الفهرس 
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Abstract
Chronic kidney disease is a worldwide public health problem and is now recognized as a common condition that is associated with an increased risk of cardiovascular disease and chronic renal failure.
Cardiovascular disease is the leading cause of mortality and morbidity in patients with chronic kidney disease. Recent clinical studies have shown that lower serum fetuin-A levels are associated with vascular calcification and cardiovascular mortality among patients with end-stage renal disease.
Vascular calcification is influenced by derangements of calcium and phosphate homeostasis, including deregulated calcification inhibitors and promoters, and different types of underlying arterial diseases e.g atherosclerosis vs arteriosclerosis.
Fetuin-A is an important inhibitor of calcification on the level of calcium metabolism.
Recent development in methods to monitor fetuin-A level have provided an improved understanding of its role in various diseases, particularly in cardiovascular diseases. Fetuin-A deficiency is described as the missing link between multiple cardiovascular risk factors and the development of vascular calcification and hence arterial stiffness .
In this study, we tried to assess the relationship between serum fetuin-A and the risk of cardiovascular diseases ( i.e. arterial stiffness) in the patients with chronic kidney diseases.
This study included forty patients with CKD, divided into 2 groups, twenty patients (12 males and 8 females) on RHD therapy and the other twenty patients (11 males and 9 females) on conservative therapy.
All the studied patients groups and 10 healthy control subjects were subjected to the following:
1- Clinical examination
Through history taking and complete clinical examination.
3- Laboratory Investigations :
A-Routine investigations:
Complete Blood Count (CBC) .
Kidney function tests (Urea & Creatinine ) .
Estimated creatinine clearance (eCCr ) .
Serum electrolytes :
o Serum calcium& phosphorus level .
o Serum sodium & potassium level .
Fasting blood sugar, 2 hours post prandial blood glucose .
Estimation of lipid profile (including total cholesterol and triglycerides)
Liver function tests (total bilirubin , serum albumin , prothrombin time)
B-Special investigations:
1-Serum fetuin-A: measured by elisa
2-Carotid intima media thickness:
Measured through ultrasonographic examination of carotid artery using a 5 to 10 MHz transducer. This was done for the right and left common carotid arteries.
Results showed :
Significant negative correlation between serum fetuin-A level & CIMT in both patients groups with CKD on RHD & those on conservative treatment.
Regarding the eCCr , the mean value of eCCr is significantly higher among patients with CKD on conservative treatment than patients with CKD on RHD.
Regarding the serum creatinine level , the mean value of creatinine is significantly higher in patients with CKD on RHD than in patients with CKD on conservative therapy (p<0.001) .
Regarding the serum fetuin-A level , the mean value of serum fetuin -A level is significantly higher in patients with CKD on conservative (X±SD is 489±74) than in patients with CKD on RHD (X±SD is 376±50)
Regarding the serum calcium level, the mean value of serum calcium level is significantly higher in patients with CKD on RHD (X±SD is 9.1±0.4) than in patients with CKD on conservative treatment (X±SD is 7.4±0.7).
Regarding the serum phosphorus level, the mean value of serum phosphorus level is significantly higher in patients with CKD on RHD (X±SD is 5.4±0.5) than in patients with CKD on conservative treatment (X±SD is 5±0.6).
The mean values of LCCIMT,RCCIMT and mean CCIMT are higher in HD group patients with mean± SD(0.77 ± 0.11, 0.73± 0.1, 0.79±0.14 respectively) than in patients on conservative thrapy(0.730.11).
There is significant statistical negative correlation between serum fetuin- A levels and blood urea and serum creatinine in conservative group patient with arterial stiffness (r = -0.722 ,
-0.810 respectively) .
There is significant statistical positive correlation between serum fetuin-A levels and e GFR in conservative group patient with arterial stiffness (r= 0.791)( p<0.001) .
There is significant negative correlation between serum fetuin-A levels and RCCIMT, LCCIMT and mean CCIMT ( r= -0.721, - 0.397, -0.945 respectively) in conservative group patients with arterial stiffness.
There is significant negative correlation between serum fetuin-A and RCCIMT, LCCIMT and mean CCIMT ( r= -0.715, - 0.738, -0.771 respectively) in HD group patients with arterial stiffness.