Associations of periodontitis with risk of all-cause and cause-specific mortality among us adults with chronic kidney disease

Weiqi Li; Tian Li; Yingming Wei; Xuzhuo Chen; Shanfeng Lin; Li Lin

doi:10.1016/j.jdent.2023.104712

Associations of periodontitis with risk of all-cause and cause-specific mortality among us adults with chronic kidney disease

J Dent. 2023 Nov:138:104712. doi: 10.1016/j.jdent.2023.104712. Epub 2023 Sep 22.

Authors

Weiqi Li¹, Tian Li², Yingming Wei³, Xuzhuo Chen⁴, Shanfeng Lin⁵, Li Lin⁶

Affiliations

¹ State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Scissences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, PR China.
² Department of Prosthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, PR China.
³ Department of Oral Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, Zhejiang, PR China.
⁴ Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, PR China.
⁵ Department of Oroamxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, PR. China.
⁶ Department of Periodontology, School of Stomatology, China Medical University, Shenyang, Liaoning, PR. China. Electronic address: linli@cmu.edu.cn.

PMID: 37741502
DOI: 10.1016/j.jdent.2023.104712

Abstract

Objectives: To investigate the associations of periodontitis with risk of all-cause and cause-specific mortality in a nationally representative sample of adults with chronic kidney disease (CKD) in the United States.

Methods: This prospective cohort study included 4,271 individuals aged ≥30 years at baseline with CKD participants in the National Health and Nutrition Examination Survey (NHANES) during 1988-1994, 1999-2004, and 2009-2014. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m² and/or urinary albumin/creatinine ratio (uACR) ≥30 mg/g. Multivariate cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of all-cause and cause-specific mortality in participants with CKD according to periodontitis. The associations of the quartiles of mean clinical attachment loss (CAL) and mean periodontal probing depth (PPD) levels with mortality were examined using the first quartile as the reference group.

Results: During a median of 8.67 years of follow-up, 2,146 deaths were documented. After multivariate adjustments, moderate/severe periodontitis was significantly associated with all-cause (HR:1.28; 95 % CI:1.11-1.47; P = 0.001) and cardiovascular disease (CVD)-related mortality (HR:1.44; 95 % CI:1.14-1.81; P = 0.002) in participants with CKD. Compared with the reference group of mean CAL and mean PPD levels, all-cause (CAL: HR, 1.58; 95 % CI, 1.32-1.89, P <0.001; PPD: HR, 1.35, 95 % CI, 1.09-1.67, P = 0.011) and CVD-related mortality (CAL: HR, 1.70, 95 % CI, 1.21-2.40, P = 0.001) were increased for participants in the highest quartile.

Conclusions: This study suggests that moderate/severe periodontitis and high levels of mean CAL and mean PPD are associated with an increased risk of all-cause mortality, and moderate/severe periodontitis and mean CAL associated with CVD-related mortality among adults with CKD in the US.

Clinical significance: This study details the association between periodontitis and the increased risk of all-cause mortality and CVD-related mortality in a large, representative sample of adults with CKD.

Keywords: Cardiovascular disease; Chronic kidney disease; Clinical attachment loss; Mortality; Periodontal probing depth; Periodontitis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiovascular Diseases* / complications
Cause of Death
Humans
Nutrition Surveys
Periodontitis* / complications
Prospective Studies
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / diagnosis
Risk Factors
United States / epidemiology