الفهرس 
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Abstract
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ron overload was considered rare in hemodialysis patients but its clinical frequency is now increasingly realized (Rostoker et al., 2016).
The liver is the main site of iron storage & liver iron concentration (LIC) is closely correlated with total iron stores. MRI is now the gold standard method for LIC estimation & monitoring (Rostoker et al., 2017).
Studies of LIC in hemodialysis patients by quantitative MRI demonstrated a strong relation between the risk of iron overload and the use of intravenous iron products prescribed at doses determined by the iron biomarker cutoffs contained in current anemia management guidelines (Tolouian et al., 2016).
These findings have challenged the validity of both iron biomarker cutoffs and current clinical guidelines, especially with respect to recommended IV iron doses (Macdougall et al., 2016).
Long-term observational studies have recently suggested that excessive IV iron doses may be associated with an increased risk of cardiovascular events and death in hemodialysis patients (Bailie et al., 2015).
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About 2.5% of the world population, corresponding to about 177 million individuals, are infected by hepatitis C virus (HCV). Egypt has the highest HCV prevalence with up to 15% of the population (Elgharably et al., 2017).
The prevalence of HCV infection among dialysis patients during the 2012 to 2015 period was found to be 8.7% in the DOPPS study, with nosocomial HCV spread in hemodialysis facilities still occurring (Chayama & Hayes 2016).
Increased hepatic tissue iron has a deleterious effect on the course of hepatitis C, favors development of fibrosis and cirrhosis and possibly increases the risk of liver cancer in the general population (Uchino et al., 2016).
That‘s why, it is necessary to use iron therapy cautiously and closely monitor plasma markers of iron metabolism and liver iron stores non-invasively by means of MRI to avoid iron overload in hemodialysis population with HCV (Rostoker & Vaziri, 2017).
Vitamin C is one of the most important water-soluble antioxidants. It is well established that the plasma ascorbic acid level is generally lower in hemodialysis patients than that in the general population, which is attributed to inadequate dietary intake, oxidative stress and loss during dialysis (Zhang et al., 2013).
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Ascorbic acid improves sensitivity to EPO, either by increasing iron mobilization from tissue storage or by way of antioxidant effects (Nand et al., 2017).
Several studies have demonstrated the beneficial effects of short term IV ascorbic acid, both in decreasing serum ferritin, and improving management of anemia in hemodialysis patients (Nand et al., 2017).
Our aim in this study is to evaluate hepatic iron concentration in prevalent HD patients with hepatitis C virus infection, and to study the efficacy of intravenous ascorbic acid in reducing the hepatic iron overload.
50 prevalent HD patients participated in this uncontrolled clinical trial, patients were divided according to HCV status into 2 equal groups.
All patients underwent hepatic MRI to assess LIC, and iron biomarkers along with basic labs. 22 patients with proven liver iron overload received IV ascorbic acid 300 mg thrice weekly for 3 months. MRI and labs were repeated after the treatment period.
We observed that 44% of patients had liver iron overload; 14% mild, 16% moderate and 14% with severe hepatic iron overload.
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Ferritin, serum iron and TIBC were all significantly correlated with LIC as measured by hepatic MRI. Ferritin showed the best discriminatory capacity to detect liver iron overload. Serum iron was the most sensitive test, while ferritin was the most specific.
In the present study, 60% of patients with HCV infection had iron overload compared to 28% of patients with seronegative HCV. LIC was significantly higher, and hepatic iron overload was more severe in patients with HCV infection.
LIC was significantly correlated with BMI, and patients with iron overload had significantly longer duration on hemodialysis.
After treatment with ascorbic acid, LIC significantly decreased after treatment period. Comparing the two groups, the effect of treatment on LIC was significant in both groups.
Hemoglobin level increased but this was not statistically significant.
The levels of iron biomarkers also decreased significantly after treatment. We studied the effect of treatment on both study groups, and iron biomarkers were more significantly lowered in the patients with HCV infection.
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Our study had limitations; it was an uncontrolled clinical trial, with relatively small number of participants. We didn‘t measure the HCV PCR, and serum oxalate was not measured after treatment period