Oral microbiota in hemodialysis patients; a narrative review on recent ideas

Alterations in oral microbiota can significantly affect systemic health in hemodialysis (HD) patients. Oral dysbiosis contributes to inflammation, production of uremic toxins, and microbial translocation, which can exacerbate cardiovascular disease, chronic kidney disease (CKD), malnutrition, and cognitive impairment. In addition, oxidative stress from periodontal bacteria exacerbates CKD by promoting systemic inflammation, increasing renal oxidative damage, and accelerating functional decline. Conversely, the persistent oxidative stress caused by periodontal bacteria creates a hostile microenvironment in the kidneys, characterized by mitochondrial impairment, membrane damage, disrupted calcium homeostasis, DNA and protein damage, and chronic inflammation. These factors collectively inhibit renal tissue repair mechanisms, accelerating renal failure progression and worsening of kidney outcomes. Managing oral health through good oral hygiene, dietary modifications, and interventions such as probiotics and prebiotics is crucial for improving the overall health and quality of life for HD patients.