الفهرس 
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Abstract
Hemodialysis is the most common form of treatment for end-stage renal disease, and is associated with considerable morbidity and mortality due to accelerated cardiovascular disease and infection. Despite the well-documented burden of disease, much remains to be learned about how best to prevent these complications of hemodialysis.
Hemodialysis removes uremic toxins primarily by allowing equilibration of plasma and dialysate across a semi-permeable membrane. Dialysate is created by adding carefully regulated quantities of biologically essential ions such as potassium, sodium, bicarbonate, and calcium to water that has been treated to reduce solutes to very low levels.
The dialysate concentration of other substances such as trace elements is not routinely manipulated. Substances that have lower concentrations in dialysate than in blood tend to be removed by dialysis. Although this is appropriate in the case of uremic toxins, it may lead to depletion of biologically essential substances. Besides the potential for ongoing removal of trace elements by dialysis, hemodialysis patients are at risk for low dietary intake of such substances due to uremia-related anorexia and dietary restrictions.
Alterations in trace element levels in patients receiving long-term renal replacement therapy have been implicated in immune dysfunction and increased oxidative stress. Renal dialysis is primarily directed to removal of uremic toxins by manipulating the contents of dialysate, whereas the lack of monitoring of trace elements may result in their deficiency, or accumulation in patients with end stage renal disease undergoing renal dialysis.
An excess of harmful trace elements such as lead, cadmium, and copper, and deficiency of essential trace elements such as zinc and selenium are known for their adverse effects not only in the general population, but also in patients undergoing renal dialysis, particularly hemodialysis. Although both hemodialysis and peritoneal dialysis offer similar benefits to patients with end stage renal disease, there is, however, evidence that both the treatment procedures differ with regards to the occurrence of adverse events and clinical outcomes.
Deficiency of essential trace elements (such as zinc or selenium) and excess of potentially harmful trace elements (such as lead or arsenic) are both known to have adverse consequences in the general population. Although not established, it is plausible that disordered trace element nutritional status (if present) would contribute to morbidity and mortality among hemodialysis patients as well. However, the incidence of abnormal trace element status in dialysis patients has not been comprehensively studied.
The aim of this study was selected to be conducted to assess the blood levels of trace elements (Zn, Cu, and Se) in chronic kidney disease patients and ESRD patients on hemodialysis.
This was a case- control study was carried in the nephrology Department, Minia University Hospital. This study was carried out on 90 cases (30 with chronic kidney diseases on follow up, 30 with end-stage renal disease, 30 controls). They were divided into 3 groups as follows group 1: chronic kidney disease group which consist of 30 cases. group 2: end-stage renal disease group which consist of 30 cases. group 3: Control group which consist of 30 cases. The duration of the study ranged from 6-12 months.
The main results of the study revealed that:
The age of chronic kidney disease group was ranged from 63 to 75 years; the age of end-stage renal disease group was ranged from 62 to 75 years while in Control group was ranged from 48 to 67 years. There was statistical significant difference between the study groups.
It was found that 18 (60%) patients were males and 12 (40%) patients were females in chronic kidney disease group. In end-stage renal disease group, 13 (43.3%) patients were males and 17 (56.7%) patients were females while in control group, there was 14 (46.7%) male and 16 (53.3%) females with no statistical significant difference between the three groups.
The studied groups show no significant statistical difference regarding residence.
The urea, creatinine and were highly significant increase in patients (chronic kidney disease group and end-stage renal disease group) when compared with control group. It was found that Albumin/ creatinine ratio was highly increased in end-stage renal disease group compared to chronic kidney disease and control group
There was a high significant decrease in Hb and platelet count in all patients (chronic kidney disease group and end-stage renal disease group) compared with control group.
The HbA1c, cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were highly significant increase in patients (chronic kidney disease group and end-stage renal disease group) when compared with control group.
There was non-significant difference between the study groups in level of cholesterol/ high density lipoprotein ratio.
There was non-significant difference between the study groups in level of sodium and potassium.
The zinc level was significantly decrease in ESDR group compared with control group . It was also lower in CKD group than control group but with no statistical significant difference between ESRD group compared with control group and CKD group compared with ESRD group.
The copper level was significantly decreased in ESRD group compared with control group. It was also lower in CKD group than control group but with no statistical significant difference between CKD group compared with control group and CKD group compared with ESRD group.
It was noticed that selenium level and Copper/ Zinc ratio decreased CKD group and ESRD group when compared with control group but these differences were non-significant .
Based on our findings, we recommend for further studies on larger sample size and on large geographical scale to emphasize our conclusion.