Oral Health Conditions, Cytological Changes, and Prevalence of Opportunistic Fungal Growth in Patients with Chronic Kidney Disease Undergoing Haemodialysis. A Case-Control Study.

Abstract

Background: Chronic Kidney Disease (CKD) is an increasingly common health concern worldwide and is characterized by systemic signs such as hematologic changes, bone metabolic errors, and compromised immune status. It significantly impacts oral health, and there is a bidirectional relationship between CKD and various oral diseases.

Objectives: This case-control study evaluated the state of oral health, cytological alterations, and opportunistic fungal growth, such as Candida, in CKD patients receiving dialysis ranging in age from 30 to 65 years.

Materials and methods: A case-control study was conducted on 80 adult patients with CKD on dialysis attending KMC Mangalore. Forty adult patients with CKD on dialysis (experimental group) and 40 healthy adult volunteers (control group) were included in this study. Controls of the same age and sex were chosen from the Manipal College of Dental Sciences Mangalore. Oral health was evaluated clinically, and cytological smears were taken from the patients and subjects. Smears taken were sent for morphometric analysis of buccal mucosal cells and cultured to check for the growth of fungal species. Statistical analysis was performed using SPSS Version 13. A chi-square test was performed to compare categorical variables between the groups.

Results: In our study, the average age of CKD patients was 45.65 ± 10.52 years, while the average age of controls was 42.6 ± 12.11 years. With a p-value of less than 0.001, CKD patients had significantly higher levels of creatinine and urea.There was a statistically significant correlation (p = 0.011) between educational attainment and chronic kidney disease (CKD); 17.5% of the control group held a graduate degree, whereas none of the CKD patients did. Of CKD patients, 42.5% experienced subjective dryness, and 35% reported dysgeusia. In 48.7% and 15.4% of CKD patients, respectively, moderate to severe changes in cell yield and cohesion were noted. In 41% of CKD patients, the nuclear to cytoplasmic ratio (NC ratio) increased. Among CKD patients, fungal growth was found in 5.1%, while it was absent in the control group. This difference was statistically significant.

Conclusion: The study shows that there are notable variations in renal function markers and oral health between patients with chronic kidney disease (CKD) and controls. Specifically, CKD patients have higher levels of urea and creatinine, as well as more changes to oral epithelial cells and fungal development. In order to maintain a stable internal environment and homeostasis, oral health care providers should use a holistic approach to managing patients with complicated medical issues, particularly disorders of the renal system.