الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) has been recognized as a leading public health problem worldwide. The global estimated prevalence of CKD is 13.4% (11.7–15.1%). In Egypt, CKD is one of the major health challenges. It approximately affects 13% of the adult population, resulting in significant morbidity, mortality, and health care costs. Patients with more progressive CKD (stage 3 or more) experience a high rate of cardiovascular events and death compared to earlier stages of CKD. The burden of CKD is not restricted to its effect on clinical demands for renal replacement therapy (RRT); the disease has other major outcomes including mortality and cardiovascular events which are strongly affected by kidney involvement. Strategies reducing the cardiovascular risk in CKD still need further evaluation in large trials. Early prediction and management of cardiac disease as a cause of morbidity and mortality has become mandatory in the management of CKD patients. YKL-40 also known as chitinase 3-like protein 1 (CHI3L1), is a 40kDa heparin and chitin-binding glycoprotein. It is secreted by a variety of cells such as neutrophils and activated macrophages in different tissues with inflammation and vascular smooth muscle cells. Therefore, the aim of this study was to evaluate serum YKL-40 levels in patients with CKD to assess its value as a biomarker of inflammation and its correlation with carotid intima-media thickness (CIMT) as a predictor for early atherosclerosis. The present study was conducted on fifty subjects divided into 2 groups: group I includes 25 patients with CKD (from stage 1 to stage 5 ”predialysis”) and group II (control group) includes 25 healthy volunteers. The patients were recruited from Internal Medicine Department and Nephrology Unit, Tanta university hospitals in the period between,” August 2020 to September 2021 ”. The patients’ demographic, clinical, laboratory and radiological data were recorded in a special observation sheet. The laboratory investigations including renal function tests (serum creatinine, blood urea& e-GFR), lipid profile (triglyceride, total cholesterol, LDL & HDL), complete blood picture (CBC), serum albumin, serum ferritin, ESR, CRP, and YKL-40 were obtained and the results were assessed. Additionally, CIMT was measured in both groups by an experienced radiologist. Data were statistically analyzed, and the results of this study revealed that: the age of patients ranged between 29 and 75 years. The gender of the studied patients was almost equal with a mild predominance of females (52%). Furthermore, our results show that the duration of CKD in the studied patients ranged from one to 15 years with a median of 3 years. Hypertension was the most frequently detected cause of CKD in the studied cases (52%) followed by idiopathic etiology (36%). Concerning routine laboratory investigations our study revealed: • Anaemia was found in many of the studied cases with statistical significance between the two groups. • Triglyceride & cholesterol showed borderline high levels in the studied CKD cases with significant differences between both groups. On the other hand, HDL & LDL were comparable between both groups with no significant difference. • The majority of CKD patients presented with high results of Ferritin & ESR with statistical significance between the two groups. • CRP showed astatistically significant increase in CKD patients than the control group. • In our study, the median value YKL-40 was 299.3 ng/ml in CKD cases and 69.10 ng/ml in the control group with significant differences between both groups (P=0.001). • As regards CIMT measurements for the studied cases its median value was 0.90&1 mm for the right and left carotid respectively. On the other hand, CIMT measurements for the studied volunteers were within the normal range with statistically significant differences between both groups (p=0.001). • There is a positive significant correlation between the serum YKL-40 level from the studied cases with each of triglycerides, serum urea, serum creatinine, CRP, ESR, R CIMT, and L CIMT. • Systolic blood pressure, triglyceride, cholesterol, LDL, serum urea, serum creatine, e-GFR, ESR, CRP, and YKL-40 were found to be independent predictors for CIMT (P<0.05). • Serum YKL-40 is a highly sensitive predictor of atherosclerosis in CKD and its specificity is 74% in CKD cases.