Oral Health-Related Quality of Life, A Proxy of Poor Outcomes in Patients on Peritoneal Dialysis

Sirirat Purisinsith; Patnarin Kanjanabuch; Jeerath Phannajit; Talerngsak Kanjanabuch; Pongpratch Puapatanakul; David W Johnson; Krit Pongpirul; Jeffrey Perl; Bruce Robinson; Kriang Tungsanga; Thailand PDOPPS Steering Committee

doi:10.1016/j.ekir.2022.07.008

Oral Health-Related Quality of Life, A Proxy of Poor Outcomes in Patients on Peritoneal Dialysis

Kidney Int Rep. 2022 Aug 6;7(10):2207-2218. doi: 10.1016/j.ekir.2022.07.008. eCollection 2022 Oct.

Authors

Sirirat Purisinsith¹, Patnarin Kanjanabuch², Jeerath Phannajit^{3

4}, Talerngsak Kanjanabuch^{4

5

6

7}, Pongpratch Puapatanakul^{4

7}, David W Johnson^{8

9

10}, Krit Pongpirul^{7

11

12}, Jeffrey Perl¹³, Bruce Robinson¹², Kriang Tungsanga⁴; Thailand PDOPPS Steering Committee

Collaborators

Thailand PDOPPS Steering Committee:
Kriang Tungsanga, Kearkiat Praditpornsilpa, Tanittha Chutsawan, Krit Pongpirul, Kanittha Triamamornwooth, Piyaporn Towannang, Pichet Lorvinitnun, Suchai Sritippayawan, Guttiga Halue, Kittisak Tangjittrong, Ussanee Poonvivatchaikarn, Somphon Buranaosot, Sukit Nilvarangkul, Wanida Somboonsilp, Pimpong Wongtrakul, Chanchana Boonyakrai, Surapong Narenpitak, Sajja Tatiyanupanwong, Wadsamon Saikong, Sriphrae Uppamai, Jarubut Phisutrattanaporn, Setthapon Panyatong, Puntapong Taruangsri, Rutchanee Chieochanthanakij, Niwat Lounseng, Angsuwarin Wongpiang, Worapot Treamtrakanpon, Peerapach Rattanasoonton, Narumon Lukrat, Phichit Songviriyavithaya, Uraiwan Parinyasiri, Areewan Cheawchanwattana

Affiliations

¹ Health Department, Bangkok Metropolitan Administration, Bangkok, Thailand.
² Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
³ Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁴ Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁵ Center of Excellence in Kidney Metabolic Disorders, Chulalongkorn University, Bangkok, Thailand.
⁶ Dialysis Policy & Practice Program, School of Global Health, Chulalongkorn University, Bangkok, Thailand.
⁷ Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
⁸ Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
⁹ Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
¹⁰ Translational Research Institute, Brisbane, Australia.
¹¹ Department of International Health and Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
¹² Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
¹³ St. Michael's Hospital, Toronto, Ontario, Canada.

Abstract

Introduction: We sought to evaluate the associations of poor oral health hygiene with clinical outcomes in patients receiving peritoneal dialysis (PD).

Methods: As part of the multinational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 participating PD centers throughout Thailand were enrolled from May 2016 to December 2019. The data were obtained from questionnaires that formed part of the PDOPPS. Oral health-related quality of life (HRQoL) used in this study was the short form of the oral health impact profile (oral health impact profile [OHIP]-14, including 7 facets and 14 items). Patient outcomes were assessed by Kaplan-Meier analysis. Cox proportional hazards model regression was used to estimate associations between oral HRQoL and clinical outcomes.

Results: Of 5090 PD participants, 675 were randomly selected, provided informed consent, and completely responded to the OHIP-14 questionnaire. The median follow-up time of the study was 3.5 (interquartile range = 2.7-5.1 months) years. Poor oral health was associated with lower educational levels, diabetes, older age, marriage, and worse nutritional indicators (including lower time-averaged serum albumin and phosphate concentrations). After adjusting for age, sex, comorbidities, serum albumin, shared frailty by study sites, and PD vintage, poor oral health was associated with increased risks of peritonitis (adjusted hazard ratio [HR] = 1.45, 95% confidence interval [CI]: 1.06-2.00) and all-cause mortality (adjusted HR = 1.55, 95% CI: 1.04-2.32) but not hemodialysis (HD) transfer (adjusted HR = 1.89, 95% CI: 0.87-4.10) compared to participants with good oral health.

Conclusion: Poor oral health status was present in one-fourth of PD patients and was independently associated with a higher risk of peritonitis and death.

Keywords: PDOPPS; oral health hygiene; patient survival; peritonitis.