Nilai Diagnostik dan Peran Pemeriksaan Indeks Kolapsibilitas Diameter Vena Kava Inferior dalam Menilai Berat Kering pada Pasien Hemodialisis
Authors: Yussac Muhammad Artisto Adi , Dharmeizar Dharmeizar , Abdullah Murdani , Antono Dono , Muhadi Muhadi 
Published: March 2018

Pendahuluan. Dalam praktek klinis, status cairan pada pasien hemodialisis (HD) sangat berkaitan dengan berat kering. Penentuan berat kering yang dilakukan secara klinis tidak akurat sehingga diajukan berbagai metode untuk menilai berat kering secara noninvasif diantaranya yaitu pemeriksaan analisis bioimpedansi dan pemeriksaan indeks kolapsibilitas vena kava inferior. Penelitian ini dilakukan untuk mengetahui korelasi antara pengukuran indeks kolapsibilitas diameter vena kava inferior dan pemeriksaan analisis biompedansi. Sehingga, dapat diketahui peran pemeriksaan indeks kolapsibilitas vena kava inferior dalam mengevaluasi berat kering pada pasien dialisis.Metode. Studi potong lintang dilakukan di unit HD Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada bulan Juni 2011 dengan metode pengambilan sampel konsekutif. Berat kering dinilai dengan analisis bioimpedansi dan pemeriksaan indeks kolapsibilitas vena kava inferior dinilai dengan menggunakan USG.Hasil. Dari 30 subyek penelitian dengan rentang usia 24-69 tahun dan rerata 52 tahun , 18 (60%) subyek di antaranya mengalami kelebihan cairan menurut analisis bioimpedansi, sedangkan menurut pemeriksaan indeks kolapsibilitas vena kava inferior didapatkan 21 orang kelebihan cairan. . Terdapat korelasi negatif sedang antara pemeriksaan indeks kolapsibilitas diameter vena kava inferior dengan analisis bioimpedansi (r= -0,597, p<0,0001). Nilai sensitivitas dan spesifisitas untuk pemeriksaan indeks kolapsibilitas diameter vena kava inferior yaitu 94,4% dan 66,7%. Pada kedua operator USG didapatkan nilai κ (kappa) sebesar 0,92, artinya memiliki kesesuaian yang sangat kuat.Simpulan. Pemeriksaan indeks kolapsibilitas diameter vena kava inferior mempunyai peran sebagai alat skrining yang cukup baik dalam menilai berat kering pada pasien hemodialisis.Kata kunci: analisa bioimpedansi, berat kering, hemodialisis, indekskolapsibilitas vena kava inferior, korelasiDiagnostic Value and the Role of Inferior Vena Cava Diameter Collapsibility Index to Evaluate Dry Weight in Hemodialysis PatientsIntroduction. In daily clinical practice, fluid status in Hemodialysis (HD) patients is well correlated with dry weight calculation. Dry weight calculation is commonly practiced by clinical observation, which is not accurate. Because of these, few methods has been suggested to calculate the dry weight non-invasively. Bioelectrical Impedance Analysis (BIA) is widely available in overseas but not readily available in all dialysis center in Indonesia, while inferior vena cava diameter is a relatively inexpensive method, and readily available in all dialysis center because it can be performed with ultrasonography (USG) instrument. Methods. A cross-sectional study was performed in a group of regular HD patients at the Haemodialysis Unit, Cipto Mangunkusumo Hospital in Jakarta, June 2011. Dry weight was evaluated with bioelectrical impedance analysis, while the inferior vena cava collapsibility index was evaluated using USG performed by two different observer. Results. We have recruited 30 HD patients, in which 18 (60%) of the subjects were overload according to the bioelectrical impedance analysis, while 21 (70%) were overload according to the inferior vena cava collapsibility index. The mean age of the subjects is 52 years old with the minimum 24 and maximum 69 years. In this research, we found negative correlation (r = -0.957, P<0.0001) between inferior vena cava colapsibility index and BIA. We found a 94.4% sensitivity and 66.7% specificity for inferior vena cava colapsibility index. Both of USG operators showed a κ coefficient value of 0.92, which reflected a very strong agreement between them. Conclusions. The inferior vena cava colapsibility index have a good role as a screening method in determining dry weight in dialysis patients. Keywords: Hemodialysis, dry weight, bioelectrical impedance analysis, correlation, inferior vena cava colapsibility index.