الفهرس 
Astherosclerotic Cardiovascular DiseaseOnly 14 pages are availabe for public view
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Abstract
Atherosclerotic cardiovascular disease is a major cause of morbidity and the leading cause of mortality in ESRD patients on maintenance HD.
Endothelial dysfunction had constantly been observed in CRF patients, and results in impaired modulation of vascular growth, dysregulation of vascular remodeling and altered anti-coagulant and anti-inflammatory properties of the endothelium
Chronic inflammation is a common feature of ESRD. It plays a key role in atherogenesis and atheroma development. Inflammatory mechanisms with atherosclerotic plaque formation can be triggered, maintained and enhanced by multiple factors such as activated macrophages that induce synthesis of neopterin.
Neopterin is expressed in endothelial cells, kidney epithelial cells, fibroblasts and vascular smooth muscle cells. Most studies dealing with effects of neopterin, provided evidence that interactions with reactive oxygen intermediate and the promotion of oxidative stress is a fundamental principle of neopterins mode of action
Recent studies have shown a strong association of neopterin with CVD. Studies showed association of high levels of neopterin with increased cardiac events rates. Other studies showed that neopterin levels correlated with the extent of atherosclerosis, especially coronary and PVD.
Neopterin has been identified as a potential risk factor for CVD in dialysis patients.
The aim of the study is to evaluate the association between serum neopterin level and carotid atherosclerosis in chronic kidney disease patients.
The current study was conducted on 30 patients with ESRD on maintenance HD, 30 patients with CKD stage 5 not yet on dialysis and 20 healthy control subjects in Ain shams University Hospitals.
All Subjects in this study were subjected to full history (stressing on etiology of renal failure , regimen of HD and duration on dialysis), Clinical examination and routine laboratory investigations as S. Creatinine, BUN, S.Calcium, S.phosphorus, S. PTH and lipid profile.
All subjects in the study were also subjected to the measurement of serum neopterin level, high sensitive CRP and IL 6.
All the study population were subjected to carotid duplex to measure carotid intima-media thickness also duplex ultrasound on brachial artery to measure FMD.
According to our results, CA-IMT measurement can be a more reliable indicator of atherosclerosis in CKD patients than FMD (%), as CA-IMT values were highest in group A (HD patients) and lowest in group C (healthy control subjects) with highly significant statistical difference between the three groups, whereas FMD (%) values showed non-significant statistical difference between the three groups.
Also CA-IMT values showed a statistically significant positive correlation with serum cholesterol levels in group B patients.
All inflammatory mediators showed a statistically significant difference between the three groups, also serum neopterin levels significantly increased with increasing IL 6 & HS CRP levels in group B patients.
Serum neopterin levels showed statistically significant positive correlation with serum BUN levels in both groups A & B patients, hence serum neopterin can be a more reliable indicator of inflammation in CKD and HD patients than IL 6 and HS CRP levels.