Monitoring the biochemical effect of haemodialysis in the patients with end-stage renal disease using saliva as an alternative to serum

ABSTRACT

To compare the effect of haemodialysis on biochemical changes in saliva with changes in serum in patients with end- stage renal disease [ESRD]. This is a Quasi-experimental study, which was conducted in the Department of Pathology and Nephrology, Army Medical College, Rawalpindi, Pakistan from Sep 2008 to Dec 2008. Total thirty nine patients of ESRD consisting of 28 males and 11 females on maintenance haemodialysis were included by convenient sampling technique. Pre and post haemodialysis 3 ml blood samples and saliva were collected under sterile conditions. Biochemical analysis of urea, creatinine and uric acid were carried out on clinical chemistry autoanalyser Selectra E. Electrolytes were analyzed on ion selective electrode analyzer Easylyte. Serum and salivary nitrite were estimated by Griess reaction on ELISA reader. The results were analyzed on SPSS version 16.0. The patients' age ranged from 15 to 80 years. The causes of ESRD were hypertension 15 [38%], diabetes mellitus 7[18%], pyelonephritis 6[15%], glomerulonephritis 3[8%], nephrolithiasis 3[8%] miscellaneous 2[5%] and unknown 3[8%]. The post dialysis serum and saliva revealed a significant decrease in urea [35.48% vs 30.54%], creatinine [37.48% vs 29.65%], uric acid [44.33% vs 37.51%] and nitrites [67.47% vs 52.00%] [P<0.001]. The study demonstrated significant Pearson's correlation between serum and salivary [pre and post dialysis] urea [r=0.73;p<0.001; r=0.69;p<0.001], creatinine [r=0.83;p<0.001; r=0.72;p<0.001], uric acid [r=0.69;p<0.001; r=0.64;p<0.001] and nitrite [r=0.59;p<0.001; r=0.53;p<0.001] respectively. The study demonstrated significant parallel decrease in urea, creatinine, uric acid and nitrite in the post dialysis samples of serum and saliva. Saliva offers an alternative to serum as a biological fluid that can be analyzed in the laboratory for monitoring biochemical change in the patients of ESRD