring system obtained a role in predicting radiochepalic fistula maturation with the probability of statistical error p<0,01 and the coefficient of contingency C=0,674. The degree of influence CAVeA2T2 scoring system role in predicting radichepalic AVF maturation is classified as very strong based on Guilford's classification.

Conclusion: The scoring system CAVeA2T2 has a role in predicting radiochepalic fistula maturation.

Latar Belakang. Berdasarkan panduan National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF/KDOQI), fistula radiosefalika merupakan pilihan utama akses vaskular pada pasien yang menjalani hemodialisis. Fistula dikatakan matur apabila sesuai dengan rule of six (laju aliran >600mL/menit, diameter ≥6mm dan berjarak sekitar ≤6mm dari permukaan kulit). Sistem penilaian CAVeA2T2 (akses vena sentral ipsilateral, usia >73 tahun, vena <2,2mm, riwayat angioplasty pada tungkai bawah, dan tidak ditemukannya thrill intraoperatif) memiliki potensi dalam menilai maturasi fistula radiosefalika.

Metode. Desain analitis menggunakan metode kohort prospektif dengan consecutive sampling untuk menilai perananan sistem penilaian CAVeA2T2 dalam memprediksi maturasi fistula radiosefalika. Populasi terjangkau adalah pasien gagal ginjal terminal (GGT) yang datang ke poliklinik Bedah Vaskular RSUP Dr. Hasan Sadikin Bandung dan RSKG Ny.R.A.Habibie yang akan menjalani operasi fistula radiosefalika. Uji statistik menggunakan uji univariat untuk dekskripsi data. Sampel dikelompokkan berdasarkan skor CAVeA2T2 (skor <2 dan ≥2) dan status maturasi fistula (matur/non matur) kemudian dianalisis melalui perbandingan antar kelompok melalui model bivariat. Selanjutnya analisis untuk menguji hipotesis melalui analisis Chi-Square Fisher dengan batas kemaknaan 0,05.

Hasil. Didapatkan 24 pasien (perbandingan laki-laki dan perempuan adalah 1:1) yang dilakukan analisis dengan rentang usia 21-76 tahun, rerata tekanan sistolik 149,2 (±28,4) mmHg. Didapatkan sitem penilaian CAVeA2T2 memiliki peranan dalam memprediksi maturasi fistula radiosefalika dengan probabilitas kesalahan statistik sebesar p<0,01 dan koefisien kontingensi sebesar C=0,674. Derajat peranan sistem penilaian CAVeA2T2 terhadap maturasi fistula radiosefalika tergolong sangat kuat berdasarkan klasifikasi Guilford.

Kesimpulan. Sistem penilaian CAVeA2T2 memiliki peranan dalam memprediksi maturasi fistula radiosefalika.