الفهرس 
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Abstract
Loss of residual kidney function (RKF) among hemodialysis (HD) patients is associated with reduced survival, worsened anemia, malnutrition, and inflammation. Over the past decade, more patients are initiating HD with a higher RKF and there is evidence suggesting beneficial effects of RKF on clinical outcomes in HD patients. However, RKF declines at the fastest rate within the first several months after initiating dialysis. Hence, preserving RKF has recently become an important therapeutic goal for patients starting dialysis.
While it is well known that mineral bone disorder in chronic kidney disease (CKD-MBD) parameters results from loss of RKF, CKD-MBD may lead to further loss of RKF in a positive feedback loop, increasing morbidity and mortality in predialysis and dialysis patients. The presence of hyperphosphatemia and secondary hyperparathyroidism (SHPT) has been shown to result in vascular calcifications, which in turn leads to advanced mortality and ischemic heart disease.
These vascular calcifications can also contribute to renal insufficiency in the setting of impaired renal blood flow, leading to further nephron damage. In addition, SHPT has been associated with decreased myocardial contractility, impaired insulin sensitivity, and glucose intolerance, which all may contribute to CKD progression.
There is also evidence that low serum calcium may be associated with progression of renal failure associated with vitamin D deficiency. Furthermore, abnormal levels of vitamin D and fibroblast growth factor-23 (FGF-23), factors related to CKD-MBD homeostasis, may also play a role in renal damage.
Over the last 20 years, there have been many advances in the treatment of CKD-MBD with the goal of decreasing mortality and improving cardiovascular health. It is still debatable whether targeting correction of CKD-MBD laboratory values is an adequate surrogate outcome for mortality and morbidity risks, but current guidelines continue to recommend achievement of target laboratory goals to mitigate these risks. Though there are contradictory findings in this regard, it is hypothesized that the abnormalities of MBD parameters after initiation of dialysis could affect early decline in RKF.
The aim of study is to evaluate the impact of residual kidney function on biomarkers of mineral bone disorders mainly (Ca, PO4 and iPTH) in chronic hemodialysis patients.
This study was carried out as across sectional analytic hospital-based study on a wide variety of Egyptian population in Shebin Elkom Teaching Hospital Menoufia governorate.
This study was conducted on 100 hemodialysis patients and they were divided into two groups,equal in numbers,:
group 1: patients on regular hemodialysis sessions with residual urine output (> 50ml/24hrs)
group 2: patients on regular hemodialysis sessions with no residual urine output (<50ml/24hrs)
All the included patients were subjected to: - Complete history taking - Examination. - Laboratory tests including: Corrected Calcium, S.phosphorus, iPTH, S.Albuminm Calculation of (kt\v) per session, Hemoglobin level and Serum alkaline phosphatase. - Estimation of Carotid intimal Thickness - Measuring residual kidney function
By analyzing and processing the data obtained from the history, clinical examination and laboratory investigations, the study declared that:
There was no significant difference between the 2 groups regarding cause of ESRD as the prevalence of DM in group 1 and group 2 was; 38%& 42%, respectively and the prevalence of HTN in group 1 and group 2 was; 30%& 26%, respectively. There was no significant difference between the 2 groups regarding Hb as the mean Hb level in group 1 and group 2 was; 9.11 ± 1.28& 9.09 ± 1.25, respectively. There was no significant difference between the 2 groups regarding albumin as the mean albumin level in group 1 and group 2 was; 3.59 ± 0.37 & 3.54 ± 0.39, respectively. There is significant lower total calcium level and corrected calcium level among group 2 than group 1. There was significant higher values of iPTH, ALP and PO4 were found among group 2 than group 1.
CIMT among the both groups showed high values. Also, we found higher CCIMT values were found among group 2 than group 1, although this difference still non significant.