Bruzda-Zwiech A, Szczepańska J, Zwiech R
Department of Pediatric Dentistry Medical University of Lodz, Poland 92-213 Lodz, Pomorska 251,
Med Oral Patol Oral Cir Bucal. 2018 Jul 1;23(4):e406-e412. doi: 10.4317/medoral.22294.
In 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.
The 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.
Significantly 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.
Concomitant 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.
在血液透析（HD）患者中，口干症和唾液分泌减少可能会加剧口渴感，并导致液体摄入以及透析间期体重过度增加（IWG）。由于糖尿病患者的IWG被认为高于非糖尿病血液透析患者，这会增加其死亡率，因此确定可能的潜在原因至关重要。因此，本研究调查了导致糖尿病血液透析患者IWG增加的因素。
该研究纳入了97名接受血液透析的患者（38名糖尿病患者）。所有参与者均完成了包括透析口渴量表（DTI）和口干症量表的调查。测量了非刺激性全唾液流速（USWFR），USWFR低于0.1 mL/分钟被视为唾液分泌减少。此外，评估了透析前和透析后的血清钠浓度、钠梯度和IWG。在糖尿病血液透析患者中，测量了糖化血红蛋白（HbA1c）水平。
在DTI方面（21.2±7.7对17.1±6.2：Z=2.44，p=0.03）和口干症方面（40.5±6.1对29.9±14.4：Z=4.15，p=0.003），糖尿病血液透析患者的得分显著高于非糖尿病患者。糖尿病血液透析患者中唾液分泌减少的情况更为常见（Z=2.23，p=0.04）。糖尿病患者的IGW显著更高（Z=2.44，p=0.03），透析前血清钠也是如此（Z=3.4，p=0.008）。高HbA1c水平与较低的血清钠水平相关（r=-0.67，p<0.05）。HbA1c与透析前钠梯度呈正相关（r=0.66，p<0.05）。然而，多元回归分析发现，糖尿病患者IWG增加（>4.8 IWG%）的唯一预测因素仍然是唾液流速和透析前钠梯度。
血液透析患者合并糖尿病似乎会加剧主观口干症和口渴感。它还会因透析前血清钠梯度增加而导致过度的IWG。
