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Kidney Week

Abstract: FR-PO417

Oral Mucosal Lesions and Association with Mortality in Hemodialysis Patients: A Prospective Cohort Analysis (ORAL-D Substudy)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Ruospo, Marinella, Diaverum, Lund, Sweden
  • Palmer, Suetonia, University of Otago, Christchurch, New Zealand
  • Graziano, Giusi, Diaverum, Lund, Sweden
  • Natale, Patrizia, Diaverum, Lund, Sweden
  • Saglimbene, Valeria Maria, Diaverum, Lund, Sweden
  • Craig, Jonathan C., Flinders University, Adelaide, New South Wales, Australia
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Tonelli, Marcello, University of Calgary, Calgary, Alberta, Canada
  • Celia, Eduardo Jorge, Diaverum, Lund, Sweden
  • Dulawa, Jan J., SUM Katowice, Katowice, Poland
  • Bednarek, Anna, Diaverum, Lund, Sweden
  • Török, Marietta, Diaverum, Lund, Sweden
  • Stroumza, Paul, Diaverum, Lund, Sweden
  • Del castillo caba, Domingo, Health Service, Spain, Spain
  • Bernat, Amparo, Diaverum, Lund, Sweden
  • Hegbrant, Jorgen BA, Diaverum, Lund, Sweden
  • Wollheim, Charlotta, Diaverum, Lund, Sweden
  • Gargano, Letizia, Diaverum, Lund, Sweden
  • Strippoli, Giovanni F.M., Diaverum, Lund, Sweden

Impaired oral health is prevalent and frequently severe for adults treated with long term hemodialysis. We aimed to evaluate the prevalence of oral mucosal lesions and association with mortality outcomes among hemodialysis patients.


We did a planned analysis of ORAL-D. ORAL-D is a prospective multinational cohort study evaluating a standardized oral and dental examination among 4726 hemodialysis. Oral mucosal lesions included ulceration, red lesion, white lesion, geographical tongue, fissured tongue, candidiasis and herpes using WHO recommended methods. The association between mucosal lesions and all-cause and cardiovascular mortality was estimated using a Cox proportional hazard regression model adjusted for age, sex, education, smoking history, prior myocardial infarction, diabetes, hemoglobin, serum albumin, serum phosphorus, time on dialysis and body mass index. Analyses were clustered by country. The outcomes were prevalence and all-cause and cardiovascular mortality.


4205 adults (mean age 61.6 ± 15.6 years) had a complete oral examination. 40% had at least one oral lesion. The point prevalence of oral lesions was (in ascending order of frequency): oral herpes 0.5%, mucosal ulceration 1.7%, neoformation 2.0%, white lesion 3.5%, red lesion 4.0%, oral candidiasis 4.6%, geographical tongue 4.9%, petechial lesions 7.9%, and fissured tongue 10.7%. During median follow-up of 3.5 years, 2114 patients died (1013 from cardiovascular causes). Oral candidiasis was associated with all-cause mortality (adjusted hazard ratio (aHR) 1.37, 95% CI 1.00 to 1.86) and cardiovascular mortality (aHR 1.64, 95% CI 1.09 to 2.46). There was no association observed for any other oral mucosal lesion with mortality.


Oral mucosal lesions are prevalent in hemodialysis patients. Oral candidiasis appears to be a risk factor for death.


  • Veterans Affairs Support