Kidney Week

Abstract: FR-PO835

Prevalence of Oral Mucosal Lesions in Hemodialysis Patients and Association with Mortality: A Prospective Cohort Study

Session Information

• Dialysis: Hospitalization and Mortality
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Ruospo, Marinella, Diaverum Medical Scientific Office, Lund, Sweden

Marinella Ruospo,

• Török, Marietta, Diaverum Medical Scientific Office, Lund, Sweden

Marietta Török,

• Murgo, Marco Angelo, Diaverum Medical Scientific Office, Lund, Sweden

Marco Angelo Murgo,

• Bednarek, Anna, Diaverum Medical Scientific Office, Lund, Sweden

Anna Bednarek,

• Del castillo caba, Domingo, Diaverum Medical Scientific Office, Lund, Sweden

Domingo Del castillo caba,

• Bernat, Amparo, Diaverum Medical Scientific Office, Lund, Sweden

Amparo Bernat,

• Stroumza, Paul, Diaverum Medical Scientific Office, Lund, Sweden

Paul Stroumza,

• Wollheim, Charlotta, Diaverum Medical Scientific Office, Lund, Sweden

Charlotta Wollheim,

• Hegbrant, Jorgen BA, Diaverum Medical Scientific Office, Lund, Sweden

Jorgen BA Hegbrant,

Group or Team Name

• Oral-D investigators: M Ruospo, S Palmer, P Natale, V Saglimbene, G Graziano, G Wong, J Craig, M Petruzzi, M De Benedittis, E Celia, R Gelfman, M Leal, M. Torok, A Bednarek-Skublewska, J Dulawa, D del Castillo, A Bernat, P Stroumza, L Frantzen, J Hegbrant, C Wollheim, L Gargano, S Schon and GFM Strippoli

Background

Oral mucosal lesions are highly prevalent and frequently severe for adults treated with longterm hemodialysis. We aimed to evaluate the prevalence of mucosal lesions and association with mortality among hemodialysis patients.

Methods

The ORAL-D study was a multinational cohort study that involved a comprehensive, standardized oral and dental examination among 4726 patients with ESKD disease treated with haemodialysis in Europe and South America. We evaluated oral mucosal lesions assessed by trained dentists according to standard WHO guidelines.The association between mucosal lesions and all-cause and cardiovascular mortality was estimated using a Cox proportional hazard regression model. Analyses were adjusted for sociodemographic and clinical variables. The primary outcome was all-cause mortality.

Results

70 participants (1.7%) had mucosal ulceration, 147 (3.5%) presented white stain, 169 (4%) red stain, 85 (2%) neoformation, and 331 (7.9%) had petechial lesions. Overall, 207 (4.9%) had geographical tongue and 450 (10.7%) had a fissured tongue. Oral candidiasis was observed in 192 (4.6%) participants and 21 had oral herpetic lesions. 401 participants (9.5%) had a cancer-related mucosal lesion and 213 participants (5%) an infection-related lesion.
During a median 3.47 (1.55-5.78) months of follow-up, there were 2114 deaths including 1013 cardiovascular deaths. In unadjusted survival analyses, the proportion of patients who died was higher among those with red stain, fissured tongue, and petechial lesions. Similarly, the estimated proportion of patients who had a cardiovascular death was higher among those with red stain, fissured tongue, petechial lesions, neoformation and oral candidiasis. When adjusting for clinical and sociodemographic factors, only the presence of oral candidiasis was significantly associated with an increased risk of all cause (adj HR 1.37, 95% CI 1.00-1.86) and cardiovascular mortality (adj HR 1.64, 95% CI 1.09-2.46). This association was confirmed in competing risks analysis and using a shared frailty model to account for clustering by country.

Conclusion

There is generally limited evidence of an independent association between oral mucosal lesions and mortality outcomes among hemodialysis patients.