SALIVARY GLAND DYSFUNCTION IN PATIENTS UNDERGOING HEMODIALYSIS IN PESHAWAR

Abstract

Background: Salivary gland dysfunction is a prevalent but under-recognized complication in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD), leading to xerostomia, impaired oral function, and decreased quality of life. This study aims to assess salivary flow rates, pH, and biochemical parameters among HD patients in Peshawar, evaluating their relationship with dialysis-related factors and xerostomia severity.

Methods: A cross-sectional study was conducted from January to April 2025 in two tertiary HD centers in Peshawar. Forty ESRD patients on maintenance HD for ≥3 months were compared with 20 healthy controls matched for age and sex. Unstimulated and stimulated saliva samples were collected pre- and post-dialysis to measure flow rate, pH, urea, phosphate, and total protein. Subjective xerostomia was evaluated using a Visual Analogue Scale (VAS) and the OHIP-14 questionnaire. Oral examination assessed mucosal dryness, tongue coating, and DMFT index. Statistical analyses included paired and independent t-tests and Pearson’s correlation (significance at p<0.05).

Results: HD patients showed significantly reduced salivary flow rates compared to controls: unstimulated (0.13 ± 0.06 vs 0.30 ± 0.08 mL/min) and stimulated (0.80 ± 0.25 vs 1.35 ± 0.40 mL/min). Post-dialysis values showed partial improvement. Salivary pH was elevated in HD patients (7.5 ± 0.4 pre-HD vs 6.9 ± 0.2 controls, p<0.01). Urea, phosphate, and total protein were significantly higher in HD patients, though decreased post-dialysis. Xerostomia was reported by 70% of patients (mean VAS 56.4 ± 18.5), with elevated OHIP-14 scores (p<0.01). Correlations revealed that longer HD duration was associated with lower unstimulated flow (r = –0.42, p<0.01), while higher interdialytic weight gain (IDWG) correlated positively with xerostomia severity (r = 0.47, p<0.01). DMFT scores were significantly worse in HD patients (17.4 ± 5.2) compared to controls (10.2 ± 3.7; p<0.01).

Conclusion: Salivary gland dysfunction is common among HD patients in Peshawar, manifesting as reduced salivary flow, elevated urea and phosphate levels, and pronounced xerostomia. These disturbances are associated with HD duration and IDWG. Regular salivary analysis and integrated oral healthcare in HD settings can significantly improve patient outcomes and quality of life.