| Abstract | Cilj istraživanja: Poznato je kako bolesnici s kroničnom bubrežnom bolesti (KBB) i bolesnici liječeni hemodijalizom pate od brojnih patoloških promjena u usnoj šupljini koje pridonose već uvelike narušenoj kvaliteti života povezanoj sa zdravljem ovih bolesnika. Nadalje, neke sistemske komplikacije bolesnika s KBB, poput kardiovaskularnih bolesti i proteinsko energetske pothranjenosti (PEP) povezuju se s bakterijskom infekcijom iz usne šupljine, posebice iz parodontnih tkiva, a mogle bi biti smanjene adekvatnom oralnom higijenom. Glavni fokus ovog istraživanja bio je promotriti postoje li razlike u kvaliteti života povezanoj s oralnim zdravljem te istražiti postoje li razlike u oralno higijenskim navikama između bolesnika s KBB i bolesnika liječenih peritonejskom dijalizom (PD). Nadalje, cilj istraživanja bio je promotriti postoje li navedene razlike s obzirom na postojanje šećerne bolesti (ŠB) u bolesnika s KBB i bolesnika liječenih PD kao i istražiti povezanost oralno higijenskih navika sa sastavom tijela u navedenim skupinama ispitanika.
Materijali i metode: U istraživanje je uključeno ukupno 57 bolesnika; 35 bolesnika s KBB (medijan dobi 66 (IQR 17,5), 23 (65,71%) muškarca i 12 (34,29 %) žena) te 22 bolesnika liječena PD (medijan dobi 57 godina (IQR 23,5), 11 (50%) muškaraca i 11 (50%) žena). Za sve ispitanike zabilježeni su dob bolesnika (godine), spol bolesnika, navike pušenja, postojanje ŠB, biokemijski pokazatelji uključujući serumske vrijednosti ureje (mmol/L), kreatinina (μmol/L), hemoglobina (g/L), albumina (g/L), C-reaktvnog proteina (mg/L), kalija (mmol/L), kalcija (mmol/L), fosfora (mmol/L), triglicerida (mmol/L), kolesterola-ukupnog (mmol/L), LDL-a (eng. low-density lipoprotein ) (mmol/L) i urata (μmol/L), izračunata razina glomerularne filtracije (GF) i određen sastav tijela uključujući masno tkivo (kg), masno tkivo (%), visceralna pretilost (kg), mišićna masa (kg), skeletna mišićna masa (kg), skeletna mišićna masa (%). Uz navedeno, zabilježene su oralno higijenske navike koje uključuju plak (%), krvarenje pri sondiranju (%), učestalost pranja zubi, sredstva za održavanje oralne higijene te prisutnost ili odsutnost krvarenja prilikom četkanja i neugodnog zadaha. Nadalje, kvaliteta života povezana s oralnim zdravljem procijenjena je pomoću Oral Health Impact Profile-14 (OHIP-14) upitnika. Za procjenu sastava tijela koristilo se Tanita MC780 Multi Frequency segmentni analizator sastav tijela.
Rezultati: Nije bilo statistički značajne razlike u oralno higijenskim navikama niti u kvaliteti života povezanoj s oralnim zdravljem između bolesnika s KBB i bolesnika liječenih PD. Analizom razlike u ispitivanim parametrima u bolesnika s KBB s obzirom na postojanje ŠB, pokazalo se kako su bolesnici sa ŠB imali statistički značajno veću količinu mišićnog tkiva izraženog u kilogramima (P=0,026) u usporedbi s onim bolesnicima koji nisu imali ŠB. Analizirajući kvalitetu života vezanu uz oralno zdravlje pomoću OHIP upitnika rezultati ukazuju kako su se oni bolesnici sa ŠB statistički značajno manje žalili na neugodan okus izazvan problemima sa zubima, čeljustima ili s protetskim radom (P=0,029). Nadalje, pokazalo se kako je na razini statističke značajnosti više bolesnika s KBB osjećalo tjeskobu zbog problema sa zubima, ustima, čeljustima ili zbog protetskog rada nego li bolesnika liječenih PD (P=0,050). Također, bolesnici s KBB su imali statistički značajno višu vrijednost ukupnog zbroja OHIP upitnika (lošiju kvalitetu života vezanu uz oralno zdravlje) u usporedbi s bolesnicima liječenim PD (P= 0,026). Nadalje, u skupini ispitanika s KBB rezultati ukazuju na statistički značajnu pozitivnu povezanost između ukupnog OHIP zbroja i kolesterola (r=0,43, P=0,044) te oralno higijenskih navika; nađena je statistički značajna pozitivna povezanost između ukupnog zbroja OHIP upitnika s učestalošću uporabe čačkalica (r=0,38, P=0,025), epizodama krvarenja prilikom četkanja (r=0,37, P=0,028) te neugodnog zadaha (r=0,38, P=0,024). U skupini bolesnika liječenih PD nađena je statistički značajna negativna povezanost između ukupnog OHIP zbroja i količine mišićnog tkiva izraženog u kilogramima (r=-0,53, P=0,016). Rezultati ukazuju kako kod bolesnika s KBB koji nisu imali ŠB postoji statistički značajna pozitivna povezanost između zbroja OHIP upitnika s učestalosti uporabe čačkalica (r=0,50, P=0,026) te krvarenjem prilikom četkanja (r=0,54, P=0,015). Također, nađena je i statistički negativna povezanost između učestalosti uporabe vodice za usta i OHIP zbroja (r=0,47, P=0,034). Analizirajući povezanost oralno higijenskih navika sa sastavom tijela, rezultati istraživanja ukazuju na statistički značajnu pozitivnu povezanost između postotka masnog tkiva i učestalosti krvarenja prilikom četkanja zubi u bolesnika s KBB (r=0,38, P=0,042). U skupini bolesnika liječenih PD nađena je statistički značajna negativna povezanost između uporabe vodice za usta i mišićne mase izražene u kilogramima (r=-0,47, P=0,035).
Zaključak: Rezultati ovog istraživanja nisu uputili na značajne razlike u kvaliteti života vezane uz oralno zdravlje niti u oralno higijenskim navikama između bolesnika s KBB i bolesnika liječenih PD. Rezultati dobiveni isključivanjem mogućih utjecaja ŠB na usnu šupljinu ukazuju na lošiju kvalitetu života u vezi s oralnim zdravljem bolesnika s KBB. Ovi rezultati možda su psihološki produkt težine i ograničenja PD koja nosi svoje posljedice na svakodnevni život ovih bolesnika koji onda manju važnost pridaju oralnim patologijama bez obzira na njihovu prisutnost. KBB ne boli, stoga bi se dalo pretpostaviti da bolesnici s KBB neovisni o dijalizi ne osjećaju u jednakoj mjeri teret bolesti, pridajući pažnju i drugim zdravstvenim problemima, uključujući oralne bolesti. Nadalje, neki od uzroka PEP-a mogu biti sistemska upala i mastikatorna disfunkcija uzrokovana gubitkom zubi uslijed bolesti ovisnih o dentalnom biofilmu. Ovim istraživanjem je potvrđena povezanost oralno higijenskih navika sa sastavom tijela u obe skupine bolesnika. Buduća istraživanja na većem broju ispitanika, koja bi uključila i bolesnike liječene hemodijalizom kao i kontrolnu skupinu ispitanika bez KBB, dala bi odgovor postoje li razlike u ispitivanim parametrima s obzirom na uremiju i modalitet liječenja KBB. |
| Abstract (english) | Objectives: It is well known that patients with chronic kidney disease (CKD) and patients treated with hemodialysis suffer from a number of pathological changes in the oral cavity that contribute to the already severely impaired health related quality of life of these patients. Furthermore, some systemic complications of patients with CKD, such as cardiovascular disease and protein energy wasting (PEW), are associated with bacterial infection from the oral cavity, especially from periodontal tissues, and could be reduced by adequate oral hygiene. The main concern of this study was to examine whether there are differences in oral health related quality of life and to investigate whether there are differences in oral hygiene habits between patients with CKD and patients treated with peritoneal dialysis (PD). Furthermore, the aim of the study was to examine whether there are differences regarding diabetes mellitus (DM) in patients with CKD and patients treated with PD as well as to investigate the association of oral hygiene habits with body composition in these groups of patients.
Materials and methods: A total of 57 patients were included in the study; 35 patients with CKD (median gets 66 (IQR 17.5), 23 (65.71%) men and 12 (34.29%) women) and 22 patients treated with PD (median gets 57 years (IQR 23.5), 11 (50%) men and 11 (50%) women). Information about the age (years), sex, smoking habits, the presence of DM, biochemical parameters including serum values of urea (mmol / L), creatinine (μmol / L), hemoglobin (g / L), albumin (g / L), C-reactive protein (mg / L), potassium (mmol / L), calcium (mmol / L), phosphorus (mmol / L), triglycerides (mmol) / L), total cholesterol (mmol / L), LDL (low density lipoprotein) (mmol / L) and urate (μmol / L), glomerular filtration rate (GFR) and body composition involving adipose tissue (kg), adipose tissue (%), visceral obesity (kg), muscle mass (kg), skeletal muscle mass (kg) and skeletal muscle mass (%) were collected. Furthermore, frequency of teeth brushng, oral hygiene products, the presence or absence of bleeding when brushing and halitosis were collected. Oral health related quality of life was assessed through oral health impact profile-14 (OHIP-14). To asses body compositiona, Tanita MC780 Multi Frequency segmental body composition analyzer was used.
Results: There were no statistically significant differences in oral hygiene or oral health related quality of life between patients with CKD and patients treated with PD. By analyzing the differences among recipients with CKD regarding DM, results showed that patients with DM had a statistically higher number of muscle mass expressed in kilograms (P = 0.026) compared to those patients without DM. Analyzing the oral health related quality of life trough OHIP questionnaire, the results indicate that those patients with DM complained less about the unpleasant taste caused by problems with teeth, jaws or prosthetic restauration (P = 0.029). Furthermore, it was shown that at the level of statistical significance, more patients with CKD were more sensitive due to dental problems, assessments, sizes or prosthetic restauration than patients treated with PD (P = 0.050). Also, patients with CKD had higher value of the total OHIP score (poorer quality of life in oral health) compared to patients treated with PD (P = 0.026). Furthermore, among CKD patients, the results indicate a statistically significant positive association between total OHIP score and cholesterol (r = 0.43, P = 0.044), and oral hygiene; the statistical significance of the positive correlation between the total OHIP score with the use of toothpicks (r = 0.38, P = 0.025), episodes of bleeding during brushing (r = 0.37, P = 0.028), and the halitosis (r = 0.38, P = 0.024). In the group of patients treated with PD, there was a statistically significant negative association between total OHIP and muscle mass in kilograms (r = -0.53, P = 0.016). The results indicate that patients with CKD without DM had a statistically significant positive association between the total OHIP score with the use of toothpicks (r = 0.50, P = 0.026) and bleeding when brushing (r = 0.54, P = 0.015), Also, a statistically negative correlation between the frequency mouthwash use and the total OHIP score (r = 0.47, P = 0,034) was stated. Analyzing the association of oral hygiene with body composition, the results of the study indicate a statistically significant positive association between the percentage of adipose tissue and the frequency of bleeding when brushing teeth in patients with CKD (r = 0.38, P = 0,042). In the group of PD patients, there was a statistically significant negative association between the use of mouthwash and muscle mass expressed in kilograms (r = -0.47, P = 0.035).
Conclusion: The results of this study didn’t show significant differences in oral health related quality of life nor in oral hygiene between patients with CKD and patients treated with PD. The results provided by exclusion of the possible effects of DM on oral patologies indicate a poorer oral health related quality of life among patients with CKD. These results may be a psychological product of the severity and limitation of PD that carries its consequences on the daily lives of these patients who then pay less attention on oral pathology regardless of its presence. CKD does not hurt, so on could assume that dialysis – independent CKD patients do not feel the burden of the disease equally, paying attention to other medical problems, including oral diseases. Furthermore, some of the causes of PEW may be systemic inflammation and masticatory dysfunction induced by biofilm-dependent oral diseases. This study confirmed the association between oral hygiene and body composition in both groups of patients. Future studies should include larger number of subjects, patients treated with hemodialysis as well as a control group of subjects without CKD. Those modifications should provide an answer to the existing difference in the examination of parameters regarding uremia and modality of treatment of CKD. |
