الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 98 |  |  |
| | | from | 98 | | |
Abstract
BACK GROUND:
Chronic kidney disease occurs when kidney can no longer perform their function to full capacity. Kidney failure means GFR less than 15ml/min and this necessitate replacement therapy either dialysis or kidney transplantation. Mortality is higher in hemodialysis (HD) patients than in an age-matched general population, cardiovascular disease is the largest cause of morbidity and mortality in hemodialysis patients, possible factors behind this observation are the early development of left ventricular hypertrophy (LVH), atherosclerotic heart disease and arrhythmias in hemodialysis patients.
OBJECTIVES:
The aim of our study to evaluate whether persistent elevation of CRP level predicts cardiac hypertrophy and dysfunction.
METHODS:
The study was carried on three groups: Group A: includes 30 elderly hemodialysis patients above 65 years. Group B: includes 20 elderly healthy individuals above 65 years. Group C: includes 10 young healthy individuals (20-40) years.
All candidates were subjected to: Through history taking. Full clinical examination with exclusion of patients with acute or chronic inflammation, connective tissue disorders, recent myocardial infarction, neoplastic diseases, cerebrovascular diseases.
Laboratory investigations including:
A- Serum hs CRP: (in hemodialysis group it withdrawn twice before each dialysis session at a 3 weeks interval.
B- Routine investigations: - Complete blood picture. - Blood urea and creatinine.- Blood glucose level. - Serum albumin level, and total serum protein. -Serum cholesterol, triglycerides and low density lipoprotein. - Serum calcium and phosphorus. - ECG (electrocardiogram) before dialysis session. - Echocardiogram performed to all subjects, in hemodialysis patients it was done after Dialysis session on dry weigh achieved.
RESULTS:
The results of our study can be summarized as following: There was a highly significant increase in CRP in HD group than the other two groups, with a mean of 73.0±43.14 mg/l and there was a significant increase in CRP after 3 weeks than that on first occasion, with a mean of 90.97±38.84 mg/l in the second occasion. While the mean of CRP in group B was 7.12±2.61 mg/l and 1.33±0.63 for group C. CRP is correlated positively with ESR and negatively with serum albumin. The patients with diastolic dysfunction and left ventricular hypertrophy (LVH) are numerous in the dialyzed group; peak early velocity/peak atrial velocity (E/A ratio) is significantly decreased in HD group than other two groups. There were 18 patient(60% of HD group) with E/A ratio <1, while 1 subject(5% 0f old control group) with E/A<1 and neither one(0% of young control group) with E/A<1. Left ventricular end diastolic dimension was greater in HD group than other two groups with a mean of 51.635.98 in HD group, 49.204.32 in group B and 44.604.09 for group C. CRP is correlated positively with LVEDD and negatively with ejection fraction and E/A ratio. From the above results we can conclude that sustained elevated CRP level can predict cardiac hypertrophy and dysfunction in hemodialysis patients.
CONCLUSIONS
From the present study we can conclude that: C reactive protein (CRP), which reflects chronic inflammation is elevated in hemodialysis patients, and is a strong predictor of cardiovascular morbidity and mortality in these patients. Cardiovascular diseases represent the single largest cause of mortality in hemodialysis patients, in particular left ventricular hypertrophy which is determined by echocardiography, as an important influence on mortality in these patients. Persistent elevation of CRP, may predict cardiac hypertrophy and dysfunction in elderly patients maintained on hemodialysis.