Nephrology Dialysis Transplantation, Vol 12, Issue 10 2093-2098, Copyright © 1997 by Oxford University Press
M Griep, P Van der Niepen, J Sennesael, T Mets, D Massart and L Verbeelen
Background: The sense of smell plays an important role
in the quality of life. Many studies have shown a declining odour
perception in the elderly, as well as in subjects in poor health or
nutritional state. Considering the high prevalence of poor nutritional
state in renal disease and the importance of odour perception in nutrition
and health, the relationship between renal function, nutritional state, and
odour perception is explored in this study. Method: A
total of 101 patients with chronic renal failure participated in the study.
Thirty-eight haemodialysis patients (mean age=64.3 years) were evaluated
both before and after dialysis. Sixteen patients on peritoneal dialysis
treatment (mean age=64.0 years), 28 transplanted patients (mean age=53.5
years, mean creatinine clearance=64.0 ml/min) and 19 patients with varying
degrees of renal insufficiency were also included (mean age=63.7 years,
mean creatinine clearance=29.5 ml/min). Patients with cognitive deficits or
upper respiratory airway diseases were excluded. A validated objective
procedure was used to measure odour perception, by determining the
detection threshold for isoamyl acetate (banana odour) as the lowest
detectable odour concentration. Results: Healthy
control persons had significantly lower odour thresholds compared to
patients on peritoneal (P=0.001) and haemodialysis (P=0.02). No significant
difference was observed in odour perception between patients on peritoneal
and haemodialysis (P=0.779) and for patients on haemodialysis before and
after a dialysis session. Transplanted patients had significantly better
odour perception compared to matched patients on dialysis (P
<0.001). Odour perception of transplanted patients and matched
healthy control persons was similar (P-0.81). In patients with varying
degrees of renal insufficiency, including healthy controls and transplanted
patients, a significant positive correlation was found between odour
perception and creatinine clearance (P=0.02). A significant negative
correlation was found between odour perception and serum concentration of
urea (P <0.001), serum phosphorus (P=0.022) and protein catabolic
rate (P <0.05). Other parameters measuring nutritional status
(albumin, BMI) were not correlated with odour perception.
Conclusion: Our results show that the ability to smell
is severely impaired in patients with chronic renal failure and is related
to the degree of renal impairment and the degree of accumulation of uraemic
toxins. After renal transplantation, patients have a normal odour
perception, indicating the capacity of the olfactory system to recover once
the concentration of uraemic toxins remains below a critical threshold.
Acute removal of uraemic toxins by dialysis does not correct olfactory
disturbances, suggesting a long lasting effect of uraemia on olfactory
function. Keywords: age; body mass index (BMI);
creatinine clearance; albumin; PCR; odour perception
ORIGINAL ARTICLES
Odour perception in chronic renal disease
Department of Pharmaceutical and Biomedical Analysis, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Belgium; Section of Nephrology and Section of Geriatrics, Department of Medicine, Academic Hospital, Vrije Universiteit Brussels, Laarbeeklaan 101, B-1090 Brussels, Belgium; Corresponding author
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