الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) is a public health problem, with a prevalence that is steadily increasing. The high prevalence rate of CKD is explained by the increased proportion of elderly people, hypertension, and diabetes in the context of a longer life expectancy. CKD reflects the occurrence of a premature aging process, similar to other chronic diseases. Muscle mass is an important factor in determining the prognosis of these patients.
Muscle wasting is an important feature in the syndrome of protein-energy wasting (PEW) present in patients with chronic kidney disease (CKD), which undoubtedly contributes to the increased mortality of this patient population. Although multiple catabolic or anabolic alterations have been shown to contribute to the mechanisms of CKD-related muscle wasting, the molecular pathways have not been fully elucidated.
Myostatin, also called growth/differentiation factor-8, belongs to a transforming growth factor-β superfamily and regulates the synthesis and degradation of skeletal muscle protein. Myostatin, which is mainly produced in muscle, suppresses growth in skeletal muscle and its inhibition leads to muscle hypertrophy. Myostatin levels are increased in patients with chronic skeletal muscle wasting diseases, such as CKD, chronic liver disease, or chronic heart failure
Conversely, higher myostatin levels are associated with higher muscle mass in peritoneal dialysis (PD) patients. It is not clear that myostatin levels are increased to prevent decreases in muscle mass in dialysis patients. Increased myostatin is associated with vascular inflammation and atherosclerotic changes.
Sarcopenia, defined as a decline in skeletal muscle mass and strength, is increasingly important in the aging society. In CKD patients, loss of quantity and quality of the skeletal muscle progressively occurs, which is called sarcopenia. Further, under the maintenance dialysis therapy, the patients often show loss of fat tissue in addition to sarcopenia, which is now called the status of protein energy malnutrition or of protein energy wasting (PEW).
The study is aimed to assess myostatin level in CRF patients with HBV and its correlation with sarcopenia.
This study is a cross - sectional study, was carried out at at outpatients’ clinics and internal medicine and nephrology department Ain Shams university hospital and Sharq Elmadinah Hospital, Alexandria, on 70 patients on regular hemodialysis divided into 3 groups: (group A); included 20 patients with HBV infection, (group B); included 20 patients without HBV infection, (group C); included 10normal persons without CRF or HBV, during period from February 2021 till August 2021.
The main results of the study revealed that:
There was no significant difference between groups as regard demographic data.
There was no significant difference between groups as regard height, weight or BMI.
There was no significant difference between groups as regard other Comorbidities.
There was no significant difference between groups as regard liver function tests.
There was high significant difference between groups as regard Platelets.
There was no significant difference between groups as regard renal function tests.
There was no significant difference between groups as regard Myostatin level.
Myostatin level showed a significant negative correlation with BMI and SMI.
The cut-off value was 39.8ng/ml, with 94.5% sensitivity, 84.6% specificity, 81.0% positive predictive value, 95.0% negative predictive value, and 90% accuracy.
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.