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Abstract: FR-PO418

Oral Symptoms and Salivary Function 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
  • 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

Oral symptoms and impaired salivary function are frequently reported by adults treated with long term hemodialysis. We evaluated the association of oral symptoms and salivary function and with all-cause and cardiovascular mortality.


We did a planned sub-analysis in the ORAL-D study, a multinational cohort study involving a standardized oral and dental examination among 4726 hemodialysis patients. We assessed oral mucosal self-reported symptoms (thirst and xerostomia) and salivary characteristics (pH, buffer capacity, flow rate pre/post dialysis). The association with all-cause and cardiovascular mortality was estimated using a Cox proportional hazard regression model adjusted for country, age, sex, education, smoking history, prior myocardial infarction, diabetes, and time on dialysis.


In 4205 adults (mean age 61.6±15.6 years), the mean salivary pH was 7.45 (SD 1.35), with more than 60% of patients (n=1621) with high salivary buffering capacity. The mean pre-dialysis salivary flow rate was 0.83 (SD 0.74) ml/min, and slightly decreased at the end of dialysis (0.76 ± 0.80 ml/min). During median follow-up of 3.5 years, salivary flow rate was associated with lower all-cause (adjusted hazard ratio (aHR) 0.85, 95% CI 0.76 to 0.95 for pre-dialysis flow rate and aHR 0.84, 95% CI 0.75 to 0.94 for post-dialysis flow rate) and cardiovascular mortality (HR 0.74, 95% CI 0.62 to 0.90 for pre-dialysis flow rate and HR 0.74, 95% CI 0.61 to 0.90 for post-dialysis flow rate). When considering the risk of mortality associated with Xerostomia Inventory items, requiring to sip a drink to swallow better was associated with all-cause and cardiovascular mortality (HR 1.26, 95% CI 1.07 to 1.48 and 1.30, 95% CI 1.02 to 1.66, respectively). Similarly, Thirst Inventory items were associated with all-cause mortality.


Oral symptoms are prevalent in haemodialysis patients. Salivary characteristics and related symptoms are associated with mortality.