Cytopathological changes of oral mucosa in dialysis-dependent chronic kidney disease: association with KDIGO staging
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Abstract
Objective: To determine cytopathological changes in the oral mucosa of patients with chronic kidney disease (CKD) undergoing dialysis and to assess their association with Kidney Disease: Improving Global Outcomes (KDIGO) staging.
Methods: This cross-sectional study was conducted at University of Health Sciences, Lahore, from January to November 2019, after institutional ethical approval. One hundred CKD patients on dialysis were recruited from tertiary care hospitals in Lahore using predefined criteria. Socio-demographic data, oral hygiene status, clinical oral manifestations and relevant laboratory parameters were documented. CKD staging was performed according to KDIGO-2013 guidelines, and renal ultrasound grading was assessed. Oral mucosal smears were evaluated for inflammatory changes and cytological atypia. Associations between clinical, cytological, and KDIGO variables were analyzed through SPSS version-23.
Results: Mean age of participants was 50.09±14.98 years, with a male predominance. Xerostomia (86%), metallic taste (48%), and uremic fetor (45%) were the most frequent oral manifestations. Cytologically, reactive- and non-reactive atypia were identified in 29% and 40% cases respectively. Significant associations were found between inflammatory atypia and thickened mucosa, and between non-reactive atypia and angular cheilitis. Prominent nucleoli were significantly associated with metallic taste and higher KDIGO stages. Grades 3b and 4 CKD showed significant associations with duration of dialysis, xerostomia, periodontitis, and prominent nucleoli.
Conclusion: Oral cytopathological alterations are common in CKD patients undergoing dialysis and show significant associations with disease severity as per KDIGO staging. Oral cytology may serve as a useful adjunctive tool for early detection and monitoring of mucosal changes in patients with advanced CKD.
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