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Xerostomia in patients on chronic hemodialysis

Nature Reviews Nephrology volume 8, pages 176–182 (2012)Cite this article

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Abstract

Xerostomia is the subjective feeling of a dry mouth, which is relatively common in patients on chronic hemodialysis. Xerostomia can be caused by reduced salivary flow secondary to atrophy and fibrosis of the salivary glands, use of certain medications, restriction of fluid intake and old age. In patients undergoing hemodialysis, xerostomia is associated with the following problems: difficulties in chewing, swallowing, tasting and speaking; increased risk of oral disease, including lesions of the mucosa, gingiva and tongue; bacterial and fungal infections, such as candidiasis, dental caries and periodontal disease; interdialytic weight gain resulting from increased fluid intake; and a reduction in quality of life. Unfortunately, no effective treatment exists for xerostomia in patients on chronic hemodialysis. The stimulation of salivary glands by mechanical means (such as chewing gum) or pharmacological agents (such as pilocarpine and angiotensin-converting-enzyme inhibitors, the latter alone or in combination with angiotensin-receptor blockers), as well as saliva substitutes, are all ineffective, or effective only in the short term. Xerostomia remains a frustrating symptom for patients on hemodialysis, and further efforts should be made to find an effective treatment for it in the near future.

Key Points

  • Xerostomia is frequently reported in patients on chronic hemodialysis; mechanisms that contribute to its development include low saliva flow, mouth breathing, diabetes mellitus and altered salivary composition

  • Low saliva flow might be secondary to atrophy and fibrosis of salivary glands, use of medications, restriction of fluid intake or old age

  • Clinical effects of xerostomia include difficulty chewing, swallowing and speaking; increased risk of oral lesions and infections; taste alteration; oral halitosis; interdialytic weight gain; and impaired quality of life

  • Two therapeutic strategies to stimulate salivary glands—by use of chewing gum and use of saliva substitutes—have been tested in patients undergoing hemodialysis, with contradictory and inconclusive results

  • Pilocarpine treatment significantly improves xerostomia and decreases interdialytic weight gain; unfortunately, these benefits persist only as long as the drug treatment continues

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Authors and Affiliations

  1. Department of Surgery, Hemodialysis Service, Catholic University of the Sacred Heart, Largo A. Gemelli 8, Rome, 00168, Italy

    Maurizio Bossola & Luigi Tazza

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Both authors contributed equally to discussions of the article content and to review and/or editing of the manuscript before submission. M. Bossola researched data for the article and wrote the Review.

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Correspondence to Maurizio Bossola.

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Bossola, M., Tazza, L. Xerostomia in patients on chronic hemodialysis. Nat Rev Nephrol 8, 176–182 (2012). https://doi.org/10.1038/nrneph.2011.218

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