Kidney Week

Abstract: FR-PO417

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

Session Information

• Hemodialysis and Frequent Dialysis - III
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Ruospo, Marinella, Diaverum, Lund, Sweden

Marinella Ruospo,

• Palmer, Suetonia, University of Otago, Christchurch, New Zealand

Suetonia Palmer,

• Graziano, Giusi, Diaverum, Lund, Sweden

Giusi Graziano,

• Natale, Patrizia, Diaverum, Lund, Sweden

Patrizia Natale,

• Saglimbene, Valeria Maria, Diaverum, Lund, Sweden

Valeria Maria Saglimbene,

• Craig, Jonathan C., Flinders University, Adelaide, New South Wales, Australia

Jonathan C. Craig,

• Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia

David W. Johnson,

• Tonelli, Marcello, University of Calgary, Calgary, Alberta, Canada

Marcello Tonelli,

• Celia, Eduardo Jorge, Diaverum, Lund, Sweden

Eduardo Jorge Celia,

• Dulawa, Jan J., SUM Katowice, Katowice, Poland

Jan J. Dulawa,

• Bednarek, Anna, Diaverum, Lund, Sweden

Anna Bednarek,

• Török, Marietta, Diaverum, Lund, Sweden

Marietta Török,

• Stroumza, Paul, Diaverum, Lund, Sweden

Paul Stroumza,

• Del castillo caba, Domingo, Health Service, Spain, Spain

Domingo Del castillo caba,

• Bernat, Amparo, Diaverum, Lund, Sweden

Amparo Bernat,

• Hegbrant, Jorgen BA, Diaverum, Lund, Sweden

Jorgen BA Hegbrant,

• Wollheim, Charlotta, Diaverum, Lund, Sweden

Charlotta Wollheim,

• Gargano, Letizia, Diaverum, Lund, Sweden

Letizia Gargano,

• Strippoli, Giovanni F.M., Diaverum, Lund, Sweden

Giovanni F.M. Strippoli,

Background

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.

Methods

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.

Results

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.

Conclusion

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

Funding

• Veterans Affairs Support