Effects of Expelling of Induced Hypersalivation on Serum Phosphorus, Urea and Creatinine Levels in End Stage Renal Disease Patients

Abstract

Introduction: Saliva has hundreds of components that may serve to detect systemic diseases or as evidence of exposure to various harmful substances, as well as provide biomarkers of health and disease status. Pilocarpine has effects on serum urea, creatinine and phosphorus in patients with chronic kidney disease (CKD) and patients with End Stage Renal Disease (ESRD) on hemodialysis. Pilocarpine is a parasympathomimetic drug used to induce hypersalivation. Parasympathetic stimulation leads to acetylcholine (ACh) release into the salivary acinar cells. ACh causes the salivary gland to release kallikrein, an enzyme that converts kininogen to lysyl-bradykinin. Lysyl-bradykinin acts upon blood vessels and capillaries of the salivary gland to generate vasodilation and increased capillary permeability respectively. The resulting increased blood flow to the acini allows production of more saliva. Aim of work: To determine the effects of expelling induced hyper salivation on serum Phosphorus, urea and creatinine levels in CKD and ESRD patients. Materials and Methods: It is a case control study which included 80 patients divided into Group A: 40 patients with End Stage Renal Disease on Hemodialysis for at least six months in Assiut University Hospital and Group B: 40 patients with Chronic Kidney Disease (stage 3,4) on conservative medical treatment. Both groups were complaining of hyperphosphatemia. Their ages ranged from 18 to 60 years old with mean age ± SD (51 ± 11) pilocarpine mouth washer (4% concentration, 5 ml pilocarpine which equals 13 mg, three times daily) is given for two months. Results:. After pilocarpine intake; there was a decrease in serum phosphorus level in CKD patients (33%) than those with ESRD (30%). But there was a decrease in serum creatinine level in ESRD patients (23%) than those with CKD patients (15%). The two groups had the same percentage of decrease in blood urea level (40%). In salivary measures after pilocarpine intake; one hundred percent increase in phosphorus excretion in both group but patients with ESRD showed more creatinine excretion compared to patients with CKD (84% vs. 60%). CKD patients had more urea excretion in saliva versus to patients with ESRD (100% and 55%) respectively. Conclusion: Pilocarpine has a role in improving hyperphosphatemia in CKD patients and ESRD patients, also pilocarpine led to decrease in serum urea and creatinine levels so it can be used as an adjuvant therapy in CKD and ESRD patients.