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Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients: Evidence from an Observational Study and a Pilocarpine Clinical Trial

Junne-Ming Sung^*, Shih-Chen Kuo, How-Ran Guo, Shu-Fen Chuang, Szu-Yuan Lee^|| and Jeng-Jong Huang^*

^* Internal Medicine; Operative Dentistry, National Cheng Kung University Hospital; Institute of Clinical Pharmacy; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University; and ^|| Department of Internal Medicine, Kuo’s General Hospital, Tainan, Taiwan

Address correspondence to: Dr. Jeng-Jong Huang, Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan, Taiwan 70428, R.O.C. Phone: +886-6-2766138; Fax: +886-6-3028036; E-mail: jjhuang{at}mail.ncku.edu.tw

Received for publication April 3, 2005. Accepted for publication July 26, 2005.

Decreased salivary flow rate causes xerostomia (symptoms of oral dryness) in patients who undergo hemodialysis (HD); however, whether it thus contributes to thirst and excess interdialytic weight gain (IDWG) remains undetermined. In the observational study, 3 mo of data of 90 stable HD patients were collected, and sensations of thirst and xerostomia were assessed by 100-mm visual analog scales (VAS). Multivariate analyses revealed that the VAS oral dryness score was an independent determinant for thirst, daily IDWG, and IDWG%. Unstimulated whole salivary flow rate (UWS) was measured in 45 participants and was negatively correlated with VAS oral dryness score (r = –0.690, P 0.001), daily IDWG (r = –0.361, P = 0.016), and daily IDWG% (r = –0.302, P = 0.045). In the interventional trial, the test drug was 5 mg of oral pilocarpine solution or placebo. Sixty hyperdipsic HD patients (IDWG% > 2%/d) were randomly assigned to either the sequence pilocarpine (2 wk)–washout (3 wk)–placebo (2 wk)–washout (2 mo)–placebo (3 mo) or placebo (2 wk)–washout (3 wk)–pilocarpine (2 wk)–washout (2 mo)–pilocarpine (3 mo) with 35 participants completing the trial. During the 2-wk crossover period (the first to seventh weeks), pilocarpine increased UWS and decreased xerostomia and thirst. The IDWG_2d decreased (by approximately 0.2 kg; P = 0.013) but not IDWG_3d. During the 3-mo interventional period, pilocarpine increased UWS but decreased both IDWG_2d (by 0.76 kg; P = 0.021) and IDWG_3d (by 1.07 kg; P = 0.007). It also modestly increased serum albumin and decreased mean BP. Pilocarpine-related adverse effects were generally mild. In conclusion, decreased salivary flow is a dipsogenic factor in HD patients, and pilocarpine can alleviate it.

This article has been cited by other articles:

				J.-M. Sung, S.-C. Kuo, H.-R. Guo, S.-F. Chuang, S.-Y. Lee, and J.-J. Huang The role of oral dryness in interdialytic weight gain by diabetic and non-diabetic haemodialysis patients Nephrol. Dial. Transplant., September 1, 2006; 21(9): 2521 - 2528. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673