Adaptation and validation of the Kidney Disease Quality of Life-Short Form questionnaire in the Greek language.

AIM: The aim of this study was to examine the validity, reproducibility and internal consistency of a Greek translation of the Kidney Disease Quality of Life-Short Form (KDQOL-SF) questionnaire. METHODS: The KDQOL-SF questionnaire was translated from English to Greek and was administered in 240 randomly selected patients undergoing hemodialysis in six Renal Units in Greece. The instrument's validity was tested by examining the association between patient's KDQOL-SF scores and comorbidity assessed with the Index of Coexistent Disease. Reproducibility was examined by readministering the questionnaire in 50 randomly selected patients within 1 month. Internal consistency was assessed by estimating Cronbach's alpha coefficient. RESULTS: Patients were divided into two groups according to the severity of comorbidity assessed with the Index of Coexistent Disease. Those with less comorbid conditions had significantly higher scores in most components of the KDQOL-SF questionnaire, confirming its validity. The correlation coefficients between the two administrations of the instrument ranged from 0.88 to 0.98 for each of the main components, which was above the desired level of 0.85. Cronbach's alpha coefficient ranged from 0.91 to 0.92 for the various components, values well above the minimum desired 0.70 level. CONCLUSIONS: The present study shows that the Greek version of the KDQOL-SF questionnaire has high validity, reproducibility and internal consistency. Production of validated translations of the KDQOL-SF questionnaire in various languages will help promote health-related quality of life of end-stage renal disease patients all over the world.

Coagulation factors as biological risk markers of endothelial dysfunction. Association with the thrombotic episodes of chronic hemodialysis patients.

BACKGROUND AND AIM: The aim of our study was to assess the coagulation factors as endothelial dysfunction markers and prospectively their association with thrombotic episodes in chronic hemodialysis patients. PATIENTS AND METHODS: Fifty-four randomly selected patients on chronic hemodialysis (HD), 34 men and 20 women were included in this study. Their mean age was 56 years and the mean hemodialysis duration was 53.0861.92 months. The variations of tissue factor pathway inhibitor (TFPI), thrombomodulin (TM) and von Willebrand factor (vWF) were studied. The above-mentioned parameters were measured before and after HD session. Low molecular weight heparin (tinzaparin) was administered to all patients during hemodialysis. The results were compared with those obtained from 20 healthy volunteer-controls, age and sex matched. After the initial assessment, all patients were followed for a period of 15 months. RESULTS: Two patients experienced one hemorrhagic event each, regarding the upper and/or the lower gastrointestinal tract. Twenty patients showed at least one thrombotic episode. Eleven patients presented fistula thrombosis, four angina pectoris incidents and five thrombosis of the lower limbs. The rest of the patients did not experience any clinical symptomatology that could be attributed to coagulation disorders. Parameter differences between patients and controls were statistically significant (p<0.005 for TFPI and p<0.001 for TM and vWF) and were improved after hemodialysis session. The age and the elevated levels of the vWF were found to be significantly different (p<0.03 and p<0.02 respectively) between the groups of patients who experienced or not thrombotic episodes. CONCLUSIONS: Coagulation factors TFPI, TM, and vWF are increased in hemodialysis patients and the clinical disorders are mainly thrombotic episodes. The age of patients and the elevated levels of vWF are associated with the thrombotic incidents. Hemodialysis contributes in the improvement of these coagulation factors, which could be considered as biological risk markers of endothelial dysfunction in chronic HD patients.

Childhood and parental obesity in the poorest district of Greece.

BACKGROUND AND AIM: Childhood obesity represents a rising threat in southern Europe. It is widely accepted that childhood obesity is an important risk factor for the appearance of obesity in adulthood. Our aim was to estimate the prevalence of obesity in school aged children living in one of the poorest districts of Europe, as well as to estimate the association between the frequency of obesity observed in these children and their parents. MATERIAL AND METHODS: We examined and calculated the body mass index (BMI) in 107 children aged 12.2+/-0.78 years. BMI was adjusted for age and sex and it was correlated with children parents' weight status. RESULTS: Obesity was diagnosed in 16% of the children. The relationship between children's and their parents weight status was very strong. In 40% of the obese parents, their children were found to be obese also (p<0.001). CONCLUSION: In the present study a strong relationship between children weight status and their parents' weight status was confirmed. Additionally, this correlation was proven at a district with very low house income. Knowing that it is easier to prevent obesity, rather than to cure it, our aim should be, when a child is brought to the doctor, independently of the cause, to assess both the child as well as its parents' weight status.

Insertion of long-term tunneled cuffed hemodialysis catheters via the external jugular vein by using a simple, safe and reliable surgical technique.

OBJECTIVE: Description of our technique for the insertion of long-term tunneled cuffed hemodialysis (HD) catheters via the external jugular vein. METHODS: From December 1999 to August 2006, 357 long-term tunneled cuffed HD catheters were inserted in 308 patients, who were referred to us from various hospitals and clinics in Greece. About half of them (168, or 47%) were inserted via the external jugular vein. We describe our surgical technique for the insertion of long-term tunneled cuffed HD catheters via the external jugular vein. RESULTS: During our study, there was a gradual increase in using the external jugular vein as a method for the insertion of permanent HD catheters. In all cases, the intraoperative catheter blood flow was measured >300 ml/min. No major complications occurred. CONCLUSIONS: Long-term tunneled cuffed HD catheters can be inserted via the external jugular vein by using an easy, simple, safe surgical technique. This procedure provides the possibility of using the internal jugular vein in the future.

Angina pectoris and intensive intravenous iron treatment in hemodialysis patients.

BACKGROUND: Intravenous iron and erythropoietin are commonly used for the treatment of anemia in end stage renal disease (ESRD) patients. Even though i.v. iron is proven to be very effective, there is great concern regarding its possible toxic effects. The aim of our study was to evaluate the possible correlation between iron administration and the incidence of angina pectoris in hemodialysis patients. METHODS: The study sample consisted of 10 stable coronary heart disease patients, receiving chronic hemodialysis treatment. The patients followed consecutively three different i.v. iron dose regimens according to their needs. Their standard monthly laboratory measurements were correlated with the incidence of angina pectoris and i.v. iron treatment. RESULTS: Hematocrit, ferritin, serum iron and mean rhEPO dose were related to the total amount of administered iron. Angina pectoris was related to intensive iron treatment, age and platelet count. Total white blood cell count were related to hemodialysis duration, platelet count and serum triglycerides. CONCLUSION: It is suggested that the intensive intravenous iron treatment (300 mg/week) is associated with the increased incidence of angina pectoris in stable coronary heart disease patients receiving hemodialysis.

Epidermal growth factor in saliva and serum of patients with cyclosporin-induced gingival overgrowth.

The purpose of this study was to investigate the presence of epidermal growth factor (EGF) in patients receiving cyclosporin therapy who had gingival overgrowth and to determine whether there were any differences between these patients and normal healthy controls. Seventeen patients with cyclosporin-induced gingival overgrowth and seventeen age- and sex-matched controls who were taking cyclosporin but had healthy gingiva were used for this study. Unstimulated whole saliva was collected from all individuals by expectoration. Gingival crevicular fluid (GCF) was also collected from all individuals. Blood was additionally collected from all subjects and serum was separated by keeping the samples overnight at 4 degrees C. EGF levels in all cases were measured by an ELISA assay. EGF concentrations were found to be significantly higher in the saliva of patients with cyclosporin-induced gingival overgrowth compared to the control group (401.2 +/- 31.1 pg/ml and 144.3 +/- 31.4 pg/ml, respectively), whereas the results were reversed in the serum (67.0 +/- 15.6 pg/ml and 141.6 +/- 17.7 pg/ml, respectively). EGF was not detected in the samples of GCF in either group. This study thus demonstrated an increase in EGF levels in the saliva and a decrease of EGF in the serum of patients with cyclosporin-induced gingival overgrowth.

Survival and complications of 225 catheters used in continuous ambulatory peritoneal dialysis: one-center experience in Northern Greece.

This study reports our experience with permanent peritoneal catheters. From July 1983 until December 1997, 225 catheters were implanted surgically in 207 patients (120 males, 87 females) with mean age of 58+/-16 years (range: 2-82 years), and a mean duration of continuous peritoneal dialysis (CAPD) of 21.9+/-21.3 months (range: 1-145 months). Two hundred and seventeen catheters were used in 199 patients suffering from end-stage renal disease (ESRD), and 8 catheters in 8 patients with end-stage heart failure resistant to medical therapy. One patient used 3 catheters and 16 patients used 2 catheters. The catheters used were: Tenckhoff, 2; Oreopoulos-Zellerman-1 (OZ-1), 10; OZ-2, 205; and OZ-pediatric, 8. All catheters were implanted by the same surgical team, through a paramedian incision under local anesthesia. By life table analysis, the actuarial survival rates at 1 year, 2 years, 3 years, and 5 years were 97%, 92%, 87%, and 82% respectively for all catheters. The catheter-related complications were: 5 obstructions, 2 dislodgments, 13 dialysate leaks (6 early; 7 late), 90 exit-site/tunnel infections (in 56 patients), 2 cuff extrusions, and 37 hernias (in 31 patients). Eighteen catheters were replaced for persistent peritonitis (15 cases), dislodgment (1 case), obstruction (1 case), and accidental shortening (1 case). The total observation period was 4526 patient-months. The overall incidence of peritonitis was one episode per 15 patient-months, and of exit-site/tunnel infections was one episode per 50 patient-months, with a significant improvement during the last years. We conclude that OZ catheters implanted surgically through a paramedian incision have a very high survival rate and a low complication rate.

Influenza vaccination on renal transplant patients is safe and serologically effective.

Since immunosuppressed patients are at higher risk of serious influenza virus infection than healthy subjects, we decided to study the serological effectiveness of influenza vaccination on renal transplant patients, despite the theoretical aspect that such treatment could induce glomerular lesions through an immunological process. Forty transplant patients aged from 20 to 50 years with well functioning renal graft and no febrile episode were studied. Blood samples were collected before the intramuscular injection of 0.5 ml of multivalent influenza vaccine (PASTEUR MERIEUX SERUM VACCINS), at one and at two months after the vaccination. Before vaccination, the antibody titers to influenza virus ranged from 0 to 1/20 and after vaccination from 1/20 to 1/320. One month after vaccination 17/40 (42.5%), 18/31 (58%) and 16/33 (48%) patients showed a four-fold or greater increase of serum influenza antibody titers to antigens A/H3N2, A/H1N1 and B, respectively. A similar response at two months in relation to the first month response rate after vaccination was found in 15/17 (88%), 18/18 (100%), and 15/16 (93%) of transplant patients for the above mentioned three antigens. Side-effects were observed in two of the studied patients. Serum creatinine and urine protein were not changed. Also acute graft rejection episodes were not observed. It is suggested that influenza vaccination is safe and serologically effective on renal transplant patients.