The Effect of Hemodialysis on Serum Levels of Iron and C-Reactive Protein in Patients with Renal Failure

Abstract This study was carried out to assess the effect of hemodialysis on iron and C-reactive protein (CRP) in patients with renal failure. Sixty samples were collected from patients in period between April to May 2015, chosen randomly from Association specialized hospital in Khartoum states, and thirty apparently healthy individuals as controls. Measure plasma iron and CRP by using Hitachi/cobas C311 system, and results were analyzed using statistical of package social science (SPSS), computer program. The results showed that, when the control were compared with the samples the serum level of iron was significantly decreased (17.5 ± 7.527 versus 13.8 ± 6.955 µmol/L, P-value=0.024) and the plasma level of CRP was significantly increased (0.651 ± 0.608 versus 45.4 ± 110.791mg/L, Pvalue=0.030) in the Sudanese patients under hemodialysis. Also the findings in this study showed that, there were insignificant differences (increase or decrease) between the levels of iron and CRP according to gender. The result as follow males versus female. Iron: (14.19 ± 7.53 versus13.04 ± 5.72 µmol/L p=0.550). 11 CRP: (50.18 ± 118.8 versus 35.93 ± 94.88 mg/L p=0.643). Person correlation showed that, there were insignificant correlation between duration of dialysis and the levels of iron and CRP. Iron: (r= -0.130, p-value 0.324). CRP: (r=0.045, p-value 0.733). There was significant week positive correlation between the dose of treatment (Erythropoiesis stimulating agents -ESAs) and the level of iron. (r=0.267, p-value 0.039). It is concluded that; the serum level of iron was significantly decrease in the Sudanese patients with renal failure under hemodialysis. And the serum level of CRP was significantly increased in the Sudanese patients with renal failure under hemodialysis. There was no correlation between duration of dialysis and the levels of iron and CRP, while there was significant week positive correlation between the dose of treatment (Erythropoiesis stimulating agents -ESAs) and the level of iron.

List of contents

No Titles Pages

1 A verse from the Quran I

2 Dedication II

3 Acknowledgment III

4 English abstract IV

5 Arabic abstract VI

6 contents VIII

7 List of Tables XII

8 List of Figures XIII

9 Abbreviation XIV

Chapter One

1.1 Introduction 1

1.2 Rational 3

1.3 Objective 4

Chapter Two

2 Literature Review 5

2.1 The Renal 5

2.1.1 Renal Anatomy 5

2.1.2 Renal functions 7

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2.1.3 Renal failure 7

2.1.3.1 Acute Renal Failure 7

2.1.3.2 Chronic Renal Failure 8

2.1.3.3 Causes of renal failure 8

2.1.4 Renal function test 9

2.1.4.1 Glomerular Filtration Tests 9

2.1.4.2 Clearance Tests 9

2.1.4.3 Clinical Significance 9

2.1.5 Dialysis 10

2.1.5.1 Hemodialysis (HD) 11

2.1.5.2 Pretoneal dialysis (PD) 11

2.2 Iron 12

2.2.1 Iron component 12

2.2.2 Storage Component 12

2.2.3 Diatary Iron 13

2.2.4 Iron Absorbtion 13

2.2.5 Iron Excretion 14

2.2.6 Relationship between iron and renal diseases 15

2.2.7 Treatment of nemia in people on dialysis 16

2.3 C-reactive protein 16

2.3.1 Relationship between CRP and renal diseases 18

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2.3.2 Relationship between CRP and EPO 18

Chapter three

3 Materials and Methods 19

3.1 Materials 19

3.1.1 Study design 19

3.1.2 Study area 19

3.1.3 Study population 19

3.1.4 Samples collection and processing 19

3.1.5 Ethical consideration 19

3.1.6 Requirement 20

3.1.7 Reagent and stability 20

3.1.8 Data analysis 20

3.1.9 Data collection 20

3.2 Methods 21

3.2.1 Estimation of iron 21

3.2.2 Estimation of iron 21

3.3 Quality control 21

Chapter four

4 Results 22

Chapter five

5 Discussion, Conclusion and Recommendation 28

5.1 Discussion 28

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5.2 Conclusion 32

5.3 Recommendation 33

References 34

Appendix I 38

Appendix II 39

Appendix III 42