الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cardiovascular pathology remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Two types of vascular changes are observed, atherosclerotic and arteriosclerotic .
The pathogenesis of vasculopathy in end-stage renal disease (ESRD) involves traditional risk factors of atherosclerosis (older age, hypertension, dyslipidemia, diabetes mellitus), which are highly prevalent in this patient population, but also several uremia-related risk factors (inflammation, oxidative stress, mineral and bone disorders), which are still under investigation .
Recent evidence suggests that vascular calcification is a highly regulated active process, and that the phenotypic trans-differentiation of vascular smooth muscle cells (VSMCs) into osteoblast-like cells is a key pathogenetic event.
Fetuin-A is a liver-derived potent systemic inhibitor of calcification and a negative acute phase reactant. Low fetuin-A levels have been associated with severe and extensive vascular calcification, as well as with increased all-cause and cardiovascular mortality.
The presence of HCV correlates with higher rates of patient mortality than in HCV-negative subjects on dialysis or undergoing kidney transplant.
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The aim of this study was to to study chronic hepatitis c virus infection as aputative risk factor for cardiac and arterial calcifications in end stage renal disease patients on regular hemodialysis. And we aimed to investigate the relationship between fetuin-A as a calcification inhibitor and HCV seropositivity in end stage renal disease patients on regular hemodialysis.
This cross-sectional study was conducted on 50 end stage renal disease (ESRD) patients on regular hemodialysis(HD).Studied patients were divided into two groups in comparative fashion according to their infection with viral hepatitis C. 35 HCV positive versus 15 HCV negativepatients ( which are considered control group).
For inclusion of HD patients in this study, the following criteria were considered:
Patients maintained on HD three times per week for at least 12hours per week, patients age ≥ 18 years, the minimum HD vintage ≥ 3 monthes.
The following patients were excluded from the study:
HD patients infected with Hepatitis B virus, HD patients infected with HIV, ESRD treated with renal replacement therapy other than hemodialysis , HD patients refusing participation in this study.
Full and detailed history including demographic data, thorough clinical examination, blood pressure measurements, Body mass index were taken for all studied patients.
Investigations: (Predialysis Mid Week Blood Sample)
Complete blood count , Fasting bood glucose, AST, ALT, Prothrombin time, serum albumin, bilirubin, alkaline phosphatase, CRP, Blood urea nitrogen(BUN), serum creatinine serum calcium ,phosphorus,
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total cholesterol and triglycerides, intact parathtroid hormone (iPTH), Hepatitis C virus antibody (anti-HCVab) in serum, assessment of adequacy of HD based on Kt/V, serum level of Fetuin-A ,evaluation of intimal medial thickness (CCIMT) in both common carotid arteries by B-mode ultrasonography, arterial media calcifications (AMC) were detected by plain radiography of the pelvis and both hands (Adragao score), ECG, baseline echocardiography was performed allowing M-mode, two dimensional, and pulsed Doppler measurements (Echocardiography to assess the degree of aortic and mitral valve calcification if present ).
Results:
Of the studied 50 HD patients, 35 patients (70 %) have HCV infection (group 1) and 15 patients (30 %) have no HCV infection (group 2).
HCV positive HD patients showed significant increase in age and dialysis vintage with predominance of male gender compaired to HCV negative HD patients. They showed also a significant increase in serum calcium, phosphorus, calcium × phosphorus product, alkaline phosphatase, cholesterol, intact PTH and CRP and a significant decrease in Fetuin A levels compaired to HCV negative HD patients.
As regard to results of calcification parameters, nearly half (42.9 %) of HCV positive HD patients, have abnormal CCIMT and cardiac valve calcification and three fourth (77.1 %) of the same patients have abnormal Adragao score (with arterial medial vascular calcification). Also (77.9 %) of these patients, have reduced serum fetuin -A levels.
Study of the correlation between serum fetuin-A level and clinical and laboratory data of the HCV+ve HD patients showed the following:
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In HCV positive HD patients, with abnormal CCIMT (n=15), serum fetuin-A was significantly positively correlated with serum phosphorus, Calcium × phosphorus product and CRP and significantly negatively correlated with serum calcium and triglycerides.
In HCV positive HD patients, with abnormal arterial medial vascular calcification (Adragao score)( n=27 ) serum fetuin-A was significantly positively correlated with serum phosphorus, creatinine and CRP and significantly negatively correlated with the patients age , dialysis vintage, serum creatinine and triglycerides .
In HCV positive HD patients, with cardiac valve calcification (n =15 ), serum fetuin-A was significantly positively correlated with serum phosphorus, Calcium × phosphorus product creatinine and CRP , and significantly negatively correlated with age , dialysis vintage, serum calcium , alkaline phosphatase and total cholesterol.