الفهرس 
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Abstract
Hyperparathyroidism secondary to CKD is an overproduction of parathyroid hormone (PTH) caused by several changes that occur in bone and mineral metabolism as a result of decreased kidney function. The first change that usually occurs with declining kidney function involves the deficiency of activated vitamin D and an increase in phosphorus excretion by the remaining functional nephrons. Both of these changes stimulate an increase in PTH synthesis and secretion. Secondary hyperparathyroidism (SHPT) develops early in the course of the disease before dialysis initiation. Unfortunately, it is often unrecognized and inadequately treated in patients with early stages of kidney disease when therapy would have greater benefit.
Anemia is a common complication in CKD patients, anemia in CKD can result from multiple mechanisms as iron, folate, or vitamin B12 deficiency, gastrointestinal bleeding, severe hyperparathyroidism, systemic inflammation and shortened red blood cell survival, decreased erythropoietin synthesis.
Recently, some studies and case reports indicated possible link between anemia and secondary hyperparathyroidism in CKD patients, Possible causes of low Hb level or anemia due to SHPT may be because of increased bone marrow fibrosis, which may lead to decreased erythropoietin and increased resistance to EPO. Erythropoietin cells express calcitriol receptors, which induces proliferation and maturation of erythroid progenitor cells. Therefore, deficiency of calcitriol, a cause of hyperparathyroidism may impair erythropoiesis. There are also some studies, which support an increase in erythrocyte osmotic fragility due to
Summary
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high concentration of PTH in patients on dialysis, leading to low Hb level.
An efficient control of PTH hypersecretion is therefore required to achieve a better management of anemia in HD patients.
In this study, we have analyzed the effect of SHPT in aggravating the anemia and correlation of intact parathyroid hormone (iPTH) and Hb level if there is any, in HD patients.
In the present study the aim of the work is to evaluate the role of secondary hyperparathyroidism as a cause of anemia and correlation of intact parathryroid hormone and hemoglobin level in hemodialysis patient.
This study was conducted on sixty patients selected from the Hemodialysis unit of Shebeen El Kom teatching hospital. The study was done from the period of November 2013 to December 2014.
They were divided into 2 groups;
Group 1: included anemic subjects with Hb level <11 (thirty four patients 19 males and 15 females).
Group 2: included non anemic subjects with Hb level≥11(twinty six patients 14 males and 12 females
The following patients were excluded from the study, Patients taking angiotensin- converting enzyme inhibitors, Patients taking non- steroidal anti- inflammatory drugs, Patients have external blood loss.
The following investigations were done, serum urea, serum creatinine Complete blood count, serum ferritin, total iron binding capacity, trasferrin saturation, serum calcium. Serum phosphorus, intact PTH.
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The present study revealed there were no statistically significant difference between two groups as regard age, gender and BMI (P>0.05).
The duration of dialysis, was significantly higher in group 1 than group 2 ,(P<0.001).
There was no significant difference among the studied groups as regard DM and hypertention (P>0.05)
PTH was significantly higher in group 1 than group 2 , (P<0.001).
There was no significant difference between the studied groups as regard ca and ph (P>0.05).
There was no significant difference between the studied groups as regard urea and creatinin(P>0.05)
Serum ferritin was significantly higher in group 1 than group (p<0.03).
There was no significant difference between the studied groups as regard serum iron, TSAT, TIBC, (P>0.05).
There was significant negative correlation between duration of dialysis and Hb in the studied groups (r-0.495),(p>0.001)
There was no significant correlation between age and Hb in the studied groups, (P>0.05).
There was no significant correlation between BMI and Hb in the studied groups, (P>0.05).
There was significant negative correlation between PTH and Hb in the studied groups (r-0.858 ),(p<0.001)
There was no significant correlation between Ca level and Hb in the studied groups , (P>0.05).
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There was no significant correlation between ph level and Hb in the studied groups, (P>0.05).
There was no significant correlation between serum iron, ferritin, TSAT, TIBC and Hb in the studied groups, (P>0.05).
There was no significant correlation between urea and creatinin levels and Hb in the studied groups, (P>0.05).
This study revealed that, at PTH level 401.5 or more sensitivity for perediction of anemia is (76.5%), specificity is (96.2%), PPV is (96.3%), NPV (75.8%) and accuracy is (85%).
This study revealed that, duration of dialysis and PTH level are independant risk factors of anemia in CKD patients .