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Abstract Summary CKD is a growing global health problem, and end-stage renal disease (ESRD) is a prominent and much feared complication of the disease. Chronic kidney disease (CKD) is defined as an abnormality of kidney function, as determined by clinical, laboratory data and imaging tests as ultrasonography, which have been present for at least 3 months. CKD has replaced “chronic renal failure” and “chronic renal insufficiency” as the globally accepted terminology for persistent renal dysfunction. Chronic kidney disease in Egyptian children less than 5 years of age is attributed to parenchymatous disease in 73% of cases and obstructive etiology in 27% of cases, while after 5years of age, Parenchymatous disease is the cause in 67% and obstructive etiology constitutes 33% of cases. ESRD represent the state in which a patient’s renal dysfunction has progressed to the point at which homeostasis and survival can no longer be sustained with native kidney function or maximal medical management. At this point renal replacement therapies (dialysis or renal transplantation) become necessary.Hemodialysis should be initiated when one or more of the following are present: symptoms or signs attributable to kidney failure (serositis, acid-base or electrolyte abnormalities, pruritus); inability to control volume status or blood pressure; a progressive deterioration in nutritional status refractory to dietary intervention; or cognitive impairment. This often but not invariably occurs in the GFR range between 5 and10 ml/min/1.73 m2. However, evaluation of the need for dialysis should begin at a higher GFR level, probably somewhere around 15-20 mL/ minute/1.73 m². Problems with criteria that are limited to clearance measures occur in patients with renal impairment who have problems with fluid overload, hyperkalemia, or “failure to thrive” that are out of proportion to their GFR. For example, patients with advanced cardiac disease and borderline GFR may have trouble with refractory fluid retention. Many Cardio-vascular complications can occur in ESRD including anemia, hypertension, vascular calcification and stiffness of arteries. Chronic kidney disease (CKD) is associated with premature atherosclerosis and increased incidence of cardiovascular morbidity and mortality. Several factors contribute to atherogenesis and cardiovascular disease in patients with CRF. Notable among the CRF-induced risk factors are lipid disorders, oxidative stress, inflammation, physical inactivity, anemia,hypertension, vascular calcification, endothelial dysfunction, and depressed nitric oxide availability. When the diagnosis of ESRD is determined, a decision concerning the most appropriate mode of renal replacement for the patient must be made. Options for renal replacement therapy (RRT) for the ESRD include Kidney transplantation, peritoneal dialysis, hemodialysis and supportive therapy in the form of drugs for hypertension and anemia and diet control. Haemodialysis continues to be the most frequently utilized modality for renal replacement therapy in incident pediatric ESRD patients. Oxidative stress may be defined as an imbalance between the production and elimination of ROS (reactive oxygen species). Oxidative stress results from either an overproduction of free radicals or diminution in antioxidant defenses. When this delicate balance is upset, oxidative stress may lead to cellular injury and subsequent organ dysfunction. Although free radicals are potentially damaging, It should always be remembered that they are also essential for normal cell function. In this regard, we should try to use the term oxidative stress when we describe the pathological sequelae to alterations in the oxidant/ antioxidant status of a cell.The present study was carried out on 35 children with ESRD on regular hemodialysis in Pediatric Nephrology Unit of Tanta University Hospital and 35 healthy age and sex matched children were serving as controls. All patients and control were subjected to history taking and clinical examination including anthropometric measurements. Routine laboratory assessment was done measuring complete blood picture (CBC),) blood urea, BUN, serum Creatinin,, PTH, PT, PTT, bleeding time, clotting time ,blood electrolytes and urine analysis. In this study, children with ESRD on regular HD were investigated by serum levels of interleukin 1 β(IL-1β), tumour necrosis factor alpha(TNF-α), thiobarbituric acid reactive substances(TBARS) and malondialdehyde (MDA) as indices of oxidative stress in comparison with the studied healthy children as a control group. All patients were receiving antioxidant drugs in the form of vitamin E in a dose of 5mg/kg/day, vitamin C in a dose of 100-200 mg /day and N-Acetyl Cystiene in a dose of one sachet (200 mg) twice daily with meal. |