الفهرس 
Anemia in chronic kidney diseaseOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease is a real growing problem. The total number of treated patients has markedly increased during the last 30 years. CKD is a chronic inflammatory state characterized by increased oxidative stress which is leading to impaired cellular physiology in form of genetic mutations, carcinogenesis and collagen degradation, lower activity of transmembrane pumps, lower ATP concentration, and decreased enzymatic activity. Anemia is a common feature of CKD especially patients on HD, it is a multifactorial process. The main causes are insufficient EPO production, iron deficiency anemia. Nowadays chronic inflammation and oxidative stress have a role in the pathogenesis of anemia. Adequate EPO replacement therapy is the main line of treatment of anemia after rebuilding of iron stores. Adding an antioxidant agent may help in improving anemia and quality of the life of the patient. The current study was done on 64 patients with ESRD on regular hemodialysis at attending at nephrology and hemodialysis unit in Tanta university hospitals to evaluate G6PD enzyme before and after EPO therapy. All cases included in the study were subjected for the duration of HD, the number of sessions per week, dialysis adequacy and adequacy of EPO replacement therapy. Iron status was assessed by T.sat, also assessment of hemolysis was done by measurement of corrected reticulocyte count and indirect bilirubin. The following results were obtained: • There was a significant increase in G6PD enzyme activity after EPO replacement (p <0.001*). • There was a significant decrease in corrected reticulocyte count after EPO therapy (p <0.001*) meaning decrease hemolysis. • There was a significant decrease in indirect bilirubin after EPO therapy (p = 0.035*) which meaning reduction of hemolysis. • There was a significant negative correlation between G6PD and indirect bilirubin (p <0.001*). • There was a positive significant correlation between G6PD and duration of dialysis (p = 0.006*). • G6PD has no significant correlation with the corrected reticulocyte count & urea reduction ratio. We favor concluding that that G6PD activity is decreased in CKD patients to be normalized after adequate EPO replacement therapy through the antioxidant effect of EPO. Also, it is related to the duration of dialysis, the longer duration, the lesser activity of G6PD due to removal of trace elements and much exposure to oxidative agents related to dialysis. Hemolysis in CKD patient on HD is improving by EPO therapy through increase integrity of erythrocyte cytoskeleton.