title: The role of oral dryness in interdialytic weight gain by diabetic and non-diabetic haemodialysis patients.
abstract: BACKGROUND
  Factors influencing the percentage of daily interdialytic weight gain (IDWG%) and their interactions in haemodialysis (HD) patients have not been well-defined, especially in diabetic patients. We analysed contributing factors for the increase of IDWG%, particularly xerostomia (oral dryness), among diabetic and non-diabetic HD patients.
  
  
  METHODS
  We collected 3 month prospective data in 184 stable HD patients (116 non-diabetic and 68 diabetic), including assessments of xerostomia by 100 mm visual analog scales (VASs), and the unstimulated whole salivary (UWS) flow rate was measured in 91 patients by a spitting method.
  
  
  RESULTS
  Diabetic patients have higher IDWG% (P = 0.042) and VAS oral dryness score (P = 0.021), whereas, have lower UWS (P = 0.032). In non-diabetic patients, the VAS oral dryness score, age, Kt/V and blood urea nitrogen (BUN) level correlated independently with IDWG%. In diabetic patients, the haemoglobin A(1C) (HbA(IC)) correlated significantly with IDWG% after controlling for age, Kt/V and BUN level; however, when VAS oral dryness score was introduced into the regression model, the effect of HbA(IC) became marginally significant (P = 0.073) while the VAS oral dryness score became significantly correlated with IDWG%. The increases in IDWG% per unit change in VAS oral dryness score did not show significant difference between the non-diabetic and total diabetic patients; however, it was larger in patients with HbA(IC) >or=9%.
  
  
  CONCLUSIONS
  Xerostomia plays a significant role in increasing IDWG% among diabetic and non-diabetic HD patients. In diabetic patients, the increased IDWG% associated with the increasing HbA(1C) level is largely dependent on the severity of xerostomia, and we speculate that insulin deficiency may operate synergistically with xerostomia in increasing IDWG% in patients with HbA(1C) >or=9%.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Rd, Tainan 70428, Taiwan, ROC.
authors.forename: Junne-Ming
authors.initials: JM
authors.lastname: Sung
authors.forename: Shih-Chen
authors.initials: SC
authors.lastname: Kuo
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Chuang
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Lee
authors.forename: Jeng-Jong
authors.initials: JJ
authors.lastname: Huang
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012463:Saliva / Q000378:metabolism; D015430:Weight Gain; D014987:Xerostomia / Q000209:etiology* / Q000378:metabolism