Sugar-Free Chewing Gum Shows Potential for Thirst Relief Among Maintenance Hemodialysis Patients, Finds Study

Lei-Wen Tang and colleagues from the Nursing Department of the Second Affiliated Hospital of Zhejiang University School of Medicine, China, aimed to assess whether chewing sugar-free gum could effectively manage thirst and dry mouth among patients undergoing maintenance hemodialysis (MHD). 

Thirst is one of the most common and troublesome symptoms faced by patients on long-term dialysis. It not only reduces quality of life but also contributes to complications such as fluid overload. Despite its prevalence, no gold-standard approach exists for managing thirst in this population. Against this backdrop, sugar-free gum has been suggested as a simple behavioral intervention, but evidence supporting its effectiveness has remained unclear.

To address this gap, the research team systematically reviewed and analyzed data from seven randomized controlled trials involving 395 participants. The primary outcomes included thirst intensity, measured using the Visual Analogue Scale (VAS) and Dialysis Thirst Inventory (DTI), along with xerostomia, measured via the Summated Xerostomia Inventory (SXI). Secondary outcomes assessed salivary flow rate and IDWG. The researchers also examined whether the effects varied by intervention duration or type of control group.

Key Findings:

• Sugar-free chewing gum significantly reduced thirst scores measured by VAS.
• Xerostomia symptoms improved with the intervention.
• Interventions lasting six weeks or more showed stronger effects on thirst reduction, though statistical analysis did not confirm a significant duration-related difference.
• Compared with non-intervention controls, chewing gum lowered thirst scores on the DTI scale.
• There were no significant improvement when compared with active controls.
• There were no benefits for salivary flow rate, overall DTI scores, or IDWG.

While the results highlight potential benefits, the authors cautioned that the certainty of evidence was very low to low, based on GRADE assessment. Methodological shortcomings, such as unclear randomization, lack of blinding, and small sample sizes, contributed to this limitation. Furthermore, most included studies were conducted in Asia and the Middle East/North Africa region, which may restrict generalizability to other populations.

The authors emphasized the need for future research to adopt stronger trial designs with proper randomization, allocation concealment, and blinding. They also recommended the use of standardized evaluation tools, larger sample sizes, and comparisons with other low-cost interventions such as lemon mouthwash. Exploring multimodal strategies that combine chewing gum with additional therapies could offer a more comprehensive approach to managing thirst in MHD patients.

"The meta-analysis indicates that sugar-free chewing gum may serve as a convenient and inexpensive option to ease thirst and dry mouth among patients receiving hemodialysis. However, due to limited and low-quality evidence, its clinical use should be approached cautiously until further large-scale, high-quality trials provide more definitive answers," the authors concluded.

Reference:

Li, SY., Tang, LW., Li, J. et al. Sugar-free chewing gum’s effect on patients receiving maintenance hemodialysis: a meta-analysis of RCTs. BMC Nephrol 26, 502 (2025). https://doi.org/10.1186/s12882-025-04430-7