The present work aimed to study the possible role of
inflammatory process in the pathogenesis of anemia, malnutrition,
ischemic heart disease, half and half nail sign
dyslipidemia and hypoalbuminemia in patients with chronic
renal failure under hemodialysis and the predictive value
of C-reactive protein (CRP) in these disorders. The subjects
of this work comprised of fifty patients with chronic
renal failure in the Nephrology unit Benha University Hospital.
They were divided into two groups including twenty
patients under conservative treatment and thirty patients
under regular hemodialysis treatment: 10 patients using
polysulphone dialyzers and 20 patients using cuprophane
dialyzers. In addition ten healthy subjects were used as
controls. For all of them the following was done; full medical
history, complete clinical examination, hematological
parameters (Hb. content, lit value, complete blood picture,
mean corpuscular volume, mean corpuscular hemoglobin
and mean corpuscular hemoglobin concentration), biochemical
tests (blood urea, serum creatinine, serum albumin,
serum cholesterol and C-reactive protein) and electrocardiogram.
The results showed that CRP level in chronic
renal failure patients either under conservative treatment
or hemodialysis was elevated (12±3.980 mg/dL and
11.73±8.081 mg/dL respectively) as compared to the control
group (1.85±1.1 mg/dL) and p < 0.05. There was no
significant difference between group with conservative
treatment and group with hemodialysis > 0.05). CRP
level was higher in patients using cuprophane dialyzers
than patients using polysulphone dialyzers (14.7±8.3 mg/
dL vs 5.8±2.3 mg/dL) and p < 0.05. Hemoglobin concentration
was statistically insignificant between patients dialyzed
by cuprophane or polysulphone (mean value 8.3t2.6
gm/dl vs 9.91-2.6 gm/di, p > 0.05). CRP level was negatively
correlated with serum albumin level in CRF under
hemodialysis patients tr = 0.409 and p < 0.05). Serum albumin
level was significantly higher in patients dialyzed
by polysulphone than those dialyzed by curprophan (mean
value 4.11±-0.66 gm/d1 vs 3.33±0.89 gm/d1. p < 0.05). CRP
level was not correlated with occurrence of half and half
nail sign in hemodialysis patients (r -= 0.25. p> 0.05). CRP
level was not correlated with serum total cholesterol level
in hemodialysis patients (r = 0.13221, p > 0.05) while
there was high incidence of ischemic ECG changes in
those patients. High CRP levels were associated with hypoalbuminemia
and low body mass index in hemodialysis
patients, this signifies that inflammatory process contributes
in occurrence of malnutrition in hemodialysis patients.
Thus we have concluded that, inflammatory process
contributes to anaemia, malnutrition, ischemic heart disease
and hypoalbuminemia in hemodialysis patients and
C-reactive protein can predict these disorders. The use of
biocompatable membranes for dialysis leads to less inflammatory
process and consequently better nutritional
state of the patients. |
