PREVALENCE OF ORAL MUCOSAL LESIONS IN HEMODIALYSIS PATIENTS AND ASSOCIATION WITH MORTALITY: A PROSPECTIVE COHORT STUDY

INTRODUCTION AND AIMS: Oral infections, mucosal lesions and impaired oral health are highly prevalent and frequently severe for adults treated with long-term hemodialysis. We aimed to evaluate the prevalence of mucosal lesions and association with mortality outcomes among hemodialysis patients. METHODS: Data were obtained from the ORAL-D study. The ORAL-D study was a multinational cohort study that involved a comprehensive, standardized oral and dental examination among 4726 patients with end-stage kidney disease treated with long term hemodialysis in 7 countries in Europe and South America. Oral mucosal lesions were ulceration, white stain, red stain, neoformation, petechial lesions, geographical tongue, scrotal tongue, thrush, and herpes, assessed by trained dentists according to standardWHOguidelines. The association between mucosal lesions and all-cause and cardiovascular mortality was estimated using a Cox proportional hazard regression model. Analyses were adjusted for sociodemographic and clinical variables (country, age, sex, education, smoking history, prior myocardial infarction, diabetes, hemoglobin, serum albumin, serum phosphorus, time on dialysis and body mass index). The primary outcome was all-cause mortality. RESULTS: Overall, 70 participants (1.7%) had mucosal ulceration, 147 (3.5%) participants had white stain, 169 (4%) had red stain, 85 (2%) had neoformation, and 331 (7.9%) had petechial lesions. 207 (4.9%) had geographical tongue and 450 (10.7%) had scrotal tongue. Thrush was observed in 192 participants ( 4.6%). Twenty-one participants had oral herpetic lesions. During a median 3.47 (1.55-5.78) months of follow-up, there were 2114 deaths including 1013 cardiovascular deaths. In unadjusted survival analyses, the proportion of patients who died was higher among those with red stain, scrotal tongue, and petechial lesions. Similarly, the estimated proportion of patients who had a cardiovascular death was higher among those with red stain, scrotal tongue, oral petechial lesions, neoformation, and oral thrush. When adjusting for clinical and sociodemographic factors, only the presence of oral thrush was significantly associated with an increased risk of all cause (adjusted HR 1.37, 95% CI 1-1.86) and cardiovascular mortality (adjusted HR 1.64, 95% CI 1.09-2.46). This association was confirmed in competing risks analysis and using a shared frailty model to account for clustering by country. CONCLUSIONS: There is generally limited evidence of an independent association between oral mucosal lesions and mortality outcomes among hemodialysis patients.