Long-term Association of Periodontitis With Decreased Kidney Function

Abstract

Rationale & objective: Previous studies have yielded inconclusive findings regarding the relationship between periodontitis and kidney function. We sought to investigate whether periodontitis is associated with subsequent decreases in kidney function (reductions in estimated glomerular filtration rate [eGFR] and increased urinary albumin-creatinine ratio [UACR]) in the general population.

Study design: Population-based cohort study.

Setting & participants: We used baseline and 11-year follow-up data from 2,297 and 1,512 adult participants, respectively, in the Study of Health in Pomerania (SHIP). Age range was limited to 20 to 59 years to avoid the potential influence of tooth loss.

Exposures: Periodontal status defined by periodontal pocket probing depth (PPD) and clinical attachment level. Mean levels and the percentage of sites ≥ 3mm was determined for either all sites (PPD) or interproximal sites (clinical attachment level). All PPDs≥4mm were summed to calculate the total PPD.

Outcomes: GFR estimated from serum creatinine and serum cystatin C (eGFR_cr-cys). Moderately increased albuminuria defined as UACR>30mg/g.

Analytical approach: Adjusted linear and logistic mixed regression models.

Results: At baseline and follow-up, average eGFR_cr-cys was 118.3 and 105.0mL/min/1.73m², respectively. Using mixed models, no consistently significant associations between periodontitis variables and eGFR_cr-cys were detected. Long-term changes in UACR were inconsistently associated with periodontitis measures. After imputation of missing data, associations were either attenuated or no longer detectable.

Limitations: Because periodontal assessments were performed using a partial recording protocol, periodontal disease severity estimates might have been underestimated, resulting in attenuated effect estimates.

Conclusions: We found no consistent evidence for an association between periodontitis and decreased kidney function. In contrast to previous studies, these results do not support the hypothesis that periodontitis is an important risk factor for chronic kidney disease.

Keywords: Gum disease; albuminuria; clinical attachment level (CAL); estimated glomerular filtration rate (eGFR); periodontitis; pocket probing depth (PPD); renal function; urinary albumin-creatinine ratio (UACR).