Original ResearchPeriodontal Status, Inflammation, and Malnutrition in Hemodialysis Patients – Is There a Link?
Introduction
Recent studies have shown that malnutrition, inflammation, and atherosclerosis are highly prevalent in hemodialysis (HD) patients and are associated with increased morbidity and mortality.1, 2, 3, 4, 5, 6
During the past decade, studies revealed oral infections, particularly periodontal disease (PDD), to be associated with malnutrition, inflammation, atherosclerotic cardiovascular disease7, 8, 9 and therefore with higher mortality rate in HD patients.
Oral health is defined by the World Health Organization (WHO) as “a state of being free from mouth and facial pain, oral infection and sores and PDD”10 and “is essential to the quality of life”.10, 11
Patients with chronic kidney disease (CKD) are predisposed to PDD of various causes: high prevalence of diabetes, protein waste products retention, metabolic, endocrinologic and immunologic disturbances, drugs, dialysis treatment itself,12, 13 changes in daily life, with dental hygiene neglection.11, 14, 15
PDD is highly prevalent in HD patients (about 80%).16 However, oral health status is not regularly investigated; periodontitis is underdiagnosed and undertreated, although a treatable risk factor.17
The aim of the study was to assess the prevalence of PDD and the possible relationship among PDD, inflammation and malnutrition in HD patients.
Section snippets
Subjects
All 263 stable chronic HD patients from a single dialysis center, without malignancies or acute illness were evaluated in a cross-sectional observational study. Twenty-five patients (9.5%) were excluded for edentulism.
Statistical analysis was performed on 238 patients.
Parameters
Oral health status was assessed according to WHO recommendations, by a single examiner. The oral health indicators were (1) plaque index, a measure of oral hygiene; (2) loss of clinical attachment level—the distance between the
Patients' Characteristics
There were 238 HD patients (60% males) with a mean HD vintage of 6.6 ± 4.9 years and a mean age of 57.4 ± 12.3 years. Primary renal diseases were mainly primary glomerulopathies (34%) and only in 11% of cases diabetic nephropathy.
The main characteristics of the enrolled patients are listed in Table 1.
HD treatment included for all patients at least 13.5 hours of HD per week, in 3 sessions, with high flux biocompatible membranes (polisulfone) and bicarbonate-based dialysate, medium blood flow
Discussion
This cross-sectional observational study assessed the prevalence of periodontitis and the possible association among PDD, inflammation, and malnutrition in HD patients, focusing on possible promoters and consequences of PDD.
PDD was highly prevalent in HD patients, with an important percentage of severe injury. Older age, diabetes, smoking, and long HD vintage were associated with higher prevalence, smoking and HD duration being the most important determinants. PDD was more frequent in
Practical Application
The manuscript “Periodontal Status, Inflammation and Malnutrition in Hemodialysis Patients – Is There a Link?” draw attention on the high prevalence of impaired periodontal health in HD patients, especially in elderly, diabetics, smokers, and in those with longer HD vintage. The prevalence is higher in malnourished and in inflamed patients; inflammation seems to accompany PD and to influence anemia response to treatment.
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2020, International Journal of Dental Hygiene
Financial Disclosure: The authors declare that they have no relevant financial interests.