الفهرس 
CVD in chronic kidney disease patientsOnly 14 pages are availabe for public view
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Abstract
This is a prospective study, that enrolled 80 patients. They were divided into 2 groups: group Ӏ: which concluded 30 patients were non- dialysis dependent CKD patients without metabolic acidosis (MA). group ӀӀ which concluded 50 patients were non- dialysis dependent CKD patients with MA and divided into group ӀӀ A: non- dialysis dependent CKD patients with MA before sodium bicarbonate administration. group ӀӀ B: non- dialysis dependent CKD patients with MA after sodium bicarbonate administration. group ӀӀ had received oral sodium bicarbonate 650 mg tablet (twice to three time per day) till HCO3¯ level increased up to ≥22mmol/l for over a period of 2 weeks then treatment was continued over a period of 6 months.
In CKD patients the leading cause of morbidity and mortality is CVD. This contribution increases as eGFR decreases as metabolic acidosis (MA) in CKD increases, so MA contributes to increased CKD- related cardiovascular mortality (Wesson DE., 2016).
This study revealed in a comparison between group ӀӀ A and group Ӏ that:
• There was statistically significant lower PH in group ӀӀ A p value
<0.001 as the mean PH in group ӀӀ A was (7.26±0.03) and in group Ӏ was (7.37±0.04).
• There was statistically significant lower in HCO3 in group ӀӀ A p value <0.001 as the mean serum HCO3 in group ӀӀ A was (13.65±1.1) and in group Ӏ was (24.93±1.39).
• There was statistically significant higher anion gap in group ӀӀ A p value <0.001 as the mean anion gap in group ӀӀ A was (19.67±2.02) and in group Ӏ was (11.18±1.28).
• There was statistically significant lower eGFR in group ӀӀ A p value
<0.001 as the mean eGFR in group ӀӀ A was (25.06±6.05) and in group Ӏ was (61.77±14.24).
• There was statistically significant higher both serum creatinine and blood urea in group ӀӀ A p value (<0.001, <0.001) respectively as the mean serum creatinine in group ӀӀ A was (2.47±0.56) and in group Ӏ was (1.16±0.30) and the mean blood urea in group ӀӀ A was (127.14±19.02) and in group Ӏ was (44.03±11.8).
• There was statistically significant higher both serum potassium and serum chloride levels in group ӀӀ A p value (<0.001, <0.001) respectively as the mean serum potassium in group ӀӀ A was (4.59±0.35) and in group Ӏ was (3.92±0.41) and the mean serum chloride in group ӀӀ A was (108.11±1.94) and in group Ӏ was (104.32±1.77).
• There was statistically significant lower serum albumin and total serum calcium levels in group ӀӀ A p value (<0.001, <0.001) respectively as the mean serum albumin in group ӀӀ A was (3.72±0.19) and in group Ӏ was (4.17±0.33) and the mean total serum calcium in group ӀӀ A was (8.34±0.41) and in group Ӏ was (9.18±0.49).
• There was statistically significant higher serum phosphorus and PTH in group ӀӀ A p value (<0.001, <0.001) respectively as the mean serum phosphorus in group ӀӀ A was (4.53±0.46) and in group Ӏ was (3.39±0.58) and the mean PTH in group ӀӀ A was (457.98±176.72) and in group Ӏ was (138.34±95.35).
• There was statistically significant lower specific gravity of urine in group ӀӀ A p value <0.001 as the mean specific gravity of urine in group ӀӀ A was (1016.88±2.38) and in group Ӏ was (1020.57±2.96)
• There was statistically significant higher urinary PH and 24-hour urinary albumin in group ӀӀ A p value (<0.001, <0.001) respectively as the mean urinary PH in group ӀӀ A was (5.5±0.36) and in group Ӏ was (6.1±0.40) and as the mean 24-hour urinary albumin in group ӀӀ A was (655.12±558.62) and in group Ӏ was (127.03±97.98).
• There was statistically significant higher TSH in group ӀӀ A p value
<0.001 as the mean TSH in group ӀӀ A was (5.09±2.78) and in group Ӏ was (2.65±1.95).
• There was statistically significant lower FT3 and FT4 in group ӀӀ A p value (<0.001, <0.001) respectively. as the mean FT3 in group ӀӀ A was (3.32±0.80) and in group Ӏ was (4.47±1.05). as the mean FT4 in group ӀӀ A was (11.94±3.35) and in group Ӏ was (14.64±3.66).
• There was statistically significant higher triglyceride & total cholesterol in group ӀӀ A p value (<0.001, <0.001) respectively as the mean triglyceride in group ӀӀ A was (198.68±24.16) and in group Ӏ was (137.73±27.85) and the mean total cholesterol in group ӀӀ A was (247.58±17.4) and in group Ӏ was (152.33±26.4).
• There was statistically significant higher LDL-C in group ӀӀ A p value <0.001 as the mean LDL-C in group ӀӀ A was (170.1±12.27) and in group Ӏ was (72.27±23.18).
• There was statistically significant lower in HDL-C in group ӀӀ A p value <0.001 as the mean HDL-C in group ӀӀ A was (41.82±2.14) and in group Ӏ was (48.23±4.01).
• There was statistically significant higher CRP in group ӀӀ A p value
<0.001 as the mean CRP in group ӀӀ A was (26.97±7.75) and in group Ӏ was (9.78±4.41).
• There was statistically significant higher LA in group ӀӀ A p value
<0.008 as the mean LA in group ӀӀ A was (3.66±0.24) and in group Ӏ was (3.5±0.28)
• There was statistically significant higher IVS and PW in group ӀӀ A p value (<0.001, <0.001) respectively as the mean IVS in group ӀӀ A was (1.16±0.12) and in group Ӏ was (0.97±0.130 and the mean PW in group ӀӀ A was (1.04±0.13), and in group Ӏ was (0.96±0.12).
• There was statistically significant higher LVESD and LVEDD in group ӀӀ A p value (<0.001, <0.001) respectively as the mean LVESD in group ӀӀ A was (3.86±0.47) and in group Ӏ was (3.27±0.5) and the mean LVEED in group ӀӀ A was (5.62±0.43) and in group Ӏ was (4.27±0.65).
• There was statistically significant lower EF% in group ӀӀ A p value (<0.001, <0.001) respectively as the mean EF% in group ӀӀ A was (52.7±5.7) and in group Ӏ was (62.07±5.81).
After 6 months of therapy, in a comparison between group ӀӀ A and group ӀӀ B that, this study revealed:
• In group ӀӀ B, there was statistically significant increase in PH (7.35±0.003) p value <0.001, statistically significant increase in serum HCO3¯ levels (23.56±0.74) p value <0.001 and statistically significant decrease in the anion gap (13.25±1.10) p value <0.001.
• In group ӀӀ B, there was statistically significant increase in eGFR (26.44±7.65) p value <0.001 & statistically significant decrease in serum creatinine (2.39±0.65) p value <0.001 and statistically significant decrease in blood urea (122.72±20.98) p value <0.001.
• In group ӀӀ B, there was statistically significant decrease in both serum potassium (4.33±0.38) p value <0.001 and serum chloride
(105.1±1.28) p value <0.001 and statistically significant increase in serum sodium (137.5±1.74) p value <0.001.
• In group ӀӀ B, there was statistically significant increase in both serum albumin (3.86±0.19) p value <0.001 and total serum calcium (8.46±0.38) p value <0.001 and statistically significant decrease in both serum phosphorus (4.46±0.43) p value <0.001 and PTH (436.98±175.78) p value <0.001.
• In group ӀӀ B, there was statistically significant increase of specific gravity of urine (1020.88±2.37) p value <0.001 and statistically significant decrease in PH of urine (6.46±0.26) p value <0.001.
• In group ӀӀ B There was improvement of the lipid profile as there was statistically significant decrease in triglyceride (189.68±28) p value < 0.001, total cholesterol (237.4±20) p value < 0.001 & LDL- C (162.76±11.36) p value < 0.001 and statistically significant increase in HDL-C (43.52±2.32) p value < 0.001.
• Comparison of biomarkers of myocardial injury (high sensitive troponin I & CK-MB) in non-dialysis dependent CKD patients. There were statistically significant lower serum levels of high sensitive troponin I in group Ӏ and higher in group ӀӀ A and there was statistically significant decrease of serum levels in group ӀӀ B (12.8±7.34, 30.33±9.19, 22.21±10.34) respectively p value <0.001. There were statistically significant lower serum levels of CK-MB in group Ӏ and higher in group ӀӀ A and there was statistically significant decrease of serum levels of CK-MB in group ӀӀ B (11.71±6.81, 21.27±9.85, 18.3±7.91) respectively p value <0.001. As a result of modification of risk factors as correction of MA, increase in eGFR, decrease of uremia, decrease in serum uric acid level, decrease in PTH, decrease in albuminuria, improvement of lipid profile and thyroid profile, improvement of malnutrition
inflammation complex syndrome (MICS) and so, we have founded that modification of all these risk factors decrease further inflammation, atherogenesis, endothelial dysfunction that leads to decrease of myocardial injury and increase of myocardial contractility (provide by decrease of LVESD and increase of EF%) and prevent of worsening of structural parameters as LVH .
Of a total of 50 CKD patients there was 68% (n=34) patients had improvement in EF% and 32% (n=16) patients had no improvement in EF%.
After 6 months of therapy, in comparison between improved and non- improved subjects of group ӀӀ, the study revealed that
• There was statistically significant higher eGFR (29.74±6.72) p value <0.001 in improved subject’s post-treatment and there was statistically significant lower in both serum creatinine (2.07±0.39) p value <0.001 and blood urea (115.09±20.35) p value <0.001 in improved subject’s post-treatment.
• There was statistically significant higher both FT3 (3.88±0.51) p value 0.005 and FT4 (13.92±2.50) p value 0.003 and lower TSH (3.58±0.94) p value post-treatment in improved group. There was statistically significant lower level of CRP (15.59±4.12) p value
0.001 in improved subjects of post-treatment group and statistically significant higher serum albumin (3.91±0.18) p value 0.001 in improved subject’s post-treatment.
• There was statistically significant lower TG (175.38±20.44) p value
<0.001, total cholesterol (230.0±18.68) p value 0.001 and LDL-C (158.53±10) p value 0.001 and statistically significant higher HDL- C (44.24±2.12) p value 0.001 improved subject’s post-treatment.
• There was statistically significant lower CRP (15.59±4.12) p value
<0.001 and statistically significant higher serum albumin (3.91±0.18) p value 0.001 improved subject’s post-treatment.
• There was statistically significant higher both EF% (58.94±5.91) p value <0.001 and LVESD (3.64±0.43) p value 0.007 and statistically significant lower LVEDD (5.52±0.45) p value 0.007 improved subject’s post-treatment.
• There was statistically significant lower high sensitive troponin I (16.83±4.67) p value <0.001 improved subject’s post-treatment as in improved subject group post-treatment had statistically significant higher eGFR, FT3 and FT4 and lower LDL-C and CRP so that lead to decrease atherogenesis and myocardial injury that lead to improvement of heart contractility (increase of EF%).