Physiological Changes of Salivary Parameters in Patients with End Stage Renal Failure

Mohammed Hadi, Khalid H. Gathwan


Background:Many oral diseases were recorded in ESRD patients including as gingivitis, tooth mobility, xerostomia, ammonia-like smell, mucosal pallor and lesions, malocclusion and an increased risk of dental erosion. Salivary changes among ESRD patients might be attributed to renal failure, use of multiple medications, vomiting, depressive mood and low oral health hygiene.
Aim of study: to assess the salivary changes of patients with end stage renal disease.To determine whether there is changes in salivary compositions and biochemical parameters (urea, creatinine, salivary PH) of patients with end stage renal failure.To find whether there is change in salivary trace element (zinc, copper).To identify whether there is change in salivary electrolyte (sodium, potassium, calcium, phosphate).Determine whether there is a change in salivary enzymes (amylase).

Subjects, Materials and Methods:A cross sectional study carried out in two dialysis centers in Baghdad (Al-Khadhimya Teaching Hospital and Al-Karamah Teaching Hospital) through a period from 1st of March to end of 30th of July, 2015 on convenient sample of 64 patients with end stage renal diseases and on 64 healthy controls. Salivary samples were collected by the researcher at the end of dialysis. Saliva was collected using the standard way of collection. The samples controlled to avoid drooling or swallowing. Whole saliva was collected under resting conditions in a quiet room. Duration was between 0900 and noon at least 1 h after di- alysis. Each patient was asked to chew a piece of Arabic gum (0.5-0.7 gm) for one minute, all saliva was removed expectoration, chewing was continued for five minutes with the same piece of gum and saliva was collected in sterile screw capped bottle. Salivary urea and Amylase were analyzed by specific kits, while slivary PH was tested by a hand-held pH meter. Salivary trace elements of saliva were analyzed at the Poisoning Consultation Center/Specialized Surgeries hospital by flame atomic absorption following standardized procedure.

Results: Mean age of ESRD patients was 50.1±14.9 years, males were more than females. No significant difference was observed between patients and controls regarding age and gender.There was a highly significant difference in salivary Potassium, Sodium, Calcium, Copper, Urea and Amylase levels between ESRD patients and controls (p<0.001). There was a significant difference in sal- ivary Zinc level between ESRD patients and controls (p=0.02). There was a significant association between increased age of ESRD patients and HT (p=0.04). A significant association was observed between HT among ESRD patients and high salivary Zinc level (p=0.008).

Conclusion: Abnormal high Salivary Urea concentration in ESRD patients are associated with or was high and it was a significant predictor of ESRD. This study showed that salivary minerals (Potassium, Sodium, Calcium and Copper) were more likely to be re- duced in ESRD patients undergone hemodialysis. 


Salivary Parameters; Renal Failure.

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Tomás, I. Marinh, J. S. Limeres, J. Santos, M. J.; Arau, L. and Diz, P. Changes in salivary composition in patients with renal failure. Archives of oral biology2008; 53: 528–532.

Baum, BJ. Yates, JR., Srivastava, S.; Wong, DT., Melvin, JE. Scientific frontiers: emerging technologies for salivary diagnostics. Adv Dent Res 2011; 23: 360‒368.

Atassi, F. Oral home care and the reasons for seeking dental

care by individuals on renal dialysis. J Contemp Dent Pract,

; 3: 31-41.

Proctor, R., Kumar, N., Stein, A., Moles, D., Porter, S. Oral

and dental aspects of chronic renal failure. J Dent Res 2005;

: 199-208.

Marakoglu, I., Gursoy, U. K., Demirer, S., Sezer H.

Periodontal status of chronic renal failure patients receiving

hemodialysis. Yonsei Med J 2003; 44: 648-652. 6. Hadi, B. A. A., Al-Jubouri, R. H. Salivary and plasma analysis of oxidative stress biomarkers in end stage renal

failure patients. J BaghColl Dentistry2011; 23: 46-50. 7. Bots, C. P., Brand, H. S., Poorterman, J. H. G., Valentijn- Benz, M., ter Wee, P. M., Veerman, E. C. I., et al. Oral and salivary changes in patients with end stage renal disease )ESRD(: a two year follow-up study. British Dental Journal

; 202: E7.

Al Wakeel, J.S., Mitwalli, A.H., Al Mohaya, S., Abu-Aisha,

H., Tarif, N., Malik, G.H., Hammad, D.Morbidity and mortality in ESRD patients on dialysis. Saudi J Kidney Dis Transpl2002; 13)4(:473-7.

Chu, J.K., Folkert, V.W.Renal function recovery in chronic dialysis patients. Semin Dial2010; 23: 606-613.

Silva, L.S., Oliveira, R.A., Silva, G.B., Lima, J.W., Silva, R.P., Liborio, A.B., et al.Cardiovascular disease in patients with end-stage renal disease on hemodialysis in a developing country. Saudi J Kidney Dis Transpl2012; 23)2(:262-6.

Manley, K.J.,Haryono, R.Y., &Keast, RSJ. Taste changes and saliva composition in chronic kidney disease. Renal Society of Australasia Journal 2012; 8)2(: 56-60.

Abdellatif, A.M., Hegazy, S.A., Youssef, J.M. The oral health status and salivary parameters of Egyptian children on hemodialysis. Journal of advanced research2011; 2: 313-318.

Bayraktar, G., Kurtulus, I., Kazancioglu, R., Bayramgurler, I., Cintan, S., Bural, C., Bozfakioglu, S., Issever, H., Yildiz, A. Oral health and inflammation in patients with End-Stage Renal failure. Perit Dial Int2009; 29: 472-479.

Al-Nowaiser, Roberts, G.J., Trompeter, R.S., Wilson, M., Lucas, V.S. )2003(. Oral health in children with chronic renal failure. PediatrNephrol 18:39–45.

Ali, S.P., Gupta, J., Nagesh, K.S., Iyengar, A.R. Blood Urea & Salivary )2013(. Urea levels in End Stage Renal Failure. Indian Medical Gazette. 373-375

Abdulla, H. I.; Al-Kotany, M. Y., and Mahdi, K. A. )2012(. Assessment of oral manifestations of patients with renal failure undergoing hemodialysis by serum a salivary biomarkers. MDJ, 9: 118-129.



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