Chewing gum and a saliva substitute alleviate thirst and xerostomia in patients on haemodialysis

Bots, Casper P.; Brand, H.S.; Veerman, E.C.I.; Korevaar, Johanna C.; Valentijn-Benz, Marianne; Bezemer, P.D.; Valentijn, R. M.; Vos, Pieter C.; Bijlsma, Joost A.; Wee, Piet M. ter; Amerongen, Barbara M. van; Amerongen, A. van Nieuw

doi:10.1093/ndt/gfh675

Cited by 82 publications

(144 citation statements)

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“…This suggests that prolonged pilocarpine treatment is required to see benefits in IDWG. A 2-wk crossover study of Bots et al (46) evaluated the effect of chewing gum or saliva substitute on thirst, xerostomia, and IDWG and found no change in IDWG. The 2-wk period might be too short, and the inclusion of both hyperdipsic and nonhyperdipsic patients might make the effect of deceasing IDWG difficult to demonstrate.…”

Section: Discussionmentioning

confidence: 99%

Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients

Sung¹,

Kuo²,

Guo

et al. 2005

Journal of the American Society of Nephrology

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Decreased salivary flow rate causes xerostomia (symptoms of oral dryness) in patients who undergo hemodialysis (HD); however, whether it thus contributes to thirst and excess interdialytic weight gain (IDWG) remains undetermined. In the observational study, 3 mo of data of 90 stable HD patients were collected, and sensations of thirst and xerostomia were assessed by 100-mm visual analog scales (VAS). Multivariate analyses revealed that the VAS oral dryness score was an independent determinant for thirst, daily IDWG, and IDWG%. Unstimulated whole salivary flow rate (UWS) was measured in 45 participants and was negatively correlated with VAS oral dryness score (r ‫؍‬ ؊0.690, P < 0.001), daily IDWG (r ‫؍‬ ؊0.361, P ‫؍‬ 0.016), and daily IDWG% (r ‫؍‬ ؊0.302, P ‫؍‬ 0.045). In the interventional trial, the test drug was 5 mg of oral pilocarpine solution or placebo. Three types of interventions for reducing thirst (the urge to drink) and interdialytic weight gain (IDWG) are identified in the literature: dialysis protocol related (increasing frequency and varying sodium concentration) (6 -9), pharmaceutical (angiotensin-converting enzyme inhibitors [ACEI]) (10 -13), and dietetic interventions (10,14). However, no definite effectiveness could be shown (5), which might be explained by the fact that many of the underlying mechanisms for thirst and drinking behavior remain unknown.Known dipsogenic factors (factors that cause thirst and high fluid intake) in HD patients include high sodium intake, potassium depletion, increased blood urea, sugar and angiotensin II (Ang II) levels, and psychologic factors (2,3,5,10 -16). Another potential dipsogenic factor is the reduction of salivary flow rate. Recently, Brunstrom et al. (17) demonstrated that healthy volunteers consume more water and drink more frequently in the xerostomic state, which is induced by decreasing saliva in the oral cavity. Because xerostomia (symptoms of oral dryness), which is caused by the reduction of salivary flow, is prevalent among HD patients (18 -23), it is conceivable that the decreased salivary flow leads to thirst and excess IDWG. Some observational studies (24,25) have described an association between xerostomia and IDWG in HD patients; however, other known dipsogenic factors (e.g., blood urea, Ang II, sugar level) were not controlled in those studies. In addition, no interventional trial in the literature indexed by Medline has demonstrated the impact of the decreased salivary flow on IDWG. Therefore, whether the decreased salivary flow influences fluid intake in HD patients remains undetermined.We conducted a 3-mo prospective observational study followed by a trial of pilocarpine-a parasympathomimetic agent that has been shown effectively to increase salivary flow in radiation-induced xerostomia or Sjö gren syndrome (26 -29)-to determine whether the reduction of salivary flow contributes to exaggerated thirst and excess IDWG in HD patients and whether pilocarpine can alleviate it.

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Section: Discussionmentioning

confidence: 99%

Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients

Sung¹,

Kuo²,

Guo

et al. 2005

Journal of the American Society of Nephrology

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“…Thirst has previously been measured and described in healthy persons, 27 in patients with renal failure, [28][29][30] terminal illness, 31,32 diabetes, 33,34 in critically ill patients at intensive care unit, 35,36 and in patients with HF. 11,20 Thirst has mostly been described in research with the sensation of intensity, 11,26,28,35,[37][38][39][40][41] which refers to the strength of the thirst.…”

Section: Definition and Description Of Thirstmentioning

confidence: 99%

“…Stress measured with saliva cortisol increased from baseline to study end in patients with high thirst intensity (median 20 nmol/L to 26 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37];…”

Section: P=0mentioning

confidence: 99%

“…P=0.001), while cortisol remained unchanged in patients with low thirst intensity (25 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] nmol/L to 23 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]; P=0.58).…”

Section: P=0mentioning

confidence: 99%

“…10 A saliva substitute or chewing gum might also be tested to increase thirst. 29 A weight-based fluid restriction (30 ml/kg/day) could also be tested, as it may cause less thirst. 84,85 The findings in this thesis also showed that thirst distress continued over time in patients with HF with a fluid restriction, which indicates the need to evaluate the effects of interventions on thirst regularly.…”

mentioning

confidence: 99%

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Thirst in Patients with Heart Failure : Description of thirst dimensions and associated factors with thirst

Waldréus

2016

Linköping University Medical Dissertations

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Introduction: Nurses and other health care professionals meet patients with heart failure (HF) who report they are thirsty. Thirst is described by the patients as a concern, and it is distressing. Currently there are no standardized procedures to identify patients with increased thirst or to help a patient to manage troublesome thirst and research in the area of thirst is scarce. In order to prevent and relieve troublesome thirst more knowledge is needed on how thirst is experienced and what factors cause increased thirst. Aim: The aim of this thesis was to describe the thirst experience of patients with HF and describe the relationship of thirst with physiologic, psychologic and situational factors. The goal was to contribute to the improvement of the care by identifying needs and possible approaches to prevent and relieve thirst in patients with HF. Methods: The studies in this thesis used a cross-sectional design (Study I) and prospective observational designs (II-IV). Studies include data from patients with HF who were admitted to the emergency department for deterioration in HF (I, IV) or visited an outpatient HF clinic for worsening of HF symptoms (III); others were patients who were following up after HF hospitalization (II), and patients with no HF diagnosis who sought care at the emergency department for other illness (I). Patients completed questionnaires on thirst intensity, thirst distress, HF self-care behaviour, feeling depressive and feeling anxious. Data on sociodemographic, clinical characteristics, pharmacological treatment and prescribed fluid restriction were retrieved from hospital medical records and by asking the patients. Data were also collected from blood, urine and saliva samples to measure biological markers of dehydration, HF severity and stress. Results: Thirst was prevalent in 1 out of 5 patients (II) and 63% of patients with worsening of HF symptoms experienced moderate to severe thirst distress at hospital admission (IV). Patients at an outpatient HF clinic who reported thirst at the first visit were more often thirsty at the follow-up visits compared to patients who did not report thirst at the first visit (II). Thirst intensity was significantly higher in patients hospitalized with decompensated HF compared to patients with no HF (median 75 vs. 25 mm, visual analogue scale [VAS] 0-100 mm; P < 0.001) (I). During optimization of pharmacological treatment of HF, thirst intensity increased in 67% of the patients. Thirst intensity increased significantly more in patients in the high thirst intensity group compared to patients in the low thirst intensity group (median +18 mm vs. -3 mm; P < 0.001) (III). Patients who were admitted to the hospital with high thirst distress continued to have high thirst distress over time (IV). A large number of patients were bothered by thirst and feeling dry in the mouth when they were thirsty (III, IV). Patients with a fluid restriction had high thirst distress over time and patients who were feeling depressed had high thirst intensity over time...

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