الفهرس 
CARDIOVASCULAR RISK FACTORS IN CKDOnly 14 pages are availabe for public view
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Abstract
Cardiovascular disease is common in chronic renal failure (CRF) patients and is responsible for more than 50% of their deaths. At the same time, renal disease, even at the earliest stages, is a cardiovascular risk factor.
Among the different localizations of cardiovascular diseases, peripheral arterial disease (PAD) affecting the lower limbs has a higher morbidity. Nevertheless, despite its importance, there are few reports of this pathology in CRF patients, and most of them, with a few exceptions, have been performed in dialysis patients.
In fact, the chronic kidney disease (CKD) population has a reverse association with some traditional risk factors; obesity, hypercholesterolemia and hypertension have been associated with a reduction in the relative risk of deaths in epidemiological studies of dialysis patients. Inflammation, malnutrition, oxidative stress and abnormal mineral metabolism are risk factors for vascular disease specific to CKD.
The importance of early PAD diagnosis is supported by studies showing that a high percentage of PAD patients will suffer intermittent claudication which will evolve to pain at rest and risk of tissue necrosis, and even to amputation. Moreover, renal patients with PAD showed a higher mortality rate than those not affected by PAD .A resting TBI of 0.70 or less is 95% sensitive in detecting PAD in patients with positive arteriography and it is almost 100% specific when identifying asymptomatic individuals.
Aim of the work was to find out the prevalence of PAD in patients on maintenance hemodialysis and the correlation between the Toe brachial index and systemic atherosclerosis measured by the carotid duplex, in patients on maintenance hemodialysis.
Our study included 80 patients receiving regular hemodialysis in Ain Shams University hospital. All patients were subjected to full history, Imaging techniques including measuring the common carotid intimal thickness by a carotid duplex, and measuring the Toe brachial index by the Doppler ultrasound, and laboratory investigations in form of CBC, Lipid profile , iPTH, Ca and Po4.
The results showed that the incidence of PAD in patients on regular hemodialysis is 32.5 %.
There was a highly significant negative correlation between the TBI and atherosclerosis.
There was no significant correlation between the TBI and hyperphosphatemia, the (Ca X Po4) product, serum cholesterol, triglycerides, LDL, calcium and serum intact PTH.
However, a strong positive correlation was found between PAD and TBI with the age, gender and hypertension. There was no significant correlation between TBI and the duration of dialysis (vintage).