الفهرس 
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Abstract
Summary
Chronic kidney disease (CKD) has been a growing health burden worldwide
Numbers of prevalent CKD patients will continue to raise reflecting the growing elderly population and increasing numbers of patients with diabetes and hypertension
Patients with CKD continue to suffer from a wide range of complications including electrolyte imbalance, Fluid overload, bone and mineral metabolism disorders and anemia
The incidence and prevalence of anemia increase as kidney functions decline and up to 50 % of CKD patients not requiring chronic dialysis
Kidney plays a very important role in vit D activation as 25 Hydroxy vit D is further hydroxylated by the kidneys to form cacitriol (1, 25 DHCC) which is the biologically active form of vit D
Available literature suggests that high prevalence of 25 (OH) vit D deficiencies may be an important contributor to secondary hyperparathyroidism which is harmful to bone health
Recently, epidemiological studies have identified a high prevalence of suboptimal 25 (OH) vit D levels in pre-dialysis CKD patients
The main results of the study revealed that:
Demographic characteristics among the studied groups. There was predominance of female gender in the four groups as there was 64.3%females in group A, 100% females in groups B, C and D.
There was no statistically significant difference between the four studied groups regarding gender (p-value was >0.05).
The mean age was 60.14± 8.47 years in group A, 55.58± 8.69 years in group B, 62.63± 7.97 years in group C and 40.22± 2.82 years in group D. Significant difference was found between the four studied groups regarding age (p-value was 0.017) and pairwise comparison showed that patients in group C were significantly older than patients in group B.
The mean creatinine was 0.92± 0.17 mg/dl, 1.76± 0.21 mg/dl,
2.29± 0.41 mg/dl and 0.63± 0.08 mg/dl in group A, group B, group C and group D respectively. Significant difference was found between the four studied groups regarding s. creatinine (p-value was >0.001) and pairwise comparison showed that the mean serum creatinine increased steadily as CKD progressed, with statistical difference among three diseased groups and control group
The mean of urea in group A, group B, group C vs control group was 40.0± 8.37 mg/dl, 60.15± 8.38 mg/dl, 77.09± 9.74 mg/dl and 30.17± 4.95 mg/dl respectively. There was a statistically significant increase in mean urea level from group A to group C. Control group showed significant decrease in urea level compared to group A, group B and group C.
The mean MCV was 84.36± 6.38 , 83.85± 5.34, 82.94± 5.23
and 83.50± 5.71 in group A, group B, group C and group D respectively. There was a non-significant difference between the four groups regarding MCV.
The mean serum iron was 0137.71± 11.19, 104.31± 9.76, 77.63±
8.50 and 86.39± 13.27 in group A, group B, group C and group D respectively. Significant difference was found between the four
studied groups regarding s. iron (p-value was >0.001) and pairwise comparison showed that the mean serum iron decreased steadily as CKD progressed, with statistical difference among four groups.
The mean serum calcium was significantly decreased progressively in group A, B, and C. On the other hand, the mean serum phosphate was significantly increased steadily as CKD progressed, with statistical difference among four groups
The mean serum PO4 levels was significantly increased as the stage of CKD progressed. The mean serum PO4 values in group A, B, C and D were 3.10± 0.45, 3.70± 0.50, 5.98± 1.71 and 3.56± 0.46
mg/dl, respectively, and there was a statistically significant increase in mean PO4 level from group A to group C.
The mean GFR 71.09± 8.33, 35.20± 5.10, 23.64± 4.08 and 107.34±
17.47 in group A, group B, group C and group D respectively. There was a statistically significant decrease in mean GFR from group A to group C. Control group showed significant increase in GFR compared to group A, group B and group C.
The mean hemoglobin was 10.28± 0.83 g/dl, 9.01± 0.65 g/dl, 8.36±
0.69 g/dl and 13.23± 1.35 g/dl in group A, group B, group C and group D respectively. The mean hemoglobin decreased steadily as CKD progressed. Control group showed significant increase in Hb. compared to group A, group B, group C and group D.
The mean vitamin D level in group A was 20.60± 9.11ng/ml, 13.67± 5.64 ng/ml in group B, 10.68± 4.19 ng/ml in group C and 23.52± 7.18 ng/ml in group D. Comparison of levels of vitamin D between group (A vs. B), (A vs. C), (B vs. D) and (C vs. D) showed that the decline in levels was statistically significant (p <
0.01). Although the decline in levels of vitamin D between group A vs. D and group B vs. C was not statistically significant.
The mean serum PTH levels was significantly increased as the stage of CKD progressed. The mean serum PTH values in group A, B, C and D were 64.50± 5.52, 83.08± 7.14, 113.06± 14.49 and
23.52± 7.18 pg/ml, respectively, and there was a statistically significant increase in mean PTH level from group A to group C.
The prevalence of abnormal vitamin D (< 30 ng/mL) was 92.9% in group A with insufficiency 78.6% and deficiency (14.3%) while prevalence of abnormal vitamin D (< 30 ng/mL) was 100% in group B with insufficiency 15.4% and deficiency (84.6%). The prevalence of abnormal vitamin D was 100% in group C with insufficiency 0% and deficiency (100%) while prevalence of abnormal vitamin D was 83.3% in group D with insufficiency 38.9% and deficiency (44.4%). There was a significant difference between the four groups regarding prevalence of abnormal vitamin D (p<0.001) as vitamin D deficiency was significantly increased steadily as CKD progressed.
In group A, there was significant positive correlation between
vitamin D level with s. creatinine (r=0.548, p=0.042) while there was significant negative correlation between vitamin D level with PO4 (r=-0.547, p=0.043).
In group B, there was no significant correlation between vitamin D level with age, creatinine, urea, GFR, Hb, MCV, iron, Ca, PO4 as well as PO4 (p>0.05).
In group C, there was significant positive correlation between vitamin D level with s. Ca (r=0.425, p=0.015).
In group D, there was no significant correlation between vitamin D level with age, creatinine, urea, GFR, Hb, MCV, iron, Ca, PO4 as well as PO4 (p>0.05).