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(CC BY-NC 4.0).
Background: Chronic kidney disease CKD impacts about 10% of people worldwide and results in the buildup of uremic toxins, often necessitating hemodialysis HD in advanced stages. It is linked to various oral health issues including dry mouth, mucosal lesions, periodontal problems, and changes in saliva composition that can negatively
impact both quality of life and systemic inflammation.
Objectives: The aims of the present study are to make a comparative evaluation of objective clinical oral findings and subjective oral symptoms in patients with Chronic kidney disease CKD undergoing Dialysis, and finding the correlation between the salivary PH and salivary Urea.
Material and Methods: In this cross-sectional study 2024–2025 at the Duhok Kidney Diseases and Transplantation Center, we enrolled 150 adult CKD patients on maintenance hemodialysis for ≥ 90 days. Each patient underwent a standardized oral examination for 13 manifestations xerostomia, uremic stomatitis, dysgeusia, halitosis, gingival enlargement, recurrent aphthous stomatitis, burning mouth, geographic tongue, white lesions, candidiasis, dry fissured lips, coated tongue, angular cheilitis. Unstimulated saliva was collected to measure flow rate mL/min, pH strip system.
Serum urea and creatinine were recorded from the most recent renal panel. Statistical analyses α = 0.05 included within-group t-tests, one-sample t-tests, chi-square tests, Pearson’s r and Spearman’s ρ.
Results: Xerostomia prevalence 58.7% matched hyposalivation 59%; p < 0.001. Halitosis 36.7% and dysgeusia 31.3% showed no significant association with coated tongue or stomatitis p > 0.05. Mean salivary pH was significantly below normal, p < 0.001; pH vs. flow Salivary urea strongly correlated with serum urea p < 0.001. Significant associations were found for coated tongue–candidiasis p = 0.04, gingival enlargement p = 0.03, and recurrent aphthous stomatitis p = 0.04. Other signs burning mouth, geographic tongue, angular cheilitis were not significant p > 0.05.
Conclusion: Patient-reported xerostomia reliably indicates hyposalivation. Salivary urea is validated as a noninvasive surrogate for blood urea, while acidic saliva reflects impaired buffering capacity. Integrated nephrologydentistry care, including routine oral screening and salivary diagnostics, may improve management of uremic oral complications.