الفهرس 
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Abstract
Chronic kidney disease creates a complex pathologic environment characterized by metabolic alterations that affect nutrient intake, metabolism and energy expenditure, predisposing patients to the development of malnutrition and an increased risk for morbidity and mortality. Inflammation, metabolic acidosis, uremic toxins and hormonal dysregulation all play significant roles in the pathogenesis of protein energy wasting and growth failure in hemodialyzed patients. Supplementation of protein and calories alone may not adequately control malnutrition. A multifaceted approach including the treatment of comorbidities is necessary. Therapeutic interventions that specifically target inflammation and other metabolic derangements are essential for the successful treatment of malnutrition in these patients. A better understanding of the mechanisms involved in hormonal regulation of appetite in hemodialyzed patients might lead to the development of novel and effective therapies for malnutrition.
Study site :
The study design was cross-sectional in nature in nephrology unit in Minia university hospital .
Subjects :
• 165 hemodialyzed patients of different ages were included .
• The age range: 18-60 years old ; with mean age 46.8±17.3 years .
• 83 patients were male and 82 patients were females.
• Patients were divided into 2 groups :
group A: It included 99 hemodialyzed chronic renal failure patients with normal nutrition (51 male and 48 female).Their ages ranged from 19 to 78 years.
group B: It included 66 hemodialyzed chronic renal failure patients with malnutrition (32 male and 34 female).Their ages ranged from 21 to 83 years.
All patients were subjected to :
1- Clinical examination of malnutrition .
2- Anthropometric measurements including weight, height BMI and arm circumference .
3- Biochemical assessment of serum albumin , Total protein , transferrin , total cholesterol and phosphate level .
Our analysis showed that the BMI and Arm circumference were significantly lower in malnutrition patients than patients with normal nutrition .
Regarding the laboratory findings , our analysis showed that serum albumin was significantly lower in malnutrition group . Moreover , patients with normal nutrition were more likely to have hypercholesterimia.
In terms of the prevalence of malnutrition in hemodialyzed chronic renal failure patients , the present study showed that 66% of the patients had malnutrition.
The malnutrition determinded by BMI lower than 18.5 Kg/m2 , Arm circumference lower than 23.5 Cm , Total protein less than 6 gm / dl and serum albumin less than 3.5g / dl .
In the present study , the correlation analysis showed that there were statistically positive correlation between BMI and ( Arm circumference , Sreum albumin , Total cholesterol , Total protien and phosphate ) .
Our analysis showed that there were statistically positive correlation between arm circumferernce and (BMI , Serum albumin , Total cholesterol , Total protien and phosphate ) .
Also , our study showed that there were statistically positive correlation between URR and (BMI , Arm circumference , Serum albumin and phosphate ).
Our study showed that there were statistically negative correlation between Protien diet restriction and (BMI , arm circumference , serum albumin , and total cholesterol ) .
Patients with malnutrition had statistically significant higher duration of hemodialysis than patients with normal nutrition .
A relationship between malnutrition and patients outcome may be found in our study , where parameters of malnutrition in the form of decrease serum albumin , total protein , BMI and arm circumference , those of patients outcome in the form of long duration of hemodialysis .