Original investigation: dialysis therapy
Salivary and lacrimal secretion is reduced in patients with ESRD

https://doi.org/10.1016/S0272-6386(03)00908-9Get rights and content

Abstract

Background:

A reduction in salivary and lacrimal secretion has been described in several diseases. However, such alterations have not been investigated fully in patients with chronic renal failure. The aim of the present study is to estimate the frequency of alterations in salivary and lacrimal secretion in long-term hemodialysis patients.

Methods:

Sixty-three hemodialysis patients and 23 healthy control subjects were studied. In all of them, we tested salivary secretion (Saxon's test), lacrimal secretion (Shirmer's test), and the presence of xerostomia and xerophthalmia symptoms. In a subgroup of patients, we performed other tests to evaluate evidence of ocular lesions and tissue damage to salivary glands. We also tested the relationship between salivary and lacrimal secretion and autonomic nervous system function.

Results:

On average, salivary and lacrimal secretion were markedly reduced in uremic patients compared with healthy controls, and alterations in salivary gland function were related strongly to salivary gland fibrosis and atrophy. Xerophthalmia often was asymptomatic, but frequently was associated with corneal lesions. Xerostomia and xerophthalmia were unrelated to autonomic dysfunction and hepatitis C virus infection.

Conclusion:

A reduction in lacrimal and salivary secretion is frequent in long-term dialysis patients. Such alterations often are asymptomatic and could be the expression of acceleration of an age-dependent decline in glandular function and attendant fibrosis and atrophy.

Section snippets

Patients

The protocol conformed to the ethical guidelines of our institution, and informed consent was obtained from each participant.

We studied 63 patients (38 men, 25 women; mean age, 50.2 ± 13.8 [SD] years; range, 13 to 79 years) treated with long-term hemodialysis for 6.5 ± 5.2 years (range, 0.1 to 17 years). Main biochemical results for these patients are listed in Table 1. These patients represent 73% of the dialysis population treated in our hemodialysis unit. We excluded from the study patients

Saxon's test and xerostomia symptoms

On average, salivary secretion was markedly reduced in uremic patients in comparison to healthy controls (3.30 ± 1.32 versus 4.09 ± 1.31 g/2 min; P < 0.02). Nineteen uremic patients (32%) presented with values less than the minimum observed in healthy controls (2.6 g/2 min; Fig 1A). In patients with reduced salivary secretion in whom the test was repeated after 4 months, average results remained unchanged and the test reproducibility VC was satisfactory (VC, 18%).

In hemodialysis patients,

Discussion

The main findings in this study are that salivary and lacrimal function are subnormal in approximately one third of dialysis patients, and impaired salivary function is associated with histological evidence of salivary gland atrophy and fibrosis.

A number of symptoms related to functional impairment of exocrine glands have been described in hemodialysis patients. Alterations of the gastric mucosa with reduced acid secretion associated with amyloid deposition,19 interstitial and periductal

Acknowledgements

The authors thank Pauline Jackson for reviewing the manuscript and Giovanni Tripepi (Epidemiology and Physiopathology of Renal Diseases and Hypertension Section statistical technician) for help given in preparation of the manuscript.

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