Decreased salivary function in patients with end-stage renal disease requiring hemodialysis

Kao, Chia‐Hung; Hsieh, Jih-Fang; Tsai, Shih‐Chuan; Ho, Yung‐Jen; Chang, Horng-Rong

doi:10.1053/ajkd.2000.19810

Cited by 84 publications

(91 citation statements)

References 21 publications

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“…The demographic data of our participants (Table 1) were comparable to that survey. Xerostomia was reported by 68.9% of the 90 participants in our observational study, which also agreed with other studies (19,25). Measurement of UWS is the most reliable method for quantifying the salivary function (38), and the mean UWS (0.162 Ϯ 0.107 ml/min) of our patients was significantly lower than the normal reference value of 0.25 to 0.5 ml/min (35).…”

Section: Discussionsupporting

confidence: 92%

“…The mechanism of salivary gland dysfunction in HD patients is unknown; however, some researchers (18,19) have proposed that it is caused by dehydration and direct uremic injury. In normal individuals, there is a relationship between the salivary flow rate and body hydration, and the UWS is larger in wellhydrated status than that in dehydrated status (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 92%

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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“…[12][13][14][15][16][17][18][19][20][21][22] They were conducted in small groups of patients, mainly chronic hemodialysis (HD) patients, and gave ambiguous results. However, a number of significant disorders (Table 1) indicating a worse condition of teeth and more advanced PD in HD patients compared to general population were found.…”

Section: Pd In Patients With Chronic Renal Failurementioning

confidence: 99%

“…21 The results of previous clinical researches showed that the PD is a significant health problem in CRF patients. [12][13][14][15][16][17][18][19][20][21][22] Risk factors of its accelerated development in this population are presence of uremic toxins, humoral and cell immunity disorders, anemia, malnutrition, vitamin D deficiency, secondary parathyroid gland hyperfunction, osteoporosis and other bone metabolism disorders, insulin resistance or diabetes, liver lesion in the course of frequent viral infections, as well as condition of general disability impairing the care for oral hygiene. [12][13][14][15][16][17][18][19][20][21][22] The role of growth factors in the pathogenesis of PD in CRF patients was not subject to research so far.…”

Section: Pd In Patients With Chronic Renal Failurementioning

confidence: 99%

Hepatocyte Growth Factor in Saliva of Patients with Renal Failure and Periodontal Disease

et al. 2012

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“…Tais mudanças sistêmicas podem refletir no meio bucal, levando a alterações na composição salivar, com aumento dos níveis de uréia, potássio, fosfato 3,4,5,6 e diminuição nos de Ca e Mg 7 ; no nível do fluxo salivar, com diminuição do mesmo 4,[8][9][10][11][12][13][14][15] ; no pH salivar, que pode ser mais alcalino 6 ; na capacidade-tampão, com aumento da mesma 10,14,16 e elevada formação de cálculo dentário 17 .…”

Section: Introductionunclassified

Avaliação da condição bucal em pacientes renais crônicos submetidos à hemodiálise

Dias¹,

Sá²,

Pereira³

et al. 2007

Rev. Assoc. Med. Bras.

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RESUMOOBJETIVOS. Avaliar a condição bucal dos pacientes com insuficiência renal crônica submetidos à hemodiálise, no município de São Luís, comparando os três centros de referência da cidade e os tempos de hemodiálise. MÉTODOS. A amostra foi constituída por 107 pacientes, nos quais analisou-se o índice de placa (IP) e a prevalência de cárie dentária (CPO-D). Os pacientes foram categorizados em três grupos, de acordo com o tempo de hemodiálise (3 meses a < 1 ano, 1 a 3 anos e > 3 anos). Os dados obtidos foram submetidos aos testes estatísticos ANOVA e Kruskal-Wallis, com nível de significância de 5%. RESULTADOS. As médias/desvios padrão do IP nos grupos foram, respectivamente, 0.91±0.61; 1.04±0.60 e 1.25±0.67. Quanto ao CPO-D destes grupos, as médias/desvios padrão foram 13.63±8.91; 13.89±8.12 e 16.79±7.31. Não houve diferenças significativas entre os centros, nem entre os tempos de hemodiálise estudados. CONCLUSÃO.O tempo de tratamento da doença não alterou ou interferiu no acúmulo de placa bacteriana e na prevalência de cárie dentária. Houve uniformidade na condição bucal dos pacientes nos três centros estudados.UNITERMOS: Insuficiência renal crônica. Saúde bucal. Cárie dentária. Epidemiologia. INTRODUÇÃOA insuficiência renal crônica (IRC) é uma doença sistêmica, relativamente comum, que implica na redução ou limitação da capacidade de filtração glomerular dos rins, causando a uremia, que se caracteriza pelo acúmulo no sangue de substâncias que deveriam ser filtradas e excretadas pelos rins, ocorrendo o comprometimento deste órgão e levando o paciente a fazer uso da hemodiálise.A IRC pode ocasionar determinadas mudanças sistêmicas, tais como alterações cardiovasculares (hipertensão arterial, aterosclerose, pericardites, cardiomiopatias, arritmias cardíacas e hipertensão pulmonar), anemia, problemas hemostáticos e linfocitopenia 1 . Também podem ser observadas alterações ósseas e bioquímicas, além de alterações gastrointestinais e dermatológicas 2 .Tais mudanças sistêmicas podem refletir no meio bucal, levando a alterações na composição salivar, com aumento dos níveis de uréia, potássio, fosfato 3,4,5,6 e diminuição nos de Ca e Mg 7 ; no nível do fluxo salivar, com diminuição do mesmo 4,[8][9][10][11][12][13][14][15] ; no pH salivar, que pode ser mais alcalino 6 ; na capacidade-tampão, com aumento da mesma 10,14,16 e elevada formação de cálculo dentário 17 .Além disso, a falta de cuidados com a higiene bucal pode afetar a saúde bucal destes pacientes, resultando em mais cáries, doenças periodontais e lesões bucais 4,15,18 . Não há consenso quanto à predisposição destes pacientes à cárie dentária. Em pesquisa realizada por Bayraktar et al. 14 , foi observado que não houve mudança quanto à ocorrência de cárie dentária. Já no estudo de Naugle et al. 19 , observou-se que a experiência de cárie dentária foi elevada nos pacientes em diálise, enquanto que nas pesquisas realizadas por AlNowaiser et al. 16 , Jaffe et al .20 e Davidovich et al. 21 , pacientes com IRC em diálise apresentaram menores índices de cárie dentá...

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Decreased salivary function in patients with end-stage renal disease requiring hemodialysis

Cited by 84 publications

References 21 publications

Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients

Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients

Hepatocyte Growth Factor in Saliva of Patients with Renal Failure and Periodontal Disease

Avaliação da condição bucal em pacientes renais crônicos submetidos à hemodiálise

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