End-Stage Renal Disease-Related Oral Manifestations and Its Respective Factors in an Iranian Population
Researcher Bulletin of Medical Sciences,
Vol. 29 No. 1 (2024),
4 January 2025
,
Page e16
Abstract
Introduction: Patients with end-stage renal disease (ESRD) suffer from various complications, including oral manifestations, which have a detrimental impact on the quality of life of these patients. We aimed to determine the prevalence of oral manifestations and the related factors in patients with ESRD undergoing hemodialysis.
Materials and Methods: This descriptive-analytical and cross-sectional study was conducted in 2022 on 105 hemodialytic ESRD patients, aging 16-90 years old in Amir Al-Momenin hospital in Tehran. The binary logistic regression model and IBM SPSS 16 software were used to determine the relevant factors' effect (p-value <0.05).
Results: Oral manifestations included coated tongue (30.5%), xerostomia (28.6%), sublingual varices (24.8%), mucosal pallor (14.3%), metallic taste (13.3%), oral candidiasis (11.4%), petechiae-ecchymosis (10.5%), burning mouth sensation (5.7%), mucosal ulcers (3.8%) and lichenoid lesions (0.95%). The DMFT (decayed, missing, and filled teeth) and O'Leary indices were 21.37±7.96 and 83.84±22.47, respectively.
Conclusions: Oral manifestations seem to be highly prevalent among ESRD patients; Coated tongue, xerostomia, and sublingual varices are the most widespread lesions in ESRD individuals. Health care providers should be aware of ESRD-related oral manifestations and their management to enhance patients' quality of life.
- Chronic kidney disease; End stage renal disease; Hemodialysis; Oral manifestation; Xerostomia
How to Cite
References
1. Gupta V, Rai R, Satia G. Oral manifestation in pre-renal transplant patients in Tertiary Care Hospital in Punjab. Int J Res Dev Pharm Life Sci 2019;8:20–3.
2. Miyata Y, Obata Y, Mochizuki Y, Kitamura M, Mitsunari K, Matsuo T, et al. Periodontal Disease in Patients Receiving Dialysis. Int J Mol Sci 2019;20. https://doi.org/10.3390/ijms20153805.
3. Dembowska, E.; Jaroń, A.; Gabrysz-Trybek, E.; Bladowska, J.; Trybek, G. Oral Mucosa Status in Patients with End-Stage Chronic Kidney Disease Undergoing Hemodialysis. Int. J. Environ. Res. Public Health 2023, 20, 835. https://doi.org/10.3390/ijerph20010835
4. Rashpa RS, Mahajan VK, Kumar P, Mehta KS, Chauhan PS, Rawat R, et al. Mucocutaneous manifestations in patients with chronic kidney disease: a cross-sectional study. Indian Dermatol Online J 2018;9:20.
5. Manley KJ, Haryono RY, Keast R. Taste changes and saliva composition in chronic kidney disease. Ren Soc Australas J 2012;8:56–60.
6. Costantinides F, Castronovo G, Vettori E, Frattini C, Artero ML, Bevilacqua L, et al. Dental Care for Patients with End-Stage Renal Disease and Undergoing Hemodialysis. Int J Dent 2018;2018:9610892. https://doi.org/10.1155/2018/9610892.
7. Swapna LA, Reddy RSL, Ramesh T, Reddy RSL, Vijayalaxmi N, Karmakar P, et al. Oral health status in haemodialysis patients. J Clin Diagn Res 2013;7:2047–50. https://doi.org/10.7860/JCDR/2013/5813.3402.
8. Ruokonen H, Nylund K, Meurman JH, Heikkinen AM, Furuholm J, Sorsa T, et al. Oral symptoms and oral health-related quality of life in patients with chronic kidney disease from predialysis to posttransplantation. Clin Oral Investig 2019;23:2207–13. https://doi.org/10.1007/s00784-018-2647-z.
9. Jafari A, Alaee A, Ghods K. The etiologies and considerations of dysgeusia: A review of literature. J Oral Biosci 2021;63:319–26. https://doi.org/10.1016/J.JOB.2021.08.006.
10. Albagieh H, Alosimi A, Aldhuhayan A, AlAbdulkarim A, Fatani B, Alabood A. Dental management of patients with renal diseases or undergoing renal transplant. Saudi Dent J. 2024 Feb;36(2):270-276. doi: 10.1016/j.sdentj.2023.11.023. Epub 2024 Jan 9. PMID: 38420005; PMCID: PMC10897630.
11. Marinoski J, Bokor-Bratic M, Mitic I, Cankovic M. Oral mucosa and salivary findings in non-diabetic patients with chronic kidney disease. Arch Oral Biol 2019;102:205–11. https://doi.org/10.1016/j.archoralbio.2019.04.021.
12. Oyetola EO, Owotade FJ, Agbelusi GA, Fatusi OA, Sanusi AA. Oral findings in chronic kidney disease: implications for management in developing countries. BMC Oral Health 2015;15:24. https://doi.org/10.1186/s12903-015-0004-z.
13. Ghadimi S, Tayyebi-khosroshahi H, Emamverdizadeh P. Evaluation of oral manifestation in patients with chronic renal failure undergoing hemodialysis referred to the dialysis department of the imam reza hospital and specialized clinic of the tabriz faculty of dentistry in 2019. Stud Med Sci 2020;31:325–34.
14. Ahmed KM, Mahmood MA, Abdulraheam RH, Ahmed SM. Oral and Dental Findings in Patients with End Stage Renal Disease Undergoing Maintenance Hemodialysis in Sulaimani City. J Interdiscipl Med Dent Sci 2015;3:2.
15. Honarmand M, Farhad-Mollashahi L, Nakhaee A, Sargolzaie F. Oral manifestation and salivary changes in renal patients undergoing hemodialysis. J Clin Exp Dent 2017;9:e207.
16. Yang M, Xie J, Ouyang Y, Zhang X, Shi M, Li X, et al. ABO blood type is associated with renal outcomes in patients with IgA nephropathy. Oncotarget 2017;8:73603.
17. Alhawary SY, Al-Abdallat ME, Alamro SAA, Saada RJ, Alshboul AAM, Alsmadi T, et al. Frequency of blood groups among a sample of patients with renal failure at Royal Medical Services. Eur Sci J 2015;11(33).
18. Naser W, Melconian A, Alsaffar dr. Study the Relationship between Hemodialysis (HD) Patients and Their ABO Blood Grouping as Well as Screening of Hemodialysis Access-related Bacterial Infections. Curr Res J Biol Sci 2013;5:291–5. https://doi.org/10.19026/crjbs.5.5431.
19. Hamed IA, Mandal AK, Parker D, Czerwinski AW, Mask DR, Wenzl JE. ABO blood groups and renal disease. Ann Clin Lab Sci 1979;9:524–6.
20. Krajewska (Wojciechowska) J, Krajewski W, Zatoński T. Otorhinolaryngological dysfunctions induced by chronic kidney disease in pre- and post-transplant stages. Eur Arch Oto-Rhino-Laryngology 2020;277:1575–91. https://doi.org/10.1007/s00405-020-05925-9.
21. Glick M. Burket’s oral medicine. In: Mehta L, editor. 13th ed., USA: People’s medical publishing house; 2021, p. 579–626.
22. Omidpanah N, Akbari J. Oral Manifestations in Patients with End Stage Renal Disease Undergoing Hemodialysis. J Mashhad Dent Sch 2019;43:312–22.
23. Moradi G, Mohamadi Bolbanabad A, Moinafshar A, Adabi H, Sharafi M, Zareie B. Evaluation of Oral Health Status Based on the Decayed, Missing and Filled Teeth (DMFT) Index. Iran J Public Heal 2019;48:2050–7.
24. Newman M, Carranza F, Takei H, Klokkevold P. Newman and Carranza’s Clinical Periodontology. 13th ed., 2019, p. 511–20.
25. Nafar M, Aghighi M, Dalili N, Abedi BA. Perspective of 20 years hemodialysis registry in Iran, on the road to progress. Iran J Kidney Dis 2020;14:95–101.
26. Arogundade FA, Sanusi AA, Hassan MO, Akinsola A. The pattern, clinical characteristics and outcome of ESRD in Ile-Ife, Nigeria: is there a change in trend? Afr Health Sci 2011;11:594–601.
27. Danser MM, Gómez SM, Van der Weijden GA. Tongue coating and tongue brushing: a literature review. Int J Dent Hyg 2003;1:151–8. https://doi.org/10.1034/j.1601-5037.2003.00034.x.
28. Senthil B, Shanmugam S, Elangovan S, Chandramouli PGE, Bhaskaran S, Ramesh C. Comparative study: Oral mucosal lesions, signs and symptoms in diabetes mellitus patients with end stage renal disease with analogous findings in diabetes mellitus patients with non-end stage renal disease. Indian J Dent Res 2017;28:406–12. https://doi.org/10.4103/ijdr.IJDR_350_16.
29. Kaushik A, Reddy SS, Umesh L, Devi BKY, Santana N, Rakesh N. Oral and salivary changes among renal patients undergoing hemodialysis: A cross-sectional study. Indian J Nephrol 2013;23:125–9. https://doi.org/10.4103/0971-4065.109421.
30. Bossola M. Xerostomia in patients on chronic hemodialysis: An update. Semin Dial 2019;32:467–74. https://doi.org/10.1111/sdi.12821.
31. Velan E, Sheller B. Oral health in children with chronic kidney disease. Pediatr Nephrol 2021;36:3067–75. https://doi.org/10.1007/s00467-020-04913-9.
32. Proctor R, Kumar N, Stein A, Moles D, Porter S. Oral and dental aspects of chronic renal failure. J Dent Res 2005;84:199–208. https://doi.org/10.1177/154405910508400301.
33. Afroozi B, Ghapanchi J, Khorshidi H, Esnaashari N, Faghih M. Oral findings in chronic kidney disease. A cross-sectional study in Shiraz, Iran. J Nephropathol 2018;7:263–7.https://doi.org/10.15171/jnp.2018.52.
34. Dande R, Gadbail AR, Sarode S, Gadbail MPM, Gondivkar SM, Gawande M, et al. Oral Manifestations in Diabetic and Nondiabetic Chronic Renal Failure Patients receiving Hemodialysis. J Contemp Dent Pr 2018;19:398–403.
35. Chuang SF, Sung JM, Kuo SC, Huang JJ, Lee SY. Oral and dental manifestations in diabetic and nondiabetic uremic patients receiving hemodialysis. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology 2005;99:689–95. https://doi.org/10.1016/j.tripleo.2004.06.078.
36. Akkaya N, Ölmez D, Özkan G. Evaluation of the factors associated with sublingual varices: a descriptive clinical study. Folia Morphol (Warsz) 2019;78:325–30. https://doi.org/10.5603/FM.A2018.0101.
37. Barzideh N, Alaee A, Azizi A. The Relationship between Smoking and Sublingual Varices in the Elderly. Oman Med J 2021;36:e288. https://doi.org/10.5001/omj.2021.94.
38. Jafari A, Alaee A, Rezai M, Masoudi M. Evaluation of Sublingual Varices Prevalence and Its Respective Factors in Two Iranian Nursing Homes in 2019. Iran J Otorhinolaryngol 2022;34:165–9. https://doi.org/10.22038/ijorl.2022.63364.3170.
39. Patil S, Khaandelwal S, Doni B, Rahuman F, Kaswan S. Oral manifestations in chronic renal failure patients attending two hospitals in North Karnataka, India. Oral Health Dent Manag 2012;11:100–6.
40. Gupta H, Bhateja S, Arora G. Oral manifestations, dental considerations and treatment protocols for chronic renal disease or end-stage renal disease 2019. IP International Journal of Aesthetic and Health Rejuvenation, July-September, 2019;2(3):48-53
41. Kuravatti S, David MP, Indira AP. Oral manifestations of chronic kidney disease-an overview. Int J Contemp Med Res 2016;3:1149–52.
42. Murali P, Narasimhan M, Periasamy S, Harikrishnan TC. A comparison of oral and dental manifestations in diabetic and non-diabetic uremic patients receiving hemodialysis. J Oral Maxillofac Pathol 2012;16:374–9. https://doi.org/10.4103/0973-029X.102490.
43. Alirezaei S, Razeghi E, Rezaie M, Moezi Ghadim N, Sabet Ghadam L. Evaluation of the Prevalence of Oral Manifestations and the Related Factors in Hemodialysis Patients at Selected Hospitals of Tehran Province in 2016. J Res Dent Maxillofac Sci 2018;3:14–23. https://doi.org/10.29252/jrdms.3.2.14.
44. Ahmadieh A, Baharvand M, Fallah F, Djaladat H, Eslani M. Oral microflora in patients on hemodialysis and kidney transplant recipients. Iran J Kidney Dis 2010;4:227–31.
45. Jafary Heidarloo M, Mehrinejad S, Sarrafan N. Evaluation of frequency of oral manifestation in end stage renal disease patients undergoing Hemodialysis in Imam Khomeini Hospital in Urmia. Stud Med Sci 2017;28:410–7.
46. Ruospo M, Palmer SC, Craig JC, Gentile G, Johnson DW, Ford PJ, et al. Prevalence and severity of oral disease in adults with chronic kidney disease: A systematic review of observational studies. Nephrol Dial Transplant 2014;29:364–75. https://doi.org/10.1093/ndt/gft401.
47. Rezazadeh F, Bazargani A, Roozbeh-Shahroodi J, Pooladi A, Arasteh P, Zamani K. Comparison of oral Lactobacillus and Streptococcus mutans between diabetic dialysis patients with non-diabetic dialysis patients and healthy people. J Ren Inj Prev 2016;5:148–52. https://doi.org/10.15171/jrip.2016.31.
48. Mahajan S, Bhaskar N, Kaur RK, Jain A. A comparison of oral health status in diabetic and non-diabetic patients receiving hemodialysis – A systematic review and meta-analysis. Diabetes Metab Syndr Clin Res Rev 2021;15. https://doi.org/10.1016/j.dsx.2021.102256.
49. Ewald DR, Sumner SC. Blood type biochemistry and human disease. Wiley Interdiscip Rev Syst Biol Med 2016;8:517–35. https://doi.org/10.1002/wsbm.1355.
50. Alhawary SY, Al-Abdallat ME, Alamro SAA, Saada RJ, Alshboul AAM, Alsmadi T, et al. Frequency of Blood Groups among Sample of Patients with Renal Failure. Eur Sci J 2015;11:17–22.
51. Silva DF, Oliveira ICR, Medeiros SA, Baeder FM, Albuquerque ACL, Lima EO. Oral health challenges in patients with chronic kidney disease: A comprehensive clinical assessment. Saudi Dent J. 2024 Feb;36(2):364-367. doi: 10.1016/j.sdentj.2023.11.026. Epub 2023 Nov 27. PMID: 38419998; PMCID: PMC10897613.
- Abstract Viewed: 60 times