الفهرس 
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Abstract
Iron deficiency anemia has been almost a significant comorbidity in CKD patients and kidney transplant recipients. A strong inverse relationship between FGF-23 and anemia. Anemia is a significant risk factor for LVH progression with increasing risk of mortality. Anemia treatment showed not only improving quality of life but also to decrease all cause of morbidity and mortality.
Our cohort prospective study investigated the effect of anemia treatments on FGF-23,LVH regression and endothelial dysfunction in CKD and kidney transplant recepients.
This cohort prospective study included 120 patients at recruitment, they were divided into 2 groups chronic Kidney Disease group (CKD)including 89 patients and renal transplanted (Tx) including 31 patients. The chronic kidney disease (CKD) group age mean 47 years( + 16.2) while The transplanted ( Tx) group mean age for the latter 35 years ( + 12.2).The study population were subdivided into 2 groups in each arm based on Hb level and transferrin saturation (TSAT%) where the cutoff points were Hb <10gm/dl and TSAT <20% into severe and non-severe anaemia subgroups.
All study population received oral iron in dose 567mg ferrous glycine sulphate complex (equivqlent to 100mg elemental iron) for a duration 1-3 months and were followed up to 6 months. ESA therapy was prescribed to 86.5 % in CKD patients in doses 4000 IU / week to 1200 IU / week. All patients were subjected for full clinical examination and the following laboratory investigation:
• Serum creatinine and blood urea nitrogen and eGFR using CKD-EPI equation,
• Full blood count.Serum iron, Total iron binding capacity(TIBC) and transferrin saturation (TSAT). Serum calcium,phosphorus and iPTH levels,Fibroblast growth factor-23.
• Detailed echocardiography including EF, IVS thickness, posterior wall thickness, left ventricular end –diastolic and end- systolic diameter and LV mass and correlated with body surface area for LV mass index.
• Flow mediated vasodilatation. Tacrolimus and Cyclosporin trough levels were also estimated.
A significant positive correlation was found between baseline hemoglobin and reduction of FGF-23 only in CKD subgroup <10gm/dl level would benefit from treatment of IDA to decrease FGF-23 as for each 1 gm/dl increase in hemoglobin level a reduction in FGF-23 level by 51.7 pg/ml. Also a negative correlation of reduction of LV mass in subgroup of severe anemia with hemoglobin < 10 gm/dl and both subgroups of renal transplant groups.
It was found that a negative correlation between baseline hemoglobin and delta Flow mediated vasodilatation in CKD patients subgroups non-severe anemia and severe anemia group, significant positive correlation between baseline hemoglobin and change in Flow mediated vasodilatation in transplant subgroup while strength of this correlation is weak in CKD severe subgroup but still statistical significant.