study of outcome of patent ductus arteriosus in preterms

presentation about patent ductus arteriosus

1. Vitamin B6 Status and Relation to Anemia in Pediatric Patients on R egular Hemodialysis Thesis Submitted for partial fulfillment of master degree in Pediatrics By: Yara Mohammad Mostafa (M.B.&B.CH)

2. Prof. Dr. Hafez Mahmoud Bazaraa Professor of Pediatrics Faculty of Medicine-Cairo University Dr. Fatma Mohamed Attia Lecturer of Pediatrics Faculty of Medicine-Cairo University Dr. Sara Ahmed Lotfy Lecturer of Chemical Pathology Faculty of Medicine-Cairo University UNDER SUPERVISION OF:

3. ACKNOWLEDGEMENT Special thanks to……. Nephrology Department, Abu elrish hospiatal

4. INTRODUCTION

5. Introduction Chronic kidney disease (CKD) can be defined as a sustained damage of renal parenchyma leading to chronic deterioration of renal function that may gradually progress to end-stage renal disease . Among the many comorbidities associated with chronic kidney disease in children, anemia and its management remains a challenging area for doctors. It is a major determinant of quality of life with decreased work productivity and increased fatigability in the patients

6. Introduction Vitamin B6 is essential to heme synthesis, and its deficiency can lead to anemia, typically microcytic, hypochromic, and sideroblastic anemia . It is often seen in chronic kidney disease (CKD), particularly those requiring dialysis. Several factors may contribute to its deficiency including altered dietary intake, decreased absorption, defective pyridoxal metabolism, drug interactions and dialysis losses.

7. Aim of the work

8. Aim of the work The aim of our study was to evaluate the relation of vitamin B6 deficiency to anemia in children on regular hemodialysis and correlate the level to hemoglobin concentration, iron profile and erythropoietin dose.

9. Patients and Methods

10. Patients and Methods The study was conducted on 39 children with ESKD and a control group of 43 healthy, sex and age-matched individuals. ESKD patients were selected from Pediatric Nephrology Unit, Abu Elrish Hospital, Cairo University, Egypt.

11. Patients and Methods Inclusion Criteria • Age (1-14) years. • ESKD of any etiology • Hemodialysis for at least 3 months.

12. Patients and Methods Clinical assessment: Full clinical assessment focusing on age, primary renal disease, weight, height, body mass index, hydration status, blood pressure, current medications, and comorbidities. Assessment of any reported blood loss, transfusion, ESA use and iron therapy.

13. Patients and Methods Routine lab tests CBC,serum urea, creatinine, iron, TIBC,ferritin , calcium, phosphorus and ALP. Vitamin B6 measurement by Enzyme Linked Immunosorbant assay.

14. RESULTS

15. Demographic characteristics of our cases:   Median Minimum Maximum Age/years 9.00 3.00 14.00   Males Females Gender 43.6% 56.4%

16. Consanguinity and family history :

17. Primary disease:   Count % Original Disease unknown 9 23.1% Reflux nephropathy 11 28.2% primary hyperoxaluria 5 12.8% PCK 3 7.7% nephrophthisis 2 5.1% Jaubert's disease 1 2.6% FSGS 4 10.3% cystinosis 1 2.6% Caroli disease 1 2.6% Bardet Biedel 1 2.6% HUS 1 2.6%

18. Weight, height and BMI:   Count % Weight Z-score below -3 7 29.2% between -3 and -2 7 29.2% between -2 and -1 7 29.2% between -1 and median 2 8.3% between median and +1 1 4.2%

19. Weight, height and BMI:   Count % Height Z-score below -3 18 46.2% between -3 and -2 11 28.2% between -2 and -1 5 12.8% between -1 and median 3 7.7% between median and +1 1 2.6% between 1 and 2 1 2.6%

20. Weight, height and BMI:   Count % BMI Z-sore below -3 6 15.4% between -3 and -2 8 20.5% between -2 and -1 8 20.5% between -1 and median 8 20.5% between median and +1 2 5.1% between 1and 2 6 15.4% between 2 and 3 1 2.6%

21. Average Hb in the last 3 months   Mean Standard Deviation Average Hemoglobin in the last 3 months (g/dl) 10.45 1.87

22. VB6 level in cases and controls   cases control   Median Minimum Maximum Median Minimum Maximum P value Serum Vitamin B6 level (ng/ml) 28.20 2.30 149.00 27.50 10.10 97.00 0.2

23. VB6 and other parameters of anemia   Serum Vitamin B6 level Correlation Coefficient P value N Age/years 0.208 0.204 39 Average Hemoglobin in the last 3 months -0.025- 0.879 39 Hb level -0.103- 0.532 39 MCV 0.064 0.700 39 MCH -0.127- 0.440 39 Hct -0.171- 0.298 39 Iron -0.079- 0.632 39 Ferritin -0.108- 0.511 39 TIBC -0.068- 0.681 39

24. Conclusion

25. Conclusion -Our study has shown that most of our patients had uncontrolled anemia. -We cannot conclude that vitamin B6 deficiency is associated with anemia in children on hemodialysis. - There is a tendency for patients with controlled anemia to have higher than normal vitamin B6 levels, but this is far from being significant.

26. Recommendations Further research is needed to verify whether a higher-than-normal vitamin B6 level may be appropriate in children on hemodialysis. • Management of anemia in children on hemodialysis is an area that merits further improvement and research.