Nutrición Hospitalaria 03786 /
Resumen| PDF (ENGLISH)

Trabajo Original

Is there a relationship between oral hygiene and nutritional status in peritoneal dialysis patients?

Sonia López-Cisneros, Ailema González-Ortiz, Samuel Ramos-Acevedo, Ángeles Espinosa-Cuevas

Prepublicado: 2021-11-26
Publicado: 2022-03-22

Logo Descargas   Número de descargas: 6037      Logo Visitas   Número de visitas: 4234      Citas   Citas: 0


Brackground: in the early stages of kidney disease, oral manifestations (gingivitis and periodontitis) may cause premature tooth loss and limit food intake. There is scarce evidence of the relationship of oral hygiene and nutritional status in patients on Peritoneal Dialysis (PD). Objective: we aimed to assess the relationship of oral hygiene with nutritional, clinical, and physical performance parameters in PD patients. Methods: this cross-sectional study included outpatients aged 34-69 years. Oral health questionnaire, nutritional, functional, and clinical assessment tools such as Malnutrition Inflammation Score (MIS), Subjective Global Assessment (SGA), handgrip strength, and Gastrointestinal Symptoms Questionnaire (GSQ) were applied. Patients were divided according to debris, calculus, and Simplified Oral Hygiene Index (OHI-S) in two groups: “clean-slightly dirty” and “dirty-very dirty”. Results: in total, 41 patients were included, those in the “dirty-very dirty” group had a worse nutritional status with higher scores on the MIS tool and worse nutritional diagnosis with SGA as compared to the “clean-slightly dirty” group. The handgrip strength was higher in patients in the best category of oral hygiene, and those with the worst hygiene presented greater severity of gastrointestinal symptoms. The risks of malnutrition in the three indices of oral hygiene with the worst category were statistically significant. Conclusion: poor oral hygiene was associated with poorer nutritional status, lower handgrip, and worse GSQ. Poor oral hygiene might be related to persistent inflammation status and catabolism that favored protein-energy wasting.

Palabras Clave: Oral hygiene. Peritoneal dialysis. Protein-energy wasting. Periodontitis. Probiotics.

Tomás I, Marinho JS, Limeres J, Santos MJ, Araújo L, Diz P. Changes in salivary composition in patients with renal failure. Arch Oral Biol 2008;53(6):528-32.
DOI: 10.1016/j.archoralbio.2008.01.006
Akar H, Akar GC, Carrero JJ, Stenvinkel P, Lindholm B. Systemic consequences of poor oral health in chronic kidney disease patients. Clin J Am Soc Nephrol [Internet] 2011;6(1):218-26. Available from:
DOI: 10.2215/CJN.05470610
Tadakamadla J, Kumar S, Mamatha GP. Comparative evaluation of oral health status of chronic kidney disease (CKD) patients in various stages and healthy controls. Spec Care Dent 2014;34(3):122-6.
DOI: 10.1111/scd.12040
Gürkan A, Köse T, Atilla G. Oral health status and oral hygiene habits of an adult Turkish population on dialysis. Oral Health Prev Dent 2008;6(1):37-43.
Xie T, Yang Z, Dai G, Yan K, Tian Y, Zhao D, et al. Evaluation of the oral health status in Chinese hemodialysis patients. Hemodial Int 2014;18(3):668-73.
DOI: 10.1111/hdi.12149
Klassen JT, Krasko BM. The dental health status of dialysis patients. J Can Dent Assoc 2002;68(1):34-8.
Grubbs V, Plantinga LC, Tuot DS, Powe NR. Chronic kidney disease and use of dental services in a United States public healthcare system: a retrospective cohort study. BMC Nephrol 2012;13(16):1-6.
DOI: 10.1186/1471-2369-13-16
Vijaya KL, Aruna M, Narayana Rao SVL, Rama Mohan P. Dietary counseling by renal dietician improves the nutritional status of hemodialysis patients. Indian J Nephrol 2019;29(3):179-85.
DOI: 10.4103/ijn.IJN_272_16
Kramer H, Jimenez EY, Brommage D, Vassalotti J, Montgomery E, Steiber A, et al. Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. J Acad Nutr Diet 2018;118(10):1958-65.
DOI: 10.1016/j.jand.2018.05.023
Ioannidou E, Swede H, Fares G, Himmelfarb J. Tooth Loss Strongly Associates With Malnutrition in Chronic Kidney Disease. J Periodontol 2014;85(7):899-907.
DOI: 10.1902/jop.2013.130347
Cengiz MI, Bal S, Gökçay S, Cengiz K. Does Periodontal Disease Reflect Atherosclerosis in Continuous Ambulatory Peritoneal Dialysis Patients? J Periodontol 2007;78(10):1926-34.
DOI: 10.1902/jop.2007.060499
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc [Internet] 1964;68:7-13. Available from:
DOI: 10.14219/jada.archive.1964.0034
Palmer SC, Tunnicliffe DJ, Singh-Grewal D, Mavridis D, Tonelli M, Johnson DW, et al. Induction and Maintenance Immunosuppression Treatment of Proliferative Lupus Nephritis: A Network Meta-analysis of Randomized Trials. Am J Kidney Dis [Internet] 2017;70(3):324-36.
DOI: 10.1053/j.ajkd.2016.12.008
Palmer SC, Ruospo M, Wong G, Craig JC, Petruzzi M, De Benedittis M, et al. Dental health and mortality in people with end-stage kidney disease treated with hemodialysis: A multinational cohort study. Am J Kidney Dis 2015;66(4):666-76.
DOI: 10.1053/j.ajkd.2015.04.051
Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 2001;38(6):1251-63.
DOI: 10.1053/ajkd.2001.29222
González-Ortiz AJ, Arce-Santander CV, Vega-Vega O, Correa-Rotter R, Espinosa-Cuevas MA. Assessment of the reliability and consistency of the “Malnutrition Inflammation Score” (MIS) in Mexican adults with chronic kidney disease for diagnosis of protein-energy wasting syndrome (PEW). Nutr Hosp 2015;31(3):1352-8.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enter Nutr 1987;11(1):8-13.
DOI: 10.1177/014860718701100108
Bilbrey GL, Cohen TL. Identification and treatment of protein calorie malnutrition in chronic hemodialysis patients. Dial Transplant 1989;18:660-78.
Frisancho AR. New standards of weight and body composition by frame size and height for assessment of nutritional status of adults and the elderly. Am J Clin Nutr 1984;40(4):808-19.
DOI: 10.1093/ajcn/40.4.808
Durnin JVGA, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 Years. Br J Nutr 1974;32(01):77-97.
DOI: 10.1079/BJN19740060
Carrera-Jiménez D, Miranda-Alatriste P, Atilano-Carsi X, Correa-Rotter R, Espinosa-Cuevas Á. Relationship between nutritional status and gastrointestinal symptoms in geriatric patients with end-stage renal disease on dialysis. Nutrients 2018;10(4):1-12.
DOI: 10.3390/nu10040425
Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, et al. Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism. J Ren Nutr [Internet] 2018;28(6):380-92. Available from:
DOI: 10.1053/j.jrn.2018.08.006
Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, et al. Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr 2013;23(2):77-90.
DOI: 10.1053/j.jrn.2013.01.001
Chen L-P, Chiang C-K, Peng Y-S, Hsu S-P, Lin C-Y, Lai C-F, et al. Relationship between periodontal disease and mortality in patients treated with maintenance hemodialysis. Am J Kidney Dis 2011;57(2):276-82.
DOI: 10.1053/j.ajkd.2010.09.016
Ogawa M, Satomi-Kobayashi S, Yoshida N, Ysuboi Y, Komaki K, Nanba N, et al. Relationship between oral health and physical frailty in patients with cardiovascular disease. J Cardiol 2021;77(2):131-8.
DOI: 10.1016/j.jjcc.2020.07.016
Fang F, Wu B, Qu Q, Gao J, Yan W, Huang X, et al. The clinical response and systemic effects of non-surgical periodontal therapy in end-stage renal disease patients: A 6-month randomized controlled clinical trial. J Clin Periodontol 2015;42(6):537-46.
DOI: 10.1111/jcpe.12411
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48(1):16-31.
DOI: 10.1093/ageing/afy169
Ausavarungnirun R, Wisetsin S, Rongkiettechakorn N, Chaichalermsak S, Udompol U, Rattanasompattikul M. Association of dental and periodontal disease with chronic kidney disease in patients of a single, tertiary care centre in Thailand. BMJ Open 2016;6(7):1-8.
DOI: 10.1136/bmjopen-2016-011836
Cunha FL, Tagliaferro EPS, Pereira AC, Meneghim MC, Hebling E. Oral health of a Brazilian population on renal dialysis. Spec Care Dent 2007;27(6):227-31.
DOI: 10.1111/j.1754-4505.2007.tb01754.x
Gautam NR, Gautam NS, Rao TH, Koganti R, Agarwal R, Alamanda M. Effect of end-stage renal disease on oral health in patients undergoing renal dialysis: A cross-sectional study. J Int Soc Prev Community Dent 2014;4(3):164-9.
DOI: 10.4103/2231-0762.142006
Shukla A, Abreu Z, Bargman JM. Streptococcal PD peritonitis - A 10-year review of one centre’s experience. Nephrol Dial Transplant 2006;21(12):3545-9.
DOI: 10.1093/ndt/gfl407
Prasad N, Gupta A, Sharma RK, Sinha A, Kumar R. Impact of nutritional status on peritonitis in CAPD patients. Perit Dial Int 2007;27(1):42-7.
DOI: 10.1177/089686080702700110
Oka H, Yamada S, Kamimura T, Aihara S, Hyodo M, Terakado N, et al. Better Oral Hygiene Habits Are Associated With a Lower Incidence of Peritoneal Dialysis-Related Peritonitis. Ther Apher Dial 2019;23(2):187-94.
DOI: 10.1111/1744-9987.12757
López-Cisneros S, Espinosa-Cuevas M de LÁ, Reyes-Guerrero R. La periodontitis en el paciente con enfermedad renal crónica. Rev Mex Nutr Ren 2019;2(2):34-40.
Cholewa M, Madziarska K, Radwan-Oczko M. The association between periodontal conditions, inflammation, nutritional status and calcium-phosphate metabolism disorders in hemodialysis patients. J Appl Oral Sci 2018;26:e20170495.
DOI: 10.1590/1678-7757-2017-0495
Chen L-P, Hsu S-P, Peng Y-S, Chiang C-K, Hung K-Y. Periodontal disease is associated with metabolic syndrome in hemodialysis patients. Nephrol Dial Transpl 2011;26(12):4068-73.
DOI: 10.1093/ndt/gfr209
Kocyigit I, Yucel HE, Cakmak O, Dogruel F, Durukan DB, Korkar H, et al. An ignored cause of inflammation in patients undergoing continuous ambulatory peritoneal dialysis: periodontal problems. Int Urol Nephrol [Internet] 2014;46(10):2021-8. Available from:
DOI: 10.1007/s11255-014-0716-z
Tekce M, Ince G, Gursoy H, Dirikan Ipci S, Cakar G, Kadir T, et al. Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: A 1-year follow-up study. J Clin Periodontol 2015;42(4):363-72.
DOI: 10.1111/jcpe.12387
Ismail FB, Ismail G, Dumitriu AS, Baston C, Berbecar V, Jurubita R, et al. Identification of subgingival periodontal pathogens and association with the severity of periodontitis in patients with chronic kidney diseases: a cross-sectional study. Biomed Res Int [Internet] 2015;2015:370314. Available from:
DOI: 10.1155/2015/370314
Takeuchi Y, Ishikawa H, Inada M, Shinozuka O, Umeda M, Yamazaki T. Study of the oral microbial flora in patients with renal disease. Nephrology 2007;12(2):182-90.
DOI: 10.1111/j.1440-1797.2007.00767.x

Artículos Relacionados:

Artículo Especial: Aspectos dietoterapéuticos en situaciones especiales del paciente oncológico. prebióticos y probióticos, ¿tienen cabida en la terapia nutricional del paciente oncológico?

Mª José Sendrós Madroño

Publicado: 2016-06-02 /

Trabajo Original: Papel de los prebióticos y los probióticos en la funcionalidad de la microbiota del paciente con nutrición enteral

María Dolores Ballesteros Pomar , Elena González Arnaiz

Publicado: 2018-04-03 /

Trabajo Original: Efecto del manejo de la obesidad clase I con metformina sobre actividad de metaloproteinasas en pacientes con periodontitis crónica

Carlos Alberto Zúñiga Curz , Claudia C. Calzada Mendoza , Iris Danae Miranda Mondragón , Alfonso Bustamante Bacame , Javier Portilla Robertson , Esther Ocharán Hernández

Publicado: 2019-03-29 /

Trabajo Original: Nutrición y microbiota en población pediátrica. Implicaciones sanitarias

Ana Isabel Jiménez-Ortega , Rosa María Martínez García , Marta Velasco Rodríguez-Belvis , Ana Belén Martínez Zazo , María Dolores Salas-González , Esther Cuadrado-Soto

Publicado: 2020-09-22 /

Trabajo Original: Simbiosis en el tracto gastrointestinal humano

Francisco Guarner

Publicado: 2020-09-22 /

Revisión: Revising concepts of artificial nutrition in contemporary surgery: from energy and nitrogen to immuno-metabolic support

Publicado: 2021-06-23 /

Trabajo Original: A mixture of Lactobacillus plantarum CECT 7315 and CECT 7316 enhances systemic immunity in elderly subjects. A dose-response, double-blind, placebo-controlled, randomized pilot trial

Publicado: 2021-06-23 /

Revisión: Evidence on the benefits of probiotics for preterm infants

Ana Maria Campos Martinez , Carmen Elizabeth Fernández Marín , Aida Ruiz López , Isabel Cubero Millán , José Uberos Fernández

Publicado: 2021-06-16 /

Revisión: The effect of probiotics on the serum lipid levels in non-obese healthy adults with hyperlipidemia: A systematic review and meta-analysis of randomized controlled trials

Kaiwen Sun , Zhenzhu Liu , Hongyan Wang

Publicado: 2021-05-07 /

Revisión: Effect of the use of probiotics in the treatment of children with atopic dermatitis; a literature review

Publicado: 2021-10-18 /

Artículo Especial: Third Jesús Culebras Lecture - Molecular Biology and Clinical Nutrition; where do we stand and where do we go?

Publicado: 2021-10-19 /

Artículo Especial: Probióticos en las enfermedades hepáticas

Publicado: 2021-10-20 /

Artículo Especial: Aplicaciones clínicas del empleo de probióticos en pediatría

Publicado: 2021-10-20 /

Revisión: Intestinal microbiota; relevance to obesity and modulation by prebiotics and probiotics

Publicado: 2021-10-26 /

Revisión: Lactobacillus Paracasei subsp. Paracasei F19; a farmacogenomic and clinical update

Publicado: 2021-10-27 /

Trabajo Original: Probióticos y enterocolitis necrotizante del prematuro; to NEC or not to NEC?, ésta es la pregunta

Publicado: 2021-10-29 /

Trabajo Original: Effect of probiotics on human blood urea levels in patients with chronic renal failure

Publicado: 2021-11-03 /

Trabajo Original: Relación del estado nutricio, densidad mineral ósea tanto corporal como mandibular, pérdida dentaria y riesgo de fractura (FRAX), en mujeres pre y postmenopáusicas con periodontitis

Publicado: 2021-11-04 /

Trabajo Original: Association between childhood obesity and oral hygiene status

Publicado: 2021-11-04 /

Trabajo Original: Nueva guía de práctica clínica sobre nutrición enteral del recién nacido de muy bajo peso al nacimiento; segunda parte

Publicado: 2021-11-04 /

Trabajo Original: The effect of Saccharomyces boulardii in patients eligible for liver transplantation

Publicado: 2021-11-24 /

Revisión: Alimentación funcional para aliviar desórdenes gastrointestinales asociados a trastornos del espectro autista: Una revisión sistemática

Julián Herrera Mejía , Arnulfo Ramos-Jiménez , Florinda Jiménez Vega , Rocío Campos Vega , Aaron F. González Córdova , Abraham Wall-Medrano

Publicado: 2021-10-08 /

Trabajo Original: Asociación de albúmina sérica y valoración global subjetiva en pacientes incidentes en diálisis peritoneal

Publicado: 2022-01-24 /

Revisión: Probiotics in the treatment of infantile colic: a meta-analysis of randomized controlled trials

YanPing Liu , Dejian Ma , XiYan Wang , YunZhi Fang

Publicado: 2021-12-25 /

Revisión: Treating asthma patients with probiotics: a systematic review and meta-analysis

Qiwei Xie , Jiatian Yuan , Yaoweng Wang

Publicado: 2022-07-17 /

Trabajo Original: Production of snack bar enriched with paraprobiotics grown in banana peel medium, nutritional, sensory and quality parameters

Merve Tokpunar , K. Esen Karaca Çelik , Murat Baş , Hakan Kuleaşan , Aylin Korkut Altıntaş

Publicado: 2023-05-23 /

Trabajo Original: A randomized double-blind controlled clinical trial demonstrating efficacy of different probiotic strains on serum lipids and glycemic biomarker

Gözde Okburan , Murat Baş , Sultan Ogmen

Publicado: 2023-04-11 /

Trabajo Original: Association between protein energy wasting and peritoneal membrane transport in peritoneal dialysis

Gabriela Leal-Escobar , Karla Berenice Cano Escobar , Magdalena Madero-Rovalo , Mónica Ancira-Moreno , Iván Armando Osuna-Padilla

Publicado: 2024-01-14 /

Artículos más populares

Revisión: Relación entre la dieta, aspectos nutricionales y la calidad del sueño en población pediátrica

.La relación entre la dieta y el sueño ha sido esc...

Publicado: 2023-06-08

Editorial: ¿Por qué debemos incorporar la determinación del ángulo de fase por impedancia bioeléctrica a nuestra práctica habitual en nutrición clínica?

Publicado: 2024-03-18

Una cookie o galleta informática es un pequeño archivo de información que se guarda en su navegador cada vez que visita nuestra página web. La utilidad de las cookies es guardar el historial de su actividad en nuestra página web, de manera que, cuando la visite nuevamente, ésta pueda identificarle y configurar el contenido de la misma en base a sus hábitos de navegación, identidad y preferencias. Las cookies pueden ser aceptadas, rechazadas, bloqueadas y borradas, según desee. Ello podrá hacerlo mediante las opciones disponibles en la presente ventana o a través de la configuración de su navegador, según el caso. En caso de que rechace las cookies no podremos asegurarle el correcto funcionamiento de las distintas funcionalidades de nuestra página web. Más información en el apartado “POLÍTICA DE COOKIES” de nuestra página web.