الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Intradialytic Hypotension (IDH) is common complication during dialysis, occurs in 20-33% of haemodialysis patients with increased mortality and rate of cardiac wall motion abnormalities during dialysis. In CKD patients there was structural abnormalities at all levels of the cardiovascular system as left ventricular systolic dysfunction, reduced venous compliance, left ventricular hypertrophy and vascular calcification all may be risk factors for the development of IDH. Hemodialysis patients have a higher degree of arterial calcification and endothelial dysfunction with insufficient responses to volume stress in addition to left ventricular hypertrophy, systolic and diastolic dysfunction frequently observed in patients with VC leading to occurence of IDH. An abnormal ankle brachial pressure index is either low ≤0.9 reflects distal ischemia or high ≥1.4 reflects vascular calcification with a worse cardiovascular prognosis, particularly when ischaemia is superimposed. BMP-7 is an inhibitory protein that would reduce, inhibit, treat vascular calcification by maintaining vascular smooth muscle cell diffrentiation in chronic kidney failure patients. It counteracts TGF-β1 induced endothelial-to-mesenchymal transition in viral cardiomyopathy, preventing and ameliorating renal fibrosis, development of peritrabecular fibrosis and decreases bone resorption in renal osteodystrophy.
So, this work was conducted with the aim to study role of cardiovascular disease and serum level of vascular calcification inhibitory protein BMP-7 in the occurrence of intradialytic hypotension.
The study was conducted on 34 patients on maintenance regular hemodialysis divided into two groups group I (17 patients with intradialytic hypotension) group II (17 patients with intradialytic normal or high blood pressure) and 21 control healthy subjects with normal renal function matched in both age and sex to the patients. Patients with diabetes mellitus, collagenic vascular diseases, active infection and female patients in the childbearing period that may be pregnant all were excluded in this study.
All included patients were subjected to:
Full history taking, clinical Evaluation, laboratory investigations including routine laboratory investigations (CBC, blood urea, serum creatinine, SGOT, SGPT and serum albumin) and serum bone morphogenetic protein-7 (BMP-7) level (Predialysis in case of H.D patient group).
The hemodialysis patients only also were subjected to the following:
History taking stressed on cause of ESRD and symptoms of intradialytic hypotension, dry body weight and interdialytic weight gain measurement.
Serum electrolytes (serum phosphorus, calcium, magnesium, potassium and sodium level 1 hour before the dialysis session at the middle of the week), Serum ferritin and PTH level.
Echocardiography, soft tissue postero-anterior fine detail native (unchanged) radiographs of the pelvis and the thigh an