الفهرس 
CHRONIC KIDNEY DISEASEOnly 14 pages are availabe for public view
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Abstract
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SUMMARY
Studies show that patients with MS have a 2.5-fold higher risk of
developing CKD. Studies suggest that the renal fibrosis seen in MS
might be caused by a constellation of insulin resistance, hypertension,
dyslipidemias and inflammation, and result in a heightened expression
of adipocytokines, angiotensin and inflammatory cytokines such as
interleukin-6 and tumor necrosis factor alpha
This study aimed to determine the prevalence and the most
common factor of metabolic syndrome in hemodialysis patients and
evaluate the relation of metabolic syndrome to dialysis adequacy.
This study was carried out on 75 Patients 16 years of age and older
who had been receiving hemodialysis for more than 6 months and 50
apparently healthy individuals as control. The patients were recruited
from hemodialysis unit at Esna Hospital from June 2012 to January 2013.
Metabolic syndrome was defined according to the ATP III criteria.
Hemodialysis was done in 4 hourly thrice weekly session for each patient
with renal failure
Patients were excluded if: they were candidates for kidney
transplantation before completing 6 months of hemodialysis or if they
were assumed to have a life expectancy of less than 6 months, patients
known to have type 1 diabetes mellitus or familial dyslipidemia or
Patients with known diseases or receiving drugs that disturb glucose or
lipid metabolism such as thiazide diuretics, beta blockers, Cushing’s
syndrome and nephrotic syndrome.
For all subjects the following was done:
Full medical history and clinical examination including cause of
end stage renal disease (ESRD), measurement of abdominal
circumference, laboratory investigations including: complete blood count,
serum total cholesterol, serum triglyceride, low-density lipoprotein
cholesterol, HDL-C cholesterol, fasting blood glucose, serum albumin,
serum calcium, serum creatinine, serum phosphorus andblood urea. Post
dialysis blood urea for hemodialysis patients.The measurement of Kt/V
was used as an indicator of the quality of dialysis.
The present study included 75 patients on regular hemodialysis for
at least 6 months, 41 (54.7%) of them were males and 34 (45.3%) of them
were females, with age ranged from (17-63) years with a meanSD
(43.56 ± 12.43) years. Fifty apparently healthy control were enrolled in
this study, 29 (58%) of them were males and 21 (42%) of them were
females, with age ranged from (23-64) years with a meanSD (47.10 ±
11.91) years.
The commonest etiology of ESRD in our patients was hypertension
in 40% followed by combined etiology (include diabetes, hypertension or
obstructive uropathy) in 32%.
In the present study, the prevalence of metabolic syndrome in
hemodialysis patients was higher (24%) than control group (16%) with no
statistical significance (P>0.05).
The most frequent criteria of MS in hemodialysis patients (75) was
high blood pressure since it affected 76% of patients, while high blood
sugar affected 37.3% of them,low HDL in 30.7%, elevated triglyceride in
28% and abnormal waist circumference in 21.3%.
Summary
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In our sample of healthy population, the most frequent criteria of
MS were high blood pressure (24%) and abnormal waist circumference
(24%).
The most frequent criteria of MS in hemodialysis patients (75) withMS was high blood pressure in (94.4%) followed by high blood sugar in
(77.8%), elevated triglyceride in (66.7%), abnormal W.C in (61.1%) and
the least frequent criteria was low HDL-C in (55.6%) while the most
frequent criteria of MS in hemodialysis patients without MS was high
blood pressure in (70.2%) followed by high blood sugar in (24.6%), low
HDL-C in (22.8%), elevated TG in (15.8%) and the least frequent criteria
was abnormal W.C in (8.8%).
As regard MS criteria there was statistically significant difference
as regard high blood pressure and hypertension being more frequent in
cases (76%) compared to (24%) in control, serum LDL and systolic blood
pressure being higher in cases and in serum cholesterol and diastolic
blood pressure being higher in control.
In the present study, metabolic syndrome was not significantly
associated with gender in hemodialysis patients despite higher prevalence
in male (26.8%) compared to (20.6%) female patients.
Also in our study, there was no association between gender and any
of MS criteria as reflected by absence of statistically significant
difference between hemodialysis female and hemodialysis male patients.
Our study revealed significant association between efficiency of
dialysis and metabolic syndrome in hemodialysis patients as reflected by:
Summary
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Statistically significant higher frequency of metabolic syndrome in
patients with inefficient dialysis (66.7%) compared to (20.3%) in
patients with efficient dialysis.
Statistically significant lower KT/V in hemodialysis patients with MS
compared to hemodialysis patients without MS.
Statistically significant negative correlation between KT/V and
number of MS criteria in hemodialysis patients.
Statistically significant negative correlation between KT/V and age,
waist circumference, fasting blood sugar, serum LDL, post dialysis
urea and diastolic blood pressure. Statistically significant positive
correlation with serum HDL-C.
In the present study, the most frequent criteria of MS in
hemodialysis patients with inefficient dialysis was abnormal W.C in
(100%) followed by high blood pressure in (83.3%), high blood sugar in
(50%), low HDL-C in (33.3%) and the least frequent criteria was elevated
triglyceride in (16.7%) while in patients with efficient dialysis the most
frequent criteria of MS was high blood pressure in (75.4%) followed by
high blood sugar in (36.2%), low HDL-C in (30.4%), elevated TG in
(28.99%) and the least frequent criteria was abnormal W.C in
(14.5%).
In our study, we tried to detect factors that associated with presence
of metabolic syndrome in our group of hemodialysis patients by
comparing patients with MS and patients without MS, which revealed
significant association between metabolic syndrome and older age, high
post dialysis urea and lower KT/V (inefficient dialysis).