CILJ: Bolesnici na hemodijalizi imaju prisutne znakove kronične sistemske upale i učestaliju pojavu sarkopenije. Loše oralno zdravlje također može potaknuti sistemsku upalu i na taj način utjecati na sarkopeniju. Cilj istraživanja bio je ispitati oralno zdravlje i prisutnost sarkopenije u bolesnika na kroničnoj hemodijalizi te utvrditi postoji li njihova povezanost.
METODE: U istraživanje je uključeno 100 ispitanika koji su na kroničnoj hemodijalizi te im je učinjen oralni status, rutinska laboratorijska obrada, analiza sastava tijela bioimpedancijom te mjerenje snage stiska šake dinamometrom. Ispitanici su zatim ispunili upitnike: jedan vezan uz oralno zdravlje (OHIP-14), a drugi vezan uz sarkopeniju (SarQoL).
REZULTATI: Od ukupnog broja ispitanika (N = 100) sarkopeniju je imalo 28,0 %. Većina ispitanika bilo je muškog spola (61,0 %). Bolesnici sa sarkopenijom značajno su rjeđe išli na pregled stomatologa (64,3 % prije više godina), imali su veći ukupan broj ispalih zubi te veći ukupan broj ispalih pretkutnjaka. Isti su bolesnici imali značajno manju pojavnost karijesa za
razliku od bolesnika bez sarkopenije. Rezultati upitnika OHIP-14 nisu postigli značajnu povezanost sa sarkopenijom, dok su rezultati upitnika SarQoL postigli navedenu povezanost. Bitno je naglasiti da su bolesnici sa sarkopenijom imali značajno više razine C-reaktivnog proteina (3,45 vs. 2,70) te niže razine albumina u krvi (37,50 vs. 40,15 g/L) u odnosu na
bolesnike bez sarkopenije.
ZAKLJUČAK: Ovim je istraživanjem potvrđeno lošije oralno zdravlje u bolesnika na hemodijalizi koji su imali sarkopeniju. Stoga su potrebne intervencijske studije s ciljem poboljšanja oralnog zdravlja bolesnika na hemodijalizi, čime bi se moguće utjecalo na
pojavnost i težinu sarkopenije.
|Abstract (english)|| |
Aim: Patients on hemodialysis have signs of chronic systemic inflammation and higher incidence of sarcopenia. Poor oral health can also trigger systemic inflammation and thus affect sarcopenia. The aim of the study was to examine oral health and the presence of sarcopenia in patients on chronic hemodialysis and to determine whether there is a correlation between them.
Materials and methods: The study included 100 patients on chronic hemodialysis who underwent oral status, routine laboratory measurements, bioimpedance analysis of body composition and measurement of hand grip strength. Patients then completed questionnaires: one related to oral health (OHIP-14) and the other related to sarcopenia (SarQoL).
Results: 28.0% of the total number of participants (N=100) had sarcopenia. The majority of participants were male (61.0%). Poor oral hygiene was recorded in as many as 39.0% of participants, while 46.0% had their last visit to the dentist several years ago. It is interesting to note that 64.3% of patients with confirmed sarcopenia were last examined by a dentist several
years ago, while in those without sarcopenia the proportion was 38.9%. The median total number of erupted teeth in all patients was 12.0 (7.0-23.0). Positive correlation of the total number of erupted teeth and erupted premolars with sarcopenia was confirmed. CRP was significantly elevated in patients with sarcopenia (P=0.035), in contrast to those
without sarcopenia (3.45 vs. 2.70). Laboratory parameters showed that the blood albumin level was reduced in all patients (P=0.002). However, in patients with sarcopenia the values were lower in contrast to patients without sarcopenia (37.50 vs. 40.15 g/L). 51% of patients had increased calculus formation, 49% had oral candidiasis, 38% periodontitis, with as many as
24% of petechiae on the mucosa and 22% of dental caries. 8% of patients had an ammonia
breath and 4% metallic taste in their mouth. Of all the examined signs and symptoms of oral health, significant differences were observed only in the incidence of dental caries, which was significantly more common in the group which did not have sarcopenia (P=0.031). However, it should be noted that in patients with sarcopenia total edentulousness was present in 17.9% as opposed to 9.7% in patients who did not have sarcopenia, i.e. 12% of the total number of participants had total edentulousness. Moreover, in 21% of patients with sarcopenia a complete denture was present in combination
with a partial denture, while that was the case in only 9.7% patients without sarcopenia. The median total score of OHIP-14 questionnaire in all subjects was 12 (4-17.75), while the median score in patients with sarcopenia was 13.50, in contrast to patients without sarcopenia where it was 12.0. The overall score of OHIP-14 did not achieve a significant correlation with
sarcopenia. The median overall score of SarQoL questionnaire for all participants was 60.37 (43.87-70,61),
and since the maximum score of 100 indicates a poorer quality of life, it can be concluded that patients on hemodialysis are aware of their problems and limitations caused by sarcopenia. Moreover, SarQoL was significantly negatively correlated with sarcopenia, which confirms the accuracy of the used questionnaire. Thus, the median overall score in patients with sarcopenia was significantly lower at 43.63 (30.10–60.56) versus 62.78 (49.83–74.24) in patients without
sarcopenia. All domains of the SarQoL questionnaire (physical and mental health–D1, movement–D2, body composition–D3, functionality–D4, daily life activities–D5, fears–D7) except domain 6 (free activities) reached a significant negative correlation with sarcopenia.
Conclusion: This study confirmed poorer oral health in hemodialysis patients who had sarcopenia. Therefore, intervention studies are needed to improve oral health of patients on HD, which could possibly influence the incidence and severity of sarcopenia.