الفهرس 
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Abstract
Hemodialysis (HD) remains the main renal replacement therapy in most countries worldwide. Cardiovascular disease (CVD) is the most common complication and a chief cause of death in patients with ESRD. Risk factors for CVD in maintenance hemodialysis patients include both traditional risk factors such as diabetes and hypertension as well as unique non-traditional risk factors, including inflammation, oxidative stress, anemia, vascular calcification, and fluid and electrolyte shifts Recently, it has been suggested that apelin, an endogenous ligand for the APJ receptor, might also contribute to the pathophysiology of human heart failure. The aim of the work is to determine the apelin level in hemodialyzed patients and to assess its association to cardiac parameters among these patients. This study was carried out at the Dialysis Unit of the Internal Medicine department, Menoufia University Hospital on 80 patients (age range 21-68) with ESRD on maintenance hemodialysis (group 1) and 20 apparently healthy volunteers (age range 24-46) as a control (group 2) from June 2015 to December 2015 Patients with the following predialysis histroy were excluded :
Diabetes Melliteus
Congenital heart disease
Ischemic heart disease
Atrial fibrillation
Pacemaker
Patients with decompensated heart failure.
Patients with decompensated liver cirrhosis.
chronic obstructive airway diseases.
Cancer
All patients and controls were subjected to the following:
1-History taking ;with special emphasis on demographic data and HD
history.
2-Complete clinical examination ; with special emphasis on mean arterial
pressure and body mass index.
3-Laboratory investigations :
Routine investigations; including lipid profile .
Special Investigations; including serum apelin level.
4-Imaging investigations ;including echocardiography.
Results of this study revealed that:
There is no significant difference between the patients group and the
control group regarding age and sex ( P>0.05 ).
Body Mass Index was significantly lower in patient groups compared to
control group ( p <0.05).
Mean arterial Pressure were significantly higher in dialysis patients
compared to control group ( p <0.05).
There were many causes for ESRD where HTN nephrosclerosis represents
51.3%, Glomerulonephritis represents 17.5%, Obstructive Uropathy
represents 13.8%, ADPKD represents 10.0% and Unknown cause represents
7.5% of the causes of end stage renal disease.
70 % of patients were using arteriovenous fistula, 20 % were using venous
catheter while 10 % were using arteriovenous graft.
HDL is significantly lower in patient group compared to control group (
p <0.05). while There is no significant difference between the patients
group and the control group regarding the rest of lipid profile ( P>0.05 ).
Cardiac dimensions including left ventricular end systolic dimension, left
ventricular end diastolic dimension, left ventricular posterior wall,
interventricular septum and left atrium were significantly higher in patient
group compared to control group ( p <0.05). while There is no
significant difference between the patients group and the control group
regarding right ventricle and aorta ( P>0.05 ).
Ejection fraction was significantly lower in patient group compared to
control group ( p <0.05).
serum apelin is highly significantly lower in patient group compared to
control group. ( p <0.001).
There is no statistically significance between causes of ESRD and
apelin. ( p <0.05).
There is no statistically significance between vascular access and apelin.
( P>0.05 ).
Serum apelin was significantly positively correlated with left ventricular
end systolic dimension, left ventricular end diastolic dimension,
interventricular septum, right ventricle ,left atrium and aorta in patients
group( p <0.05) while other parameters are insignificant ( P>0.05 ).
There is no statistically correlation between apelin and all parameters in
the control group( P>0.05 ).