الفهرس 
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Abstract
Chronic kidney disease-mineral bone disorder (CKD-MBD) is a systemic syndrome characterized by derangements in mineral metabolism, extra osseous calcification, and bone fragility. Fibroblast growth factor 23 (FGF23) is produced in bone osteoblasts, with a primary effect on renal tubules through FGF receptor 1 (FGFR1) to increase phosphate excretion and enhance synthesis of 1,25(OH)2 D in conjunction with its co-receptor α-klotho. Serum concentrations of FGF23 become markedly elevated in patients with CKD and are associated with progression of LVH and mortality.
The aim of this study is to study the relation between FGF 23 and diastolic dysfunction in CKD patients and those maintained on HD.
This study included 120 subjects divided into three groups.
group I: 40 CKD patients on MHD. Patients were maintained on regular HD 3 times / week, 4 hours / session using bicarbonate as a buffer and polysulfone membrane.
group II: 40 CKD patients (stage IV). Patients were selected according to the National Kidney Foundation criteria (GFR of 29-15 ml/ min/1.73 m2).
group III: 40 healthy age and sex matched controls.
Inclusion criteria:
• Patients maintained on regular HD at least 6 months.
• Patients age between 20 to 40 years.
Exclusion criteria:
• Coronary artery disease.
• Systolic dysfunction.
• Malignancies.
• Liver disease.
• Chronic viral infections.
• Patients on immuno-suppression drugs.
• Patients with hemoglobin level below 10 gm / dl.
• Uncontrolled hypertension.
• Atrial Fibrillation.
• Frequent premature beats.
• Valvular diseases.
Patients were selected from those attending the outpatient Nephrology and Internal Medicine clinics of the Main Alexandria University Hospital and the Dialysis Unit of Alexandria Fever Hospital.