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Abstract
BackgroundIn hemodialysis (HD) patients, xerostomia and hyposalivation may intensify sensations of thirst, and contribute to the intake of fluids and excessive inter-dialytic weight gain (IWG). Since IWG is regarded to be higher in diabetic patients than in non-diabetics HD enhancing their mortality, it is crucial to define plausible underlying causes. Therefore, the study investigates factors contributing to the increased IWG in diabetic HD patients.Material and MethodsThe study included 97 HD patients (38 diabetics) receiving hemodialysis. All participants completed surveys comprising the Dialysis Thirst Inventory (DTI) and Xerostomia Inventory. Unstimulated whole saliva flow rate (USWFR) was measured, with USWFR below 0.1 mL/min being regarded as hyposalivation. Additionally, pre- and post-dialysis serum sodium concentration, sodium gradient and IWG were assessed. In diabetic HD patients, hemoglobin A1c (HbA1c) level was measured.ResultsSignificantly higher scores were found in diabetic than non-diabetic HD patients with regard to DTI (21.2±7.7 vs. 17.1±6.2: Z=2.44, p=0.03) and xerostomia (40.5±6.1 vs. 29.9±14.4: Z=4.15, p=0.003). Hyposalivation was observed more often in diabetic HD patients (Z=2.23, p=0.04). IGW was significantly higher in participants with diabetes (Z=2.44, p=0.03), as was the pre-dialysis sodium serum (Z=3.4, p=0.008). High levels of HbA1c were associated with lower levels of serum sodium (r=-0.67 p<0.05). HbA1c positively correlated with pre-dialysis sodium gradient (r=0.66 p<0.05). However, multiple regression analysis found that the only predictors of increased IWG (>4.8 IWG%) in diabetic patients remained saliva flow rate and pre-dialysis sodium gradient.ConclusionsConcomitant diabetes in hemodialysis patients appears to intensify subjective xerostomia and thirst sensation. It also leads to excessive IWG by the increase of pre-dialysis serum sodium gradient. Key words:Diabetes mellitus, hemodialysis, hyposalivation, inter-dialytic weight gain, sodium gradient.
Highlights
According to the 2013 ERA-EDTA Registry annual report, diabetes is an important contributor to replacement renal therapy (RRT) in Europe and the Mediterranean
Owing to the fact that some studies have demonstrated that inter-dialytic weight gain (IWG) is higher in diabetic HD than in HD patients without concomitant diabetes [14,15,16] and that increased IWG is associated with a higher mortality in diabetic patients on maintenance hemodialysis [16], it is important to define the underlying causes of increased IWG in diabetic HD patients to establish new therapeutic options
The aim of the study was to determine whether concomitant diabetes considerably influences unstimulated salivary flow rate, xerostomia, thirst sensation, serum sodium gradient and IWG in hemodialysis patients, and to investigate which of the mentioned parameters contribute to an increased IWG in diabetic HD patients
Summary
According to the 2013 ERA-EDTA Registry annual report, diabetes is an important contributor to replacement renal therapy (RRT) in Europe and the Mediterranean. Our previous studies found higher inter-dialysis weight gain in hemodialysis patients with hyposalivation than those with normosalivation, and a positive correlation between both xerostomia and thirst with IWG in HD patients; multivariable analysis found that pre-dialysis sodium gradient and lowered saliva flow rate remained significant predictors of excessive IWG. Sung et al report that xerostomia and lowered serum sodium may be contributing factors to greater IGW in both diabetic and non-diabetic HD patients [14], no other previous studies have investigated whether thirst sensation or pre- and post-dialysis serum sodium gradients influence IWG in diabetic HD patients. The aim of the study was to determine whether concomitant diabetes considerably influences unstimulated salivary flow rate, xerostomia, thirst sensation, serum sodium gradient and IWG in hemodialysis patients, and to investigate which of the mentioned parameters contribute to an increased IWG in diabetic HD patients. It leads to excessive IWG by the increase of pre-dialysis serum sodium gradient
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