Prevalence of Oral Fungal Infections Among Hemodialysis Patients and Their Association With Clinical and Demographic Factors: A Retrospective Study

Background: Patients on hemodialysis are more prone to having oral fungal infections due to weakened immunity, frequent medication use, and dry mouth. Understanding how clinical and lifestyle factors are associated with fungal presence may help in early detection and prevention. Clinically evident oral candidiasis is the most commonly observed fungal infection in hemodialysis patients, with diabetes and xerostomia as key associated risk factors, but available studies are mostly small, cross-sectional, and lack robust retrospective national data or systematic analysis of oral hygiene counseling practices. Objective: We aimed to assess the prevalence of oral candidiasis in hemodialysis patients and explore their association with demographic and clinical features. Methodology: We conducted a retrospective cross-sectional, single-center study at Prince Rashid Bin Al-Hassan Military Hospital between January 2024 and January 2025 on patients who were on regular hemodialysis. We collected basic demographic information from medical records and assessed the presence of oral fungal infection, along with its severity and whether the patients experienced pain or burning sensations. Hemodialysis-related variables, such as the number of dialysis sessions per week and duration on dialysis in months, were collected. We also gathered data on medication use, fasting and postprandial blood sugar, glycated hemoglobin, and duration of diabetes. Results: Among 268 hemodialysis patients (161 males, 60%), the mean dialysis duration was 55 ± 34 months. Oral candidiasis was present in 147 (55%) patients: 39 (15%) had mild, 66 (25%) had moderate, and 42 (16%) had severe candidiasis. A total of 64 (24%) patients had positive potassium hydroxide/culture. Xerostomia occurred in 153 (57%), angular cheilitis in 83 (31%), and denture stomatitis in 86 (32%) patients. Lesions involved the tongue in 88 (33%), buccal mucosa in 67 (25%), palate in 64 (24%), and commissures in 54 (20%) patients. Compared with patients without candidiasis, those affected were more often current smokers (26% vs. 8.3%, p < 0.001), denture wearers (partial: 26% vs. 14%; complete: 14% vs. 7.6%, p = 0.006), and xerostomic (72% vs. 39%, p < 0.001); recent steroid exposure was higher (11% vs. 1.7%, p = 0.006). Diabetes (52% vs. 46%, p = 0.40), hypertension (78% vs. 81%, p = 0.80), immunosuppression (12% vs. 9.5%, p = 0.70), mouthwash use (48% vs. 44%, p = 0.70), dialysis sessions/week (p = 0.60), access type (p = 0.30), and dialysis duration (55 vs. 55 months, p = 0.80) did not differ. In multivariable analysis, independent predictors were current smoking (OR: 5.75, 95% CI: 2.13-17.4; p = 0.001), xerostomia (OR: 3.72, 95% CI: 1.89-7.53; p < 0.001), partial denture use (OR: 2.67, 95% CI: 1.10-6.87; p = 0.039), and recent steroid use (OR: 9.56, 95% CI: 1.45-192; p = 0.016). Diabetes (OR: 0.96; p > 0.90) and dialysis duration (OR: 1.00; p = 0.50) were not associated. Only 57 (22%) received antifungals, and 34 (13%) were treated at assessment, indicating undertreatment. Conclusion: In hemodialysis patients, oral candidiasis is highly prevalent and independently associated with current smoking, denture use, xerostomia, and recent steroid therapy. High-risk patients should be identified at an early stage, and preventive measures should be focused on them. Timely antifungal therapy should be taken to reduce morbidity and enhance oral health outcomes among this vulnerable group.