NDT Advance Access originally published online on May 23, 2006
Nephrology Dialysis Transplantation 2006 21(9):2521-2528; doi:10.1093/ndt/gfl236
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
The role of oral dryness in interdialytic weight gain by diabetic and non-diabetic haemodialysis patients
1 Department of Internal Medicine and, 2 Department of Operative Dentistry, National Cheng Kung University Hospital, 3 Institute of Clinical Pharmacy and 4 Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University and 5 Department of Internal Medicine, Kuo's General Hospital, Tainan, Taiwan
Correspondence and offprint requests to: Jeng-Jong Huang, MD, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Rd, Tainan 70428, Taiwan, R.O.C. Email: jjhuang{at}mail.ncku.edu.tw
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 A1C (HbAIC) 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 HbAIC 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 HbAIC 
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 HbA1C 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 HbA1C 9%.
Keywords: diabetes mellitus; haemodialysis; interdialytic weight gain; xerostomia
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