Abstract
Objectives
Periodontal disease is prevalent in patients with chronic kidney disease (CKD) and potentially associated with kidney function decline. However, it is uncertain whether periodontal disease affects the risk of mortality and morbidity in patients with advanced CKD.
Materials and methods
Taiwan’s National Health Insurance Research Database was used to conduct a nationwide population-based cohort study. Propensity score matching procedures were performed to select people with stage 5 CKD and to compare the long-term risk of mortality, end-stage renal disease, and major adverse cardiovascular events (MACE) between people with and without periodontal disease. Multivariable Cox regression analyses were conducted to calculate the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for the outcome of interest.
Results
A total of 8119 subjects with stage 5 CKD were initially included. After matching to demographic and clinical covariates, 1254 subjects with 7099 person-years of follow-up were selected for analyses. Periodontal disease was not associated with long-term risks of all-cause mortality (aHR: 0.77, 95% CI: 0.49–1.22), progression to end-stage renal disease (aHR: 0.91, 95% CI: 0.75–1.10), or MACE (aHR: 1.18, 95% CI: 0.91–1.53). These findings were generally consistent across subgroups of age, sex, comorbid diabetes, uses of systemic antibiotic, and different dental procedures.
Conclusions
Periodontal disease is not a predictor for long-term mortality or morbidity in patients with advanced CKD.
Clinical relevance
These results provide important evidence to elucidate the relationship between periodontitis and critical clinical outcomes of advanced CKD.
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Funding
This work was supported by the grants from Shuang Ho Hospital (109IIT-02), Taipei Medical University, New Taipei City, Taiwan, and Ministry of Science and Technology (MOST109-2314-B-038-024), Taipei, Taiwan.
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This study was reviewed and approved by the Institutional Review Board of Taipei Medical University and Taipei Veterans General Hospital in Taiwan (TMU-JIRB-N202010040; IRB-TPEVGH-2013-04-005E).
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Written informed consent was waived by the Institutional Review Board (chair: Professor Chung-Ming Chen of Taipei Medical University and Professor Shung-Tai Ho of Taipei Veterans General Hospital).
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Tai, YH., Chen, JT., Kuo, HC. et al. Periodontal disease and risk of mortality and kidney function decline in advanced chronic kidney disease: a nationwide population-based cohort study. Clin Oral Invest 25, 6259–6268 (2021). https://doi.org/10.1007/s00784-021-03924-6
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DOI: https://doi.org/10.1007/s00784-021-03924-6