الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Normal growth and development are major goals of pediatric CKD management. Because adequate nutritional status is important in achieving these goals, careful monitoring of nutritional status is essential. Nutritional status is a complex concept that cannot be adequately summarized by a single measurement. Multiple measures, considered collectively, are required to give a complete and accurate picture of nutritional status. Growth parameters are particularly important in children and should be accurately measured using calibrated equipment and standardized techniques.
The recommended measures by KDOQI guide lines include serum albumin, height or length, estimated dry weight, weight/height index, skinfold thickness, mid arm circumference (MAC), and head circumference (for children aged less than 3 years old).
Modified Subjective global assessment score, determined by medical history on five items and clinical findings on two items, is a well-validated tool for screening for malnutrition .
Leptin, an adipokine that is produced in subcutaneous and visceral adipose tissue, is a plausible biological mediator. Its physiological roles include signaling long-term caloric intake and fat stores to the hypothalamus, thereby modifying food consumption and energy expenditure .
The rationale of our study was to Assess the nutritional status in patients with ESRD who were being maintained on regular HD in the pediatric HD unit of Menoufia university hospital using both the anthropometric measures and Subjective Global Assessment tool and to correlate this with measured serum nutritional biomarkers and also our study aimed to Identify the role of leptin in assessing the nutritional status in patients with end-stage renal disease (ESRD).This study was conducted in the HD unit in the pediatric nephrology unit of Menoufia university hospital starting from 1/10/2016 to 1/10/2017.
Thirty children on maintenance hemodialysis for more than 6 months were included in this study, they were 15 males and 15 females.
All the included patients were subjected to full history taking, nutritional assessment using the modified Subjective Global Assessment score, Anthropometric measures. (weight in Kg, standing height in cm, BMI, MAC in cm and SFT in mm). They were plotted on growth charts and WHO Z score. Blood samples were collected from the arterial side of the vascular access and the following laboratory investigation were done:
CBC
Urea, BUN, serum creatinine (before and after dialysis), serum total calcium, phosphorous, cholesterol and albumin.
Liver functions.
Serum iron & iron binding capacity.
Parathyroid hormone.
Serum ferritin.
URR and Sp Kt/V were calculated for all patients.
Serum leptin.
Our results revealed that regarding Dialysis prescription of our patients, all our patients were on three dialysis session per week, the range of dialysis session length was 180-240 min. The mean dialysis session length was 234 (± 16.5) min, the mean of blood flow rate was 4.9 ml / kg /min and the mean of their ultrafiltration volume was 1.56 L. The type of filter was high flux in 36.7% of cases and low flux in 63.6% of cases. Effective surface area of the dialyzer membrane was 0.7 m² in 40 %of cases and 1 m² in 46.7% of cases and 1.3 m² in 13.3% of cases. As regard dialysis technique, 73.3 % of our patients were on CHD while 26.6 % were on HDF. Temporary catheter was the most commonly used initial access and AVF was the most commonly used current access.