الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) is defined as the presence of kidney damage, or a progressive loss of kidney function. Protein-energy malnutrition and wasting, which are common phenomena in patients with end-stage renal disease (ESRD), are associated with an increased morbidity and mortality several factors may contribute to malnutrition in ESRD, in particular inflammation, co-morbidity and anorexia which is caused by decreased taste and smell of food, early satiety. Ghrelin, first described at 1999 by Kojima et al, is a peptide of 28 amino acids (3315 Da) that stimulates growth hormone release from the pituitary. In addition to the stomach, ghrelin is expressed in many tissues such as duodenum, jejunum, ileum, colon, lung, heart, pancreas, kidney, testis, pituitary, and hypothalamus. Two types of ghrelin found acylated and un-acylated. Ghrelin stimulates appetite by central and peripheral pathways and via the vagus nerve. Indeed, ghrelin is locally synthesized in the hypothalamus.
Protein energy malnutrition (PEM) is often present in patients with chronic kidney disease with or without ongoing renal replacement therapy but it is more profound in hemodialysis patients.
The cachexia syndrome in patients with chronic kidney disease (CKD) consists of muscle wasting, anorexia, and increased elevated energy expenditure.
As ghrelin is involved in food intake and meal appreciation the present study is aimed to assess the relationship between total plasma ghrelin levels and nutritional status in CKD patients maintained on hemodialysis.
Inflammation is a common feature in clinical conditions associated with loss of muscle mass, such as cancer, CKD, acquired immune deficiency syndrome, and aging.
25 CKD patients undergoing maintenance hemodialysis for more than 6 months at dialysis unit Alexandria fever hospital and 20 healthy subjects were included in the present study. Full history taking, thorough clinical examination and vital signs. Serum levels of total ghrelin were measured by Ghrelin human enzyme immunometric assay kit. CBC, urea, creatinine, serum albumin, calcium, phosphorus, fasting blood sugar and CRP were measured using standard laboratory methods. Anthropometric variables (mid arm circumference and triceps skin fold) and subjective global assessment used for assessment of nutritional status. It found that total ghrelin level was significantly higher in patients with CKD maintained on hemodialysis especially mal nourished one than healthy control. It was found that CRP was significantly higher in hemodialysis patients compared with healthy control.