Title: Correlating the Severity of Chronic Kidney Disease with Oral Health: A Prospective Observational Study
Authors: Dr Mayilananthi K, Dr Durga Krishnan, Dr Sarah Premraj, Dr Bhaya Mathivanan, Prof. Dr Rajasekaran D
DOI: http://dx.doi.org/10.18535/jmscr/v4i7.53
Abstract
Background: Chronic kidney disease (CKD) is defined as a progressive and most often, irreversible decline in renal function. Changes in the oral cavity, such as periodontitis, oral candidiasis, xerostomia, halitosis, dental caries and other manifestations, are common in patients with chronic kidney disease. Only a few studies have been done to establish the relationship between different oral manifestations in various stages of CKD. Hence this study was conducted to analyze the presence of oral diseases in adults with CKD and explore the association between the various oral manifestations in different stages of CKD.
Methods: 100 patients with Chronic Kidney Disease in various stages grouped by Glomerular Filtration Rate (GFR) were screened. 89 patients who met the selection criteria were enrolled in the study. After history and physical examination, detailed oral examination was done along with collection of saliva. The results were correlated with various stages of CKD.
Results: In our study, we have examined 89 patients who are having various stages of chronic kidney disease. On which, decay was present in 34% of patients, xerostomia was present in 19% of patients, periodontitis was present in 99.4% of patients which is highly significant, and oral candidiasis was present in 31% of patients.
Conclusion: There is an increased risk of periodontal disease in patients with CKD. There is an inverse relationship between the periodontal disease and GFR. Oral manifestations such as decay, oral candidiasis, and xerostomia are also noted with increased frequency in Chronic Kidney Disease patients.
Key words: Chronic Kidney Disease, oral manifestations, periodontitis.
References
1. Andrew S. Levy, Kai-Uwe ECKARDT, Yusuke tsukamoto. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving global outcome (KDIGO) Kidney international, vol 67 (2005) PP 2089-2100
2. Ajay K Singh, Youssef MK Farrag, Bharati V Mittal Epidemiology and risk factors of chronic kidney disease in India from the SEEK (Screening and Early Evaluation of Kidney Disease) study BMC Nephrology 2013 14:114
3. Helen I McDonald, Sara L Thomas, Dorothea Nitsch Chronic kidney disease as a risk factor for acute community-acquired infections in high-income countries: a systematic review BMJ Open 2014;4:e004100
4. Cleber M Souza, Ana Paula R Braosia, Sônia M Luczyszyn,Rafaela W. Casagrande, Roberto Pecoits-Filho,Miguel C Riella, Sérgio A Ignácio, Paula C Trevilattoa Oral health in Brazilian patients with chronic renal disease Rev Med Chile. 2008 Jun;136(6):741-6
5. Patil, S., Khandelwal, S., Doni, B., Rahman, F. and Kaswan, S. Oral manifestations in chronic renal failure patients attending two hospitals in north Karnatka, India. OHDM, 2012; 11(3): 100-106
6. Loesche WJ, Grossman NS. Periodontal disease as a specific, albeit chronic, infection: diagnosis and treatment. Clin Microbiol Rev. 2001;14:727–52
7. Borawski J, Borawska WM, Stokowska W, Mys´liwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant 2007;22:457–464
8. Nadeem M, Stephen L, Schubert C, Davids MR. Association between periodontitis and systemic inflammation in patients with end-stage renal disease. SADJ 2009;64:470-473
9. NATIONAL KIDNEY FOUNDATION: K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis 39 (Suppl 1):S1–S266, 2002
10. Cutress TW1, Ainamo J, Sardo-Infirri Jnt Dent J. The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J. 1987 Dec;37(4):222-33.
11. Mahon CR, Lehman DC, Manuselis G. Textbook of diagnostic microbiology 3rd edition. Philadelphia: Saunders; 2007
12. Guggenheimer J1, Moore PA, Rossie K Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and Candidal lesions Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 May;89(5):570-6
13. Elijah O Oyetola , Foluso J Owotade Oral findings in chronic kidney disease: implications for management in developing countries Oyetola et al. BMC Oral Health (2015) 15:24 DOI 10.1186/s12903-015-0004-z
14. Proctor R, Kumar N, Stein A, Moles D, Porter S. Oral and dental aspect of chronic renal failure. J Dent Res. 2005;84:199–208
15. Udaykumar, P., Balasubramanian, S., Ramalingam, KS., Lakshmi, C., Srinivas, CR. and Mathew, A.,C. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. IJDVL, 2006; 72(2): 119-25
16. Murali, P., Narasimhan, M., Periasamy, S. and Harikrishan, T.,C. A comparision of oral and dental manifestations in diabetic and non-diabetic uremic patients receiving hemodialysis. J Oral Maxillofac Pathol, 2012; 16(3): 374-79
17. Manley KJ1. J Ren Care. Saliva composition and upper gastrointestinal symptoms in chronic kidney disease 2014 Sep;40(3):172-9. doi: 10.1111/jorc.12062. Epub 2014 Mar 20.
18. Ulasi I, Chinwuba K. The enormity of chronic Renal Disease in Nigeria. The situation in a teaching Hospital in South-East Nigeria. Journal of Tropical Medicine volume 2010 Article ID 501957, 6 pages doi: 101155/2010/501957
19. Porter SR, Hegarty A, Scully C (2004). An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Patho Oral Radiol Endod 97: 28-46
20. Thorman R, Neovius M, Hylander B. Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population. Scand J Urol Nephrol.2009;43(2):154–159
21. A. Kaushik, S. S. Reddy,1 L. Umesh,2 B. K. Y. Devi,1 N. Santana,1 and N. Rakesh1 Oral and salivary changes among renal patients undergoing hemodialysis: A cross-sectional study Indian J Nephrol. 2013 Mar-Apr; 23(2): 125–129
22. Bayraktar G, Kurtulus I, Duraduryan A, et al. Dental and periodontal findings in hemodialysis patients. Oral Dis 2007; 13:393-397
23. Gavaldá C, Bagán J, Scully C, Silvestre F, Milián M, Jiménez Y. Renal hemodialysis patients: Oral, salivary, dental and periodontal findings in 105 adult cases. Oral Dis 1999;5:299-302
24. Sobrado Marinho JS1, Tomás Carmona I, Loureiro A, Limeres Posse J, García Caballero L, Diz Dios P Oral health status in patients with moderate-severe and terminal renal failure Med Oral Patol Oral Cir Bucal. 2007 Aug 1;12(4):E305-10
25. Bots CP, Brand HS, Poorterman JH, et al. Oral and salivary changes in patients with end stage renal disease (ESRD): a two year follow-up study. Br Dent J2007;202:E3.
26. Royne T, Martin N, Britta H. Prevalence and early detection of fungi infection; A cross sectional controlled study in a group of Swedish end – stage renal disease patients. Scand J Urol Nephrol. 2009;43:325–30
27. Gavalda C, Bagan J, Scully C, Silvester F, Milian M, Jimenez Y. Renal hemodialysis patient; oral, salivary, dental and periodontal findings in 105 adult cases. Oral Dis. 1999;5:299–302.