The goal of this observational clinical trial is to Study the impact of copper to zinc ratio on the outcome of ESRD patients

End-stage renal disease (ESRD) carries high morbidity and mortality due to cardiovascular complications, highlighting the need for ongoing research. Trace elements as copper (Cu), and zinc (Zn), are essential for physiological functions, enzyme activity, metabolism, and immune defense. In ESRD patients, Cu and Zn imbalances, with a higher Cu/Zn ratio are linked to greater cardiovascular problems. The relationship between the Cu/Zn ratio and clinical outcomes in ESRD needs more exploration

Inclusion Criteria:

• ESRD patients including those on maintenance HD

Exclusion Criteria:

• Acute kidney injury or rapidly progressive glomerulonephritis, acute infections or active inflammatory conditions as sepsis and autoimmune diseases, liver cirrhosis (Child-Pugh Class B or C), gastrointestinal disorders as inflammatory bowel disease, malabsorption, history of organ transplantation excluding kidney transplantation who may be included in a separate analysis if sufficient numbers are recruited, receiving total parenteral nutrition, Cu or Zn metabolism disorders as Wilson's disease, vitamin complex supplementation or antioxidants within the past 6 months, recent hospitalization within the past 3 months, recent surgery within 3 months, recent blood transfusion < 3 months, Pregnancy or lactation, Malignancy.

this prospective observational Case control study will enroll a well-characterized cohort of 100 adult patients with ESRD(eGFR <15 mL/min/1.73 m²) , including those undergoing maintenance hemodialysis recruited from nephrology clinics and dialysis unit at Minia University Hospital . The recruited patients will be stratified into two groups;

1. Dialysis ESRD Group: It will include 100 adult patients with ESRD stage 5D on maintenance hemodialysis for at least 6 months.
2. control groub study the impact of Cu/Zn ratio on outcomme of ESRD patients