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Oral health in patients with renal disease: a longitudinal study from predialysis to kidney transplantation

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Abstract

Objectives

The aim of this longitudinal study was to compare the oral health of chronic kidney disease patients at the predialysis (baseline) and post-transplantation (follow-up) stages and to investigate differences in oral health between diabetic nephropathy and other kidney disease patients at follow-up.

Materials and methods

Fifty-three kidney disease patients (34 men) aged 31–86 years were followed up to 157 months. Clinical and radiological oral examinations, salivary and laboratory analyses, and oral health behavior questionnaires were conducted at the predialysis and follow-up stages at Helsinki University Hospital, Finland. Oral inflammatory burden was estimated by calculating deep periodontal pockets, periodontal inflammatory burden (PIBI), decayed, missing, and filled teeth (DMFT), and total dental indices (TDI). Results were analyzed using cross-tabulation Pearson chi-square or Fisher’s exact test and the Mann-Whitney U test, and the McNemar and Wilcoxon signed-rank test.

Results

At the predialysis stage, patients more often had calculus and deep periodontal pockets; TDI, PIBI, number of teeth, and salivary flow rates were also statistically significantly higher compared to follow-up. At follow-up, diabetic nephropathy patients more often had Candida growth, more plaque, and used more drugs and had lower stimulated salivary flow than patients with other kidney diseases.

Conclusion

Oral health was better at follow-up than at the predialysis stage; however, attention should be given to the lower salivary flow rate and higher number of drugs used at that stage.

Clinical relevance

This study confirms the importance of treating oral infectious foci at the predialysis stage in order to prevent adverse outcomes after kidney transplantation.

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References

  1. Sanchez-Escuredo A, Alsina A, Diekmann F et al (2015) Economic analysis of the treatment of end-stage renal disease treatment: living-donor kidney transplantation versus hemodialysis. Transplantation Proc 47(1):30–33

    Article  Google Scholar 

  2. Jensen CE, Sorensen P, Petersen KD (2014) In Denmark kidney transplantation is more cost-effective than dialysis. Dan Med J 61(3):A4796

    PubMed  Google Scholar 

  3. Ruospo M, Palmer SC, Craig JC et al (2014) Prevalence and severity of oral disease in adults with chronic kidney disease: a systematic review of observational studies. Nephrol Dial Transplant 29(2):364–375

    Article  PubMed  Google Scholar 

  4. Eckardt KU, Coresh J, Devuyst O et al (2013) Evolving importance of kidney disease: from subspecialty to global health burden. Lancet 382:158–169

    Article  PubMed  Google Scholar 

  5. Fisher MA, Taylor GW, Shelton BJ et al (2008) Periodontal disease and other nontraditional risk factors for CKD. Am J Kidney Dis 51(1):45–52

    Article  PubMed  Google Scholar 

  6. Kaswan S, Patil S, Maheshwari S, Wadhawan R (2015) Prevalence of oral lesions in kidney transplant patients: a single center experience. Saudi J Kidney Dis Transpl 26(4):678–683

    Article  PubMed  Google Scholar 

  7. Rezvani G, Davarmanesh M, Azar MR et al (2014) Oral manifestations of allograft recipients before and after renal transplantation. Saudi J Kidney Dis Transpl 25(2):278–284

    Article  PubMed  Google Scholar 

  8. Seymour RA, Thomason JM, Nolan A (1997) Oral lesions in organ transplant patients. J Oral Pathol Med 26(7):297–304

    Article  PubMed  Google Scholar 

  9. Vesterinen M, Ruokonen H, Leivo T et al (2007) Oral health and dental treatment of patients with renal disease. Quintessence Int 38(3):211–219

    PubMed  Google Scholar 

  10. Vesterinen M, Ruokonen H, Furuholm J, Honkanen E, Meurman JH (2011) Oral health in predialysis patients with emphasis on diabetic nephropathy. Clin Oral Investig 15(1):99–104

    Article  PubMed  Google Scholar 

  11. Nylund K, Meurman JH, Heikkinen AM, Honkanen E, Vesterinen M, Ruokonen H (2015) Oral health in predialysis patients with emphasis on periodontal disease. Quintessence Int 46(10):899–907

    PubMed  Google Scholar 

  12. Mattila KJ, Nieminen MS, Valtonen VV et al (1989) Association between dental health and acute myocardial infarction. Br Med J 25(298):779–781

    Article  Google Scholar 

  13. Lindy O, Suomalainen K, Mäkelä M, Lindy S (2008) Statin use is associated with fewer periodontal lesions: a retrospective study. BMC Oral Health 8(16)

  14. Page RC, Eke PI (2007) Case definition for use in population-based surveillance of periodontitis. J Periodontol 78(Suppl.7):1387–1399

    Article  PubMed  Google Scholar 

  15. Bots CP, Brand HS, Poorterman JH et al (2007) Oral and salivary changes in patients with end stage renal disease (ESRD): a two year follow-up study. Br Dent J 202:E7

    Article  Google Scholar 

  16. Thorman R, Neovius M, Hylander B (2009) Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population. Scand J of Urol 43:154–159

    Article  Google Scholar 

  17. Närhi TO, Meurman JH, Ainamo A (1999) Xerostomia and hyposalivation causes, consequences and treatment in elderly. Drugs Aging 15(2):103–116

    Article  PubMed  Google Scholar 

  18. Ortiz F, Aronen P, Koskinen PK et al (2014) Health-related quality of life after kidney transplantation: who benefits the most? Transpl Int 27:1143–1151

    Article  PubMed  Google Scholar 

  19. Laupacis A, Keown P, Pus N et al (1996) A study of the quality of life and cost-utility of renal transplantation. Kidney Int 50:235–242

    Article  PubMed  Google Scholar 

  20. Haapio M, Helve J, Kyllonen L, Gronhagen-Riska C, Finne P (2013) Modality of chronic renal replacement therapy and survival—a complete cohort from Finland, 2000-2009. Nephrol Dial Transplant 28:3072–3081

    Article  PubMed  Google Scholar 

  21. Pippias M, Stel VS, Abad Diez JM et al (2015) Renal replacement therapy in Europe: a summary of the 2012 ERA-EDTA Registry Annual Report. Clin Kidney J 8(3):248–261

    Article  PubMed  PubMed Central  Google Scholar 

  22. Greenberg MS, Cohen G (1977) Oral infection in immunosuppressed renal transplant patients. Oral Surg Oral Med Oral pathol 43(6):879–885

    Article  PubMed  Google Scholar 

  23. Lucas VS, Roberts GJ (2005) Oro-dental health in children with chronic renal failure and after renal transplantation: a clinical review. Pediatr Nephrol 20(10):1388–1394

    Article  PubMed  Google Scholar 

  24. Zwiech R, Bruzda-Zwiech A (2013) Does oral health contribute to post-transplant complications in kidney allograft recipients? Acta Odontol Scand 71(3–4):756–763

    Article  PubMed  Google Scholar 

  25. Helenius-Hietala J, Åberg F, Meurman JH, Isoniemi H (2013) Increased infection risk postliver transplant without pretransplant dental treatment. Oral Dis 19:271–278

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by hospital research funding under EVO grant TYH20012128 (EVO comes from the Finnish words “erityisvaltionosuusrahoitus,” which in English means “discretionary state funding”) and by the Finnish Dental Society Apollonia.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Diseases, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Karita M. Nylund, Jukka H. Meurman, Anna Maria Heikkinen, Jussi O. Furuholm & Hellevi M. Ruokonen

  2. Abdominal Center, Nephrology, Helsinki University Hospital, Helsinki, Finland

    Fernanda Ortiz

  3. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland

    Fernanda Ortiz

Authors
  1. Karita M. Nylund
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  2. Jukka H. Meurman
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  3. Anna Maria Heikkinen
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  4. Jussi O. Furuholm
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  5. Fernanda Ortiz
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  6. Hellevi M. Ruokonen
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Corresponding author

Correspondence to Karita M. Nylund.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study was funded by hospital research funding under EVO grant TYH20012128 (EVO comes from the Finnish words “erityisvaltionosuusrahoitus,” which in English means “discretionary state funding”) and by the Finnish Dental Society Apollonia.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

The ethical committee of the Helsinki and Uusimaa Hospital District had approved the study, which was conducted according to the principles of the Declaration of Helsinki (Dnro 305/13/03/02/2012).

Informed consent

Informed consent was obtained from all participants included in the study.

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Nylund, K.M., Meurman, J.H., Heikkinen, A.M. et al. Oral health in patients with renal disease: a longitudinal study from predialysis to kidney transplantation. Clin Oral Invest 22, 339–347 (2018). https://doi.org/10.1007/s00784-017-2118-y

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  • DOI: https://doi.org/10.1007/s00784-017-2118-y

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