الفهرس 
CHRONIC KIDNEY DISEASEOnly 14 pages are availabe for public view
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Abstract
C
hronic kidney disease (CKD) is an important source of long-term morbidity and mortality. It has been estimated that CKD affects more than 20 million people in the United States. Given that most patients are asymptomatic until the disease has significantly progressed, they remain unaware of the condition. Thus, it is essential to have clinical practice guidelines aimed at early detection, evaluation, diagnosis, and treatment of this condition. Hemodialysis is the most common method used to treat advanced and permanent kidney failure, it has made survival possible for more than a million people throughout the world who have end-stage renal disease (ESRD) with limited or no kidney function.
Kt/Vurea is a mathematical model that takes into account the urea clearance in a single hemodialysis session. It is commonly used to assess the delivered dose of dialysis in maintenance hemodialysis (MHD) patients. This parameter only reflects the efficacy of dialytic treatments in removing small toxins, but not middle and protein-bound toxins.
GSTs may act as ligandins by binding and sequestering a variety of small or large toxic compounds and peptides. Human glutathione transferase P1-1 (hGSTP1-1) is a homodimeric intracellular protein of about 46 kDa expressed in different organs and cell types. The GSTP1-1 is the most abundant form of intra-erythrocyte transferase representing 95% of entire GST pool. Erythrocyte glutathione transferase (e-GST), an enzyme devoted to cell depuration against a lot of large and small toxins, is claimed to be overexpressed in uremic patients.
The aim of the study was to assess the clinical utility of Erythrocyte Glutathione Transferase (e- GST) assay as a biomarker of uremic toxicity in chronic kidney disease patients on conservative therapy. In addition, to investigate if e- GST has a role in assessment of adequacy of hemodialysis comparable to the usual methods used.
This study was conducted at the outpatient clinics of Ain-Shams University Hospital with established diagnosis of CKD. It included (30) CKD patients under conservative therapy and (30) MHD patients on maintenance hemodialysis therapy since 6 months at least for 4hours 3 times weekly. In addition to (15) apparently healthy age and sex matched control subjects with normal renal function and no history of diabetes mellitus.
All individuals included in this study were subjected to full history taking especially any associated diseases. All participants were assayed for AST and ALT to exclude chronic liver disease, urea and creatinine to exclude renal disease in healthy control, fasting and postprandial blood glucose to exclude diabetes in healthy controls, hemoglobin concentration determined by an automated hematology analyzer and spectrophotometric assay of e- GST activity.
Our study revealed that e-GST was highly significantly increased in MHD and CKD patients compared to healthy control subjects and it was highly significantly increased in MHD patients when compared to CKD patients.
When ROC curve analysis was applied to assess the best diagnostic cut-off for e-GST in discriminating renal disease patients from healthy subjects, it revealed that the best diagnostic cut-off value was >5 u/gm Hb, each of the diagnostic sensitivity, diagnostic specificity, negative predictive value and positive predictive value was 100%. Similarly, in a trial to find the cut off for discriminating MHD patients from CKD patients, it was found that the best diagnostic cut-off value was >10 u/gm Hb with the diagnostic sensitivity of 93.33%, dignostic specificity of 100%, positive predictive value of 100% and negative predictive value of 93.7%.