title: Will mouth wash solutions of water, salt, sodiumbicarbonate or citric acid improve upper gastrointestinal symptoms in chronic kidney disease.
abstract: BACKGROUND
  Uraemic symptoms including taste changes, nausea and dry retching are common in chronic kidney disease (CKD). Taste buds detect five basic tastes: sweet, salty, sour, umami and bitter. Saliva in CKD usually has increased concentrations of urea, sodium, potassium, phosphate and higher pH levels. Genetic sensitivities to the bitter taste, with the changes in saliva can cause taste changes and impact uraemic symptoms.
  
  
  OBJECTIVE
  The aim of this study was to assess if mouth wash solutions of water, salt, sodium bicarbonate or citric acid improves upper gastrointestinal (GI) symptoms in CKD patients.
  
  
  METHODS
  An interventional crossover study with 42 CKD patients (21 men, 21 women) complaining of upper GI symptoms were recruited. Subjects completed a questionnaire to assess symptoms and tested for genetic taste sensitivities. Saliva samples were analysed. Mouth rinse solutions of salt, bicarbonate, citric acid and de-ionised water were trialled in randomized order for patient reaction and symptom improvement.
  
  
  RESULTS
  All 42 patients experienced anorexia, 39 (93%) reported taste changes, 27 (48%) nausea and 27 (48%) dry retching. All solutions improved symptoms in some patients. Sodium bicarbonate (P = 0.005) gave the greatest improvement in mouth feel and symptom control compared with the least favoured citric acid solution. Sixty-six percent of patients found sodium bicarbonate beneficial with 40% preference over other solutions.
  
  
  CONCLUSIONS
  Simple mouthwashes can be used to relieve or eliminate some uraemic symptoms. Rinsing the mouth with a sodium bicarbonate solution cleanses receptors on taste buds and may alter mouth pH thereby reducing some upper GI symptoms that CKD patients can experience.
authors.affiliation: Departments of Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Karen Joy
authors.initials: KJ
authors.lastname: Manley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019343:Citric Acid / Q000627:therapeutic use; D018592:Cross-Over Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use; D014867:Water
chemical_list: D009067:Mouthwashes; D014867:Water; D019343:Citric Acid; D012965:Sodium Chloride; D017693:Sodium Bicarbonate
keywords: bicarbonate; nausea; taste; uraemia