الفهرس 
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Abstract
Summary
It is not clear if GDF-15 is useful as early markers of anemia among pediatric CKD patients. Therefore, the aim of the current study was to estimate GDF-15 serum level in children with CKD and its relation to associated anemia.
This case control study included 45 anemic children with CKD. 34.7% of them were CKD II, 46.9% were CKD III and 18.4% were CKD IV. Their mean age was 6.61± 4.62 years old. Patients were recruited and assessed for eligibility from the Outpatient Pediatric Nephrology Clinic, Pediatric Department, Beni-Suef university hospital. An age and gender matched group including 45 children were recruited as a control group.
As regard the demographic criteria of the studied patients, our study exhibited that the majority of cases were males representing 66% of the total cases.The mostfrequent renal disease was posterior urethral valves (PUV) in 27.8% followed by pelvi-ureteric junction obstruction in 23.4%. Focal segmental glomerulosclerosis (FSGS) and nephronophthisis were diagnosed in 12.8% of patients. As PUV occur exclusively in males that explains the increased percentage of males in the present study.
Regarding blood pressure measurements, the present study indicated a statistically significant increase in SBP (107.36± 14.46 vs. 93.55± 15.82 mmHg, respectively) and DBP (69.80± 13.21 vs. 57.26± 13.16, respectively) among the cases compared with the control group (P value<0.001).
The comparison between the cases and control groups regarding the laboratory data revealed a statistically significant decrease in each of Hb level (9.58± 2.86 vs. 11.64± 0.91, respectively) (P value<0.001), WBCs levels (8.90± 3.48 vs. 4.72± 1.41, respectively) (P value<0.001), platelets level (295.47± 106.36 vs. 249.52± 63.69, respectively) (P value=0.03), and eGFR (48.55± 23.15 vs. 126.35± 24.47, respectively) (P value<0.001). Meanwhile, there was a statistically significant increase in each of urea level (91.04± 54.68 vs. 26.91± 5.14, respectively) (P value<0.001), and serum creatinine (1.65± 1.29 vs.0.34± 0.05, respectively) (P value<0.001).
The present study revealed a statistically significant increase in GDF-15 among the cases group in comparison with the control group (656.31± 300.98 ng/L vs. 451.81± 191.89 ng/L, respectively) (P value<0.001).
The comparison between different CKD stages revealed that each of age, weight, and height were significantly elevated in CKD IV in comparison with CKD II. SBP was significantly elevated in CKD IV group in comparison with CKD II (P value=0.005). HB level was significantly lower in CKD IV in comparison with the other 2 groups. Blood urea levels were significantly higher in CKD IV and serum creatinine was significantly higher in CKD III and CKD IV compared to CKD II and was higher in CKD IV in comparison with CKD III. GDF-15 levels were insignificant between the three groups. The present study revealed that anemia was more frequent in CKD IV but it was statistically non-significant (P value<0.05).
our study concluded the existence of a significant -ve correlation between GDF-15 and Hb (r=-0.468, P value=0.016) as well as eGFR (r=-0.29, P value=0.009).
our study indicated that cutoff value of GDF-15 that can discriminate between CKD patients with and without anemia was > 600.9 with 62.5% sensitivity, 88.24% specificity and AUC equal to 0.709.