Vanessa Grubbs1, Eric Vittinghoff2, George Taylor3, Donna Kritz-Silverstein4, Neil Powe5, Kirsten Bibbins-Domingo6, Areef Ishani7, Steven R Cummings8. 1. Division of Nephrology, University of California, San Francisco/San Francisco General Hospital, San Francisco, CA, USA. 2. Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA. 3. Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco,San Francisco, CA, USA. 4. Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, USA. 5. Department of Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, CA, USA. 6. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. 7. Division of Nephrology, University of Minnesota, Minneapolis, MN, USA. 8. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
Abstract
BACKGROUND: Identifying modifiable risk factors for chronic kidney disease (CKD) is essential for reducing its burden. Periodontal disease is common, modifiable and has been implicated as a novel potential CKD risk factor, but evidence of its association with kidney function decline over time is limited. METHODS: In a longitudinal retrospective cohort of 761 elderly men with preserved kidney function [estimated glomerular filtration rate > 60 mL/min/1.73 m(2) using a calibrated creatinine and cystatin C (eGFRcr-cys) equation] at baseline, we performed multivariable Poisson's regression to examine the association of severe periodontal disease with incident CKD, defined as incident eGFRcr-cys <60 mL/min/1.73 m(2) and rapid (>5% annualized) eGFRcr-cys decline. Severe periodontal disease was defined in two ways: (i) ≥5 mm proximal attachment loss in 30% of teeth examined (European Workshop in Periodontology Group C, European Workshop); and (ii) 2+ interproximal sites with attachment loss ≥6 mm and 1+ interproximal sites with probing depth ≥5 mm (Centers for Disease Control/American Academy of Periodontology, CDC/AAP). RESULTS: At baseline, the mean age was 73.4 (SD 4.8) years, the median eGFRcr-cys was 82.4 mL/min/1.73 m(2), and 35.5 and 25.4% of participants had severe periodontal disease by European Workshop and CDC/AAP criteria, respectively. After a mean follow-up of 4.9 years (SD 0.3), 56 (7.4%) participants had incident CKD. Severe periodontal disease was associated with a 2-fold greater rate of incident CKD [incidence rate ratio (IRR) 2.01 (1.21-3.44), P = 0.007] after adjusting for confounders compared with not severe periodontal disease by European Workshop criteria but did not reach statistical significance by CDC/AAP criteria [IRR 1.10 (0.63-1.91), P = 0.9]. CONCLUSIONS: Severe periodontal disease may be associated with incident clinically significant kidney function decline among a cohort of elderly men.
BACKGROUND: Identifying modifiable risk factors for chronic kidney disease (CKD) is essential for reducing its burden. Periodontal disease is common, modifiable and has been implicated as a novel potential CKD risk factor, but evidence of its association with kidney function decline over time is limited. METHODS: In a longitudinal retrospective cohort of 761 elderly men with preserved kidney function [estimated glomerular filtration rate > 60 mL/min/1.73 m(2) using a calibrated creatinine and cystatin C (eGFRcr-cys) equation] at baseline, we performed multivariable Poisson's regression to examine the association of severe periodontal disease with incident CKD, defined as incident eGFRcr-cys <60 mL/min/1.73 m(2) and rapid (>5% annualized) eGFRcr-cys decline. Severe periodontal disease was defined in two ways: (i) ≥5 mm proximal attachment loss in 30% of teeth examined (European Workshop in Periodontology Group C, European Workshop); and (ii) 2+ interproximal sites with attachment loss ≥6 mm and 1+ interproximal sites with probing depth ≥5 mm (Centers for Disease Control/American Academy of Periodontology, CDC/AAP). RESULTS: At baseline, the mean age was 73.4 (SD 4.8) years, the median eGFRcr-cys was 82.4 mL/min/1.73 m(2), and 35.5 and 25.4% of participants had severe periodontal disease by European Workshop and CDC/AAP criteria, respectively. After a mean follow-up of 4.9 years (SD 0.3), 56 (7.4%) participants had incident CKD. Severe periodontal disease was associated with a 2-fold greater rate of incident CKD [incidence rate ratio (IRR) 2.01 (1.21-3.44), P = 0.007] after adjusting for confounders compared with not severe periodontal disease by European Workshop criteria but did not reach statistical significance by CDC/AAP criteria [IRR 1.10 (0.63-1.91), P = 0.9]. CONCLUSIONS: Severe periodontal disease may be associated with incident clinically significant kidney function decline among a cohort of elderly men.
Authors: Eric Orwoll; Janet Babich Blank; Elizabeth Barrett-Connor; Jane Cauley; Steven Cummings; Kristine Ensrud; Cora Lewis; Peggy M Cawthon; Robert Marcus; Lynn M Marshall; Joan McGowan; Kathy Phipps; Sherry Sherman; Marcia L Stefanick; Katie Stone Journal: Contemp Clin Trials Date: 2005-10 Impact factor: 2.226
Authors: Abhijit V Kshirsagar; Kevin L Moss; John R Elter; James D Beck; Steve Offenbacher; Ronald J Falk Journal: Am J Kidney Dis Date: 2005-04 Impact factor: 8.860
Authors: Vanessa Grubbs; Laura C Plantinga; Deidra C Crews; Kirsten Bibbins-Domingo; Rajiv Saran; Michael Heung; Priti R Patel; Nilka Ríos Burrows; Kristina L Ernst; Neil R Powe Journal: Clin J Am Soc Nephrol Date: 2011-02-24 Impact factor: 8.237
Authors: Lesley A Inker; Christopher H Schmid; Hocine Tighiouart; John H Eckfeldt; Harold I Feldman; Tom Greene; John W Kusek; Jane Manzi; Frederick Van Lente; Yaping Lucy Zhang; Josef Coresh; Andrew S Levey Journal: N Engl J Med Date: 2012-07-05 Impact factor: 91.245
Authors: Vanessa Grubbs; Faviola Garcia; Bonnie L Jue; Eric Vittinghoff; Mark Ryder; David Lovett; Jacqueline Carrillo; Steven Offenbacher; Peter Ganz; Kirsten Bibbins-Domingo; Neil R Powe Journal: Contemp Clin Trials Date: 2016-12-20 Impact factor: 2.226
Authors: R Ausavarungnirun; S Wisetsin; N Rongkiettechakorn; S Chaichalermsak; U Udompol; M Rattanasompattikul Journal: BMJ Open Date: 2016-07-27 Impact factor: 2.692
Authors: Vanessa Grubbs; Faviola Garcia; Eric Vittinghoff; Bonnie L Jue; Mark Ryder; David H Lovett; Steven Offenbacher; George Taylor; Peter Ganz; Kirsten Bibbins-Domingo; Neil R Powe Journal: Kidney Med Date: 2019-12-02