الفهرس 
Chronic kidney diseases- mineral bone diseases (CKD-MBD)Only 14 pages are availabe for public view
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Abstract
Introduction
Vascular calcification has now been recognized as a major problem in dialysis patients because of its strong influence on the prognosis (Ohtake and Kobayashi, 2017). Along with the regulatory failure of calcification-inhibitory system, active phenotypic change of vascular smooth muscle cells (VSMCs) to osteoblast-like cells is also involved in the progression of vascular calcification (Rocha‐Singh et al., 2014).
Delaying or improving the vascular calcification is thought to be very important to improve the cardiovascular mortality in dialysis patients (Wang et al., 2018).
Early detection of vascular calcification in hemodialysis patients helps in decreasing the morbidity and mortality associated with this serious complication. Utilizing non-invasive biomarkers in diagnosis and prognosis is now getting a great attention in all fields of medicine (Kakani et al., 2019).
Aim of the study
This study was conducted to determine the frequency of Tenascin-C in prevalent hemodialysis patients and its relation to parathyroid hormone and vascular calcification.
Patients and Methods
This study was carried out on 90 adult prevalent haemodialysis who were classified into two equal groups (each of 45 patients) according to PTH level matched; group A with uncontrolled PTH level(N=45) (>300pg /ml) and group B with controlled PTH (N=45) (150-300pg/ml).
All patients were subjected to detailed history taking, clinical examination, Complete blood count (CBC), Chemistry: (BUN, Creatinine, Na, K, Total protein, Albumin, ALT, AST, calcium, and phosphorus), iPTH , Pre-dialysis urea, and post-dialysis urea. single pool Kt/V urea will be calculated.
Serum Tenascin-C level was measured with ELISA technique before the mid-week HD session. Vascular calcification was assessed by simple vascular calcification score (adragao score): by Plain X ray on hands, pelvis & vascular access.
Summary of the results:
• There was no statistically significant difference as regard age and sex distribution between the patients with normal and high PTH.
• The major causes of ESRD in the study were HTN, DM and Glomerulonephritis.
• The patients with uncontrolled PTH had higher serum creatinine, Na, phosphorus and longer duration of dialysis and using larger membrane surface area in comparison patients with controlled PTH.
• The level of Tenascin-C was statistically significantly higher in the cases with uncontrolled PTH [The median level of Tenascin-C was 9707 (Range: 2690-56664 pg\ml) and 7122 (Range: 3979-11642 pg/ml) unit/ml in the cases with group A and group B respectively].
• According to Adragao score, in the uncontrolled PTH group, 53.3% of the cases had score 0, 31.1% had score 1 and 15.6% of the cases had score 2 while in the controlled group all the cases had score 0. There was high statistically significant difference.
• There are 21 cases (23.3%) with vascular calcification.
• In the high PTH group, showed that there are 21 cases (46.7%) with vascular calcification.
• The level of Tenascin-C was statistically significantly higher in the cases with vascular calcification [The median level of Tenascin-C was 10697 (Range 2690-56664 pg/ml) and 7697 (Range 3928-21928 pg/ml) unit/ml in the cases with cases with vascular calcification and cases with no vascular calcification respectively].
• The level of PTH was statistically significantly higher in the cases with vascular calcification [The median level of PTH was 565 and 245.5 pg/ml in the cases with cases with vascular calcification and cases with no vascular calcification respectively].
• In group A, there was a highly statistically significant positive correlation between Tenascin-C and PTH level (r= 0.949, p < 0.001). There was a statistically significant negative correlation between Tenascin-C and BUN (r= -0.232, p=0.029).
• In group B, there was a highly statistically significant negative correlation between Tenascin-C and serum creatinine level (r= -0.376, p = 0.011).
• The best cut off point of Tenascin-C to identify cases with uncontrolled PTH level>300pg /ml was > 7377 with 84.4% sensitivity and 60% specificity, 78.2% PPV and 64.8% NPV.
• The best cut off point of Tenascin-C to identify cases with vascular calcification was > 8859 with 72.7% sensitivity and 72.1% specificity, 66.4% PPV and 70.8% NPV.
• The odds ratio of high PTH was 10.3 (3-34.7) with serum ≥7377 pg/ml.
• The odds ratio of Vascular calcification was 3.7 (1.2-11.1) with serum ≥8859 pg/ml.
• There is high risk for development of vascular calcification in patients with ESRD on hemodialysis and this risk in nearly duplicated in cases with uncontrolled PTH.