الفهرس 
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Abstract
Chronic kidney disease as evidenced of structural or functional kidney abnormalities (abnormal urine analysis, imaging studies or histology) that persist for at least three months with or without decreased GFR. CKD leads to many of complications as hypertension, diabetes, anemia, renal osteodystrophy, malnutrition, CVD, nerve damage. Malnutrition is recognized to be a serious and common complication of CKD and is associated with increased morbidity and mortality in children. Nutritional status should be monitored regularly in all children with chronic renal diseases.
Ascorbate is one of the most important water- soluble antioxidants in plasma has a several relation with CKD patients on MHD. The aim of this study was to : Asses ascorbic acid level in children with chronic renal failure on hemodialysis , and correlate its level with clinical and laboratory data of patients.
Our study was done on 50 subjects, 25 patients with CKD on regular HD 3 times per week attending to Nephrology unit in Pediatric Department at Menoufia University Hospital as groub1 and matched 25 healthy controls as group 2.
All patients and controls were subjected to:
1- Complete history taking: detailed history taking with special emphasis on CKD course, symptom and duration of disease.
2- Complete clinical examination: it includes general examination,chest, heart and abdominal examination.
3- The examination also includes blood pressure measurement and signs of anemia.
4- Anthropometric measures including:
- Weight.
- Length/ height.
- Body mass index.
5- Investigations which included:
a) Routine laboratory investigations:
• Hb level.
• Kidney function tests as (BUN &creatinine).
• Serum Potassium and calcium levels.
b) Specific laboratory investigation:
• Serum ascorbic acid level.
• PTH.
• Serum Albumin .
Results: As regard to demographic data, there is no significant difference between cases and controls regarding age, gender and residence.
But there were highly significant differences between cases and controls regarding to weight, height, BMI, and BP, the cases were stunted, underweight and hypertensive.
As regard to investigation, there were differences between cases and controls with decreased levels of ascorbic acid level, Hb level, calcium, albumin and increased level of BUN, creatinine, PTH, and potassium in cases versus controls.
With correlation of serum ascorbic acid levels with age, weight, height and, there was a significant correlation in the cases with no significant relation with the controls.
Also there was a highly significant relation between serum ascorbic acid and both systolic and diastolic BP in all cases versus non significant relation in the controls. A significant correlation was found between serum ascorbic acid and BUN, creatinine, and PTH in the cases versus non significant relation in the controls.
There was nosignificant difference regarding serum ascorbic acid relation with gender. Also significant relation between serum ascorbic acid and BUN, creatinine, PTH,calcium,potassium and albumin added to its relation with anthropometric data in CKD patients, makes serum ascorbic acid also a good predictor for CKD course. The strong relationship between serum ascorbic acid and BP, makes serum ascorbic acid control is very important in controlling BP in CKD patient and vice versa.
from this study we can conclude that Serum ascorbic acid was significantly low in Children with CRF on regular hemodialysis. After this study, we highly recommend Frequent measurement of serum ascorbic acid for all CKD cases on hemodialysis and further large –scale, long term studies are required to validate if vitamin C supplementation can improve outcome of dialysis patients.