الفهرس 
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Abstract
ardiovascular disease is the leading cause of morbidity and mortality in patient with ESRD, accounting for more than 50% of all deaths. In the past years, mineral metabolism abnormalities have been implicated in the risk of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients.
Fibroblast growth factor 23 (FGF-23) is a phosphate-regulating hormone largely produced by bone. Genetic and biochemical evidence indicates that FGF-23 reduces the serum phosphate concentration. The serum concentration of FGF-23 increases as kidney function declines, and its levels are extremely high in hemodialysis (HD) patients, although the role of FGF-23 in patients without functional kidneys is generally unknown .FGF-23 has been linked to LVH.
So, the aim of the present study was to study whether FGF-23 is a marker or has a potential role in developing myocardial hypertrophy in CKD patients under haemodialysis treatment. To achieve this target, 90 patients under maintenance hemodylaisis were incorporated in the present study. They included 45 patients with diabetes mellitus and 45 patients without.
Both groups were well matched regarding demographic characteristics.There was also no specific differences between both groups regarding to laboratory parameters including hematological parameters, renal functions,electrolyte levels and PTH.
Comparison of FGF-23 levels between the studied groups had shown that non-diabetic patients had higher levels of FGF-23 when compared with diabetic patients. However, the difference didn’t reach a statistical significance. In relation to the comparison between the associated clinical conditions in the studied groups, the present study found that diabetic patients’ group had a higher frequency of HCV-Antibodies when compared with the non-diabetic group.
Comparison between LV mass index in the studied groups had shown that diabetic patients had significantly higher LV mass index when compared with non-diabetics.
Regarding the correlation between the demographic characteristics and FGF-23 levels, the present study found no significant association between FGF-23 levels and the demographic characteristics including age, BMI, sex and hemodialysis duration.
Considering the correlation between FGF-23 levels and the hematological parameters, the current study detected no significant associations between FGF-23 levels and Hb%, RBCs, WBCs and platelets counts. In respect to the linkage between FGF-23 levels and serum electrolyte levels in the studied groups, the present study disclosed a statistically significant direct relationship between FGF-23 levels and Ca, P and Ca P product. However, in univariate and multivaraiate analysis, P and Ca P product only showed significant associations.
Investigating the effect of other laboratory findings on FGF-23 levels showed a significant direct relationship between FGF-23 levels and serum creatinine. Also, there was a significant association between FGF-23 levels and serum albumin.
The associated medical conditions namely, HCV and hypertension showed no significant associations with FGF-23. In respect to the relation between left ventricular hypertrophy as expressed by left ventricular mass index and FGF-23, our study had shown a significant association. This was also correct in univaraite and multivariate regression analysis.
In conclusion, FGF-23 could be a novel biomarker of LV overload, which is closely associated with the increased risk of death in HD patients.