الفهرس 
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Abstract
Non-alcoholic fatty liver disease and chronic kidney disease are worldwide public health problems, affecting up to 25–30% (Non-alcoholic fatty liver disease), and up to 10–15% of the general population. Recently, it has also been established that there is a strong association between Non-alcoholic fatty liver disease and chronic kidney disease, regardless of the presence of potential confounding diseases such as obesity, hypertension and type 2 diabetes. Since Non-alcoholic fatty liver disease and chronic kidney disease are both common diseases that often occur alongside other metabolic conditions, such as type 2 diabetes or metabolic syndrome, elucidating the relative impact of Non-alcoholic fatty liver disease on the risk of incident chronic kidney disease presents a substantial challenge for investigators working in this research field.
A growing body of epidemiological evidence suggests that Non-alcoholic fatty liver disease is an independent risk factor for chronic kidney disease and recent evidence also suggests that associated factors such as metabolic syndrome, dysbiosis, unhealthy diets, platelet activation and processes associated with ageing could also contribute mechanisms linking Non-alcoholic fatty liver disease and chronic kidney disease.
Both diseases are progressive chronic conditions that represent a spectrum of diseases extending from relatively mild disease, with only modest changes in function, to severe debilitating disease with end-stage organ damage, necessitating either chronic dialysis or organ transplantation in order to sustain life.
Non-alcoholic fatty liver disease encompasses a histopathological spectrum of metabolic liver conditions encapsulating simple steatosis alone (non-alcoholic fatty liver, i.e. NAFL); steatosis, inflammation and ballooning of hepatocytes, with or without liver fibrosis (non-alcoholic steatohepatitis, i.e. NASH), and cirrhosis. When advanced fibrosis or cirrhosis occurs, the risk of hepatocellular carcinoma also increases markedly. chronic kidney disease is a complex, progressive chronic condition that is defined by either abnormalities of kidney structure or function present for >−3 months, with serious implications for health. Either markers of kidney damage or decreased glomerular filtration rate may be present.
Early recognition and treatment of chronic kidney disease aimed at reducing renal disease progression and CVD complications may limit its health-related burden. In particular, patients with stage 3 chronic kidney disease benefit the most from early referral strategies. Despite these promises, chronic kidney disease often goes unrecognized: in the Third National Health and Nutrition Survey (NHANES III), among all individuals with stage 3 chronic kidney disease, the awareness was only 8.2%.
The high morbidity, mortality, and health care costs associated with chronic kidney disease have led investigators to seek novel modifiable risk factors. Non-alcoholic fatty liver disease, the hepatic manifestation of the metabolic syndrome, affects 30% of the general adult population and up to 60%–70% of diabetic and obese patients.
Non-alcoholic fatty liver disease encompasses a histological spectrum ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), the latter with or without advanced fibrosis. Non-alcoholic fatty liver disease confers an increased risk of cirrhosis, largely limited to NASH, and of CVD, independently of metabolic syndrome and traditional risk factors and through mechanisms which remain unclear. Growing experimental and epidemiological evidence suggests that Non-alcoholic fatty liver disease and chronic kidney disease share common pathogenic mechanisms and interactions.
The aim of this study to detect the incidence of non-alcholic steatohepatitis between non-diabetic hemodialysis patients in Beni-Suef Governorate.
This was a cross sectional study in Beni-Suef governorate, including 1000 non-diabetic Hemodialysis patients from different hemodialysis units from all the central hospitals in Beni-Suef governorate, Beni-Suef Fever hospital, Health insurance hospital, and Beni-Suef university hospital were enrolled in the study.
The main results of the study revealed that:
There were 545(54.5%) male and 455(45.5%) female with mean age(years) 48.54 (± 15.05SD) and range (18.0 – 79.0), with mean HD duration (months) 56.91 (± 38.07SD) and range (1.0 – 132.0), with mean BMI 28.12 (± 1.52SD) and range (25.10 – 31.0), there were 235(58.8%) had HTN with mean Systolic blood pressure (mmHg) 139.9 (± 20.54SD) and range (110.0 – 170.0), mean Diastolic blood pressure (mmHg) 82.50 (± 12.95SD) and range (60.0 – 100.0), mean of Mean arterial blood pressure (mmHg) 101.6 (± 14.28SD) and range (76.70 – 123.3).
as regards laboratories there were mean FBS 84.97 (± 10.01SD) and range (69.0 – 105.0), mean PPBS 109.2 (± 9.68SD) and range (91.0 – 125.0), mean Serum triglyceride (mg/dL) 176.67 (± 31.13SD) and range (130.0 – 294.0), mean Serum cholesterol (mg/dL) 197.3 (± 26.12SD) and range (160.0 – 265.0), mean LDL (mg/dL) 120.2 (± 22.03SD) and range (80.0 – 181.0), mean HDL (mg/dL) 48.42 (± 9.73SD) and range (30.0 – 66.0), mean AST (IU /L) 43.45 (± 23.18SD) and range (11.0 – 115.0), mean ALT(IU /L) 44.67 (± 22.61SD) and range (9.0 – 108.0).
According to CAP (dB/M) there were 503(50.3%) S0, 233(23.3%) S1, 100(10.0%) S1-S2, 67(6.7%) S2,10(1.0%) S2-S3 and 87(8.7%) S3.
according to liver stiffness grades there were 508(50.8%) F0, 280(28.0%) F1, 57(5.7%) F2,95(9.5%) F3 and 60(6.0%) F4.
There were 508(50.8%) F0 and 492(49.2%) F1:F4 with mean 6.14 (± 3.90SD) and range (2.0 – 19.90).
there is statistically significant difference between NASH and different parameters as regards Age (years) and BMI, while there is no statistically significant difference between NASH and different parameters as regards Gender, HD duration (months), HTN, Systolic blood pressure (mmHg), Diastolic blood pressure (mmHg) and Mean arterial blood pressure (mmHg).
There is high statistically significant difference between None NASH and NASH patients as regards liver stiffness grades and CAP value.
There is Correlation between CAP value and HD duration (months), HDL. There is strong Correlation between CAP value and Serum triglyceride, Serum cholesterol, LDL, AST and ALT, there is strong Correlation between liver stiffness value and Serum triglyceride.
There is high statistically significant difference between CAP steatosis grades as regards Liver stiffness grades and Cap value.
There is high statistically significant difference between CAP steatosis grades as regards Serum triglyceride, Serum cholesterol), LDL, AST and ALT.
Based on our findings, we recommend for further studies on larger sample and on large geographical scale to emphasize our conclusion.