Alterações salivares em pacientes adultos diagnosticados com doença renal crônica

Abstract

Chronic kidney disease is an important health problem, with an estimated prevalence of 11% of the adult population, worldwide. Patients with this disease may present changes in salivary composition, as this fluid is directly related to blood composition. The objective of this study was to assess the existing evidence regarding the relationship between the diagnosis of chronic kidney disease and salivary disorders in adult patients. In Chapter 1 – An electronic search was performed in eight databases to verify the use of creatinine and salivary urea in the diagnosis of chronic kidney disease. Only diagnostic test studies were included. The JBI tool was used to assess the risk of bias. A meta-analysis of proportions was performed, and the GRADE tool was used to assess the certainty of the evidence of the estimates. Chapter 2 - Eight databases were used to identify before and after studies with patients with hemodialysis disease. The JBI tool was used for the risk of bias. Meta-analyses were conducted to compare the salivary and serum correlation and to group the differences in proportion and mean of pre-and post-hemodialysis levels of urea and creatinine. The GRADE approach was used to assess the certainty of the evidence. Chapter 3 - An electronic search was done in nine databases to locate observational clinical studies, without the restriction of year or language of publication. Two reviewers performed the selection, data extraction, and risk of bias assessment using JBI tools. Random effects meta-analyses were performed using the standardized mean difference (SMD) as the effect estimate and 95% confidence interval. As a result, Chapter 1 - Eight studies met the eligibility criteria and were included. All studies had a moderate risk of bias. The meta-analysis described an overall sensitivity of 93.3% for salivary creatinine levels and 87.5% for salivary urea levels, while the overall specificity was 87.1% and 83.2% for levels of salivary creatinine and urea, respectively. Chapter 2 - Only six studies met the eligibility criteria and were included. All studies showed a low risk of bias and demonstrated a significant reduction in salivary and serum urea/creatinine after hemodialysis. The meta-analysis demonstrated a moderate to a high correlation between salivary and blood levels of urea (r: 0.79) and creatinine (r: 0.64), with a very low level of certainty. Chapter 3 - Thirty-three studies were included in the qualitative synthesis and 31 in the meta-analysis. Patients with chronic kidney disease had lower salivary flow (SMD: 1.87), higher pH (SMD: 1.47), and higher levels of phosphorus (SMD: 0.86). Only salivary flow showed a significant change after hemodialysis (SMD: 0.61). Scientific evidence has demonstrated the feasibility of using saliva to check indicators of renal function as an alternative to blood, in addition to confirming that patients with chronic kidney disease have important changes in salivary properties and constituents and that hemodialysis is capable of affecting salivary levels of phosphorus, urea, and creatinine and improve salivary flow.