Oral Status and Systemic Infection Complications in Dialysis Patients

Objectives: Patients on long-term hemodialysis (HD) or peritoneal dialysis (PD) are susceptible to bloodstream infections with high morbidity and mortality. We investigated the association between specific oral microorganisms and patients with cumulative septicemia or peritonitis episodes. Dental infections had been eradicated at predialysis stage. The hypothesis was that poor oral health associates with poor outcome of dialysis.
Methods: This was an observational study on 117 dialysis patients (70.9% men, 29.1% women; 26-80 years) originally examined and treated at predialysis, observed during dialysis and re-examined after kidney transplantation at the Helsinki University Hospital, Finland. 46 patients were treated with PD and 71 with HD. After kidney transplantation, 53 patients were available for re-examination. From dental records, number of teeth, Periodontal Inflammatory Burden Index (PIBI) and Total Dental Index (TDI) were calculated. Neutrophil-derived biomarkers sTREM-1, PGLYRP1, and interleukin IL-1βwere measured in saliva by enzyme-linked immunosorbent assay. Salivary MMP-8 was measured by immunofluorometric assay.
Results: During dialysis 46 PD patients had a total of 35 peritonitis episodes, whereas 71 HD patients had a total of 32 septic or other infection episodes. In HD patients, the most common microbial findings were Staphylococcus aureus (24.5%) and coagulase negative staphylococci (CONS) (15%). In PD patients, CONS (24%), S. aureus (19%) and Streptococcus viridans (11%) were the most commonly isolated bacteria. In PD group, 11% of all samples were culture-negative. Septic episodes or peritoneal infections in dialysis patients did not significantly associate with number of teeth, TDI, PIBI scores, or with any of the salivary inflammatory parameters analyzed. No significant findings in this regard were observed in the post-transplant stage either.
Conclusions: Our results showed that oral bacteria may link to systemic infections in PD patients, thus partly confirming our hypothesis. Salivary biomarkers showed weak or no association in this regard.