الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
The world’s population is aging, with the number of older adults projected to increase dramatically over the next two decades. This trend poses major challenges to health care systems, reflecting the greater healthcare utilization by more comorbid conditions among older adults.
In Egypt and according to the latest estimates of central agency for public mobilization and statistics (CAMPAS) in January 2019, the total number of elderly population (60 years and above) was 6.5 million (3.5 million men and 3 million women) and this representing 6.7% of Egypt total population. The percentage of elderly in Egypt is expected to rise to 9.2 % in 2025 and it is expected to reach 20.8 % in 2050.
Chronic kidney disease (CKD) is a complex condition in which the kidneys are unable to function properly as a result of structural or functional damage that leads to excessive fluid and waste accumulation in the blood.
The prevalence rates of CKD worldwide are high and have increased in the last few years to about 13–15%, with an increased prevalence of diabetes and hypertension.
End-stage renal disease (ESRD) is defined as irreversible decline in kidney function that is severe enough to be fatal in the absence of dialysis or transplantation. ESRD is included under stage 5 of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative classification of chronic kidney disease, where it refers to persons with an estimated glomerular filtration rate less than 15 mL per minute per 1.73 m2 body surface area, or those requiring dialysis irrespective of glomerular filtration rate. Reduction in or absence of kidney function leads to a host of maladaptive changes, including fluid retention (extracellular volume overload), anaemia, disturbances of bone and mineral metabolism, dyslipidemia, and protein-energy malnutrition.
Anxiety is a common yet frequently overlooked psychiatric symptom in patients with ESRD treated with haemodialysis (HD), yet it is also a diagnosis, applicable in diverse populations. Anxiety is characterized by disruptive feelings of uncertainty, dread, and fearfulness.
Depression is well known to affect adults with end-stage renal disease (ESRD), in part attributed to psychosocial and biologic changes that accompany dialysis.
Oxidative stress is known to be involved in many human pathological processes, such as hypertension, atherosclerosis and neurological disorders. Much evidence shows that chronic kidney disease (CKD) is also associated with increased oxidant production and decreased antioxidant defence.
In particular, recent research observed a close relationship between OS and anxiety in both human patients suffering from anxiety disorder (obsessive–compulsive disorder and panic disorder).
It was stated that prolonged psychological stress is a causative factor for major depression, which leads to increase in oxidative stress and depressive symptoms. The levels of different oxidative stress markers are found to be altered in depressive disorders.
The aim of this work was to study presence of anxiety and depressive symptoms, in relation to oxidative stress markers and the relation between frequency of haemodialysis and oxidative stress markers in ESRD elderly patients on regular haemodialysis.
This was a cross-sectional study that was conducted on convenience sample of 80 cases of elderly patients ≥ 60 years with ESRD on regular dialysis the study was conducted in the haemodialysis unite in Ain Shams University Hospital (El-Demerdash). The study period was from May 2021 to November 2021.
The results of our present study can be summarized as follows:
• In the current study, there were 41 Cases were male and 39 were female and their ages ranged from 60 to 81 years (mean 66.875 years) the mean No of co morbidities were 4.300 ± 0.906 and (28.75 %) were smokers.
• There were (88.75 %) of cases with HTN and (62.50 %) of cases with DM, (71.25 %) of cases were Married and (28.75 %) were Widow.
• In the current study, there were 30 (37.50 %) cases with Mild PHQ9, 37 (46.25 %) cases with Moderate PHQ9, 10 (12.50 %) cases with Moderate to Severe PHQ9 and 2 (2.50 %) cases with Severe PHQ9, The PHQ9 ranged from 4 to 22 with Mean 10.450 ± 3.525.
• The GAS results, all cases were Anxious, The GAS ranged from 15 to 71 with Mean 37.025 ± 11.824.
• There was a strong association between depression severity assessed by PHQ9 and blood levels oxidative stress markers GPX, MDA, TAC
• In the current study, in GPX: there was statically significant Positive Correlation Between GPX and Duration of session in hrs.
• In TAC: and there was statically significant Positive Correlation Between TAC and No. of years of hemodialysis and Duration of session in hrs.
• In MDA: there was statically significant Negative Correlation Between MDA and No of session/week.
• In the current study, in PHQ9: there was statically significant Positive Correlation Between PHQ9 and No. of years of hemodialysis, No of session/week and Duration of session in hrs.
In GAS Total: there was statically significant Positive Correlation Between GAS and No. of years of hemodialysis, No of session/week and Duration of session in hrs.