Comparative efficacy of non-pharmacological interventions on xerostomia and salivary flow rate among haemodialysis patients: A systematic review and network meta-analysis

Abstract

Background Xerostomia is a distressing symptom experienced by patients undergoing dialysis. We sought to compare and rank the efficacy of different non-pharmacological interventions on xerostomia and salivary flow rate among dialysis patients. Methods A systematic search was conducted in six English databases: Pubmed, CINAHL, Scopus, Web of Science, Embase, and Cochrane trials, in April 2023. Screening, quality appraisal, and data extraction were undertaken by two independent reviewers. A network meta-analysis was performed to assess the relative efficacy of different non-pharmacological interventions. Results The analysis included 11 randomized controlled trials involving 739 patients and eight non-pharmacological interventions. The pairwise analysis indicated that in comparison with the control group, sugarless candy, chewing sugarless gum, acupressure auricular, and licorice mouthwash had a significant positive effect on reducing the severity of xerostomia, also transcutaneous electrical nerve stimulation (TENS), licorice mouthwash, sugarless chewing gum, photobiomodulation, and pure water mouthwash, significantly improved saliva flow rate. The network analysis indicated that sugarless chewing gum significantly reduced the symptoms of xerostomia, while TENS and sugarless chewing gum were effective in improving UWS. Chewing sugarless gum and using TENS were the top-ranked interventions for relieving xerostomia and enhancing saliva flow rate among dialysis patients, respectively. Conclusions Several non-pharmacological interventions have demonstrated effectiveness in relieving xerostomia and enhancing saliva flow rates. While further research may be needed to confirm and refine these findings the interventions used in this review offer promising results and should be incorporated into the standard care of dialysis patients experiencing these symptoms to enhance their quality of life and oral health.