Oral findings in chronic kidney disease: implications for management in developing countries

BACKGROUND: The importance of oral health care in the management of patients with systemic diseases including chronic kidney disease (CKD) has been affirmed. Many CKD patients have related oral lesions, however, attention to oral health care has been lacking, especially in the developing countries with higher burden of renal diseases. METHODS: One hundred and eighty patients, 90 cases and 90 controls were recruited, interviewed and examined. Oral mucosa assessment was based on the WHO Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases. Urinalysis and blood creatinine levels were determined. Glomerular filtration rate (GFR) of each patient was calculated from the blood creatinine using Cockcroft and Gault formula. RESULTS: Oral lesions were present in 86 out of 90 (96.5%) CKD patients compared with 15 out of 90 (16.7%) controls (p < 0.001). Abnormal lip hyperpigmentation was the most frequently seen lesion in 81 out of 90 (90%) CKD patients. Other significant findings were gum bleeding, xerostomia, candidiasis, burning mouth and abnormal taste. In the controls (without CKD), the mean GFR was lower in subjects with oral lesions compared with those without oral lesions p < 0.001. CONCLUSIONS: CKD and reduced GFR in subjects without CKD are risk factors for oral lesions. The higher prevalence of oral lesions in CKD patients necessitates mandatory oral screening to identify patients with deteriorating renal function. The management of such lesions will enhance the overall well-being of CKD patients in developing countries.