Hellevi Ruokonen1, Karita Nylund1, Jussi Furuholm1, Jukka H Meurman1, Timo Sorsa1,2, Karoliina Kotaniemi1, Fernanda Ortiz3,4, Anna Maria Heikkinen1. 1. Department of Oral and Maxillofacial Diseases, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 2. Department of Dental Medicine, Division of Periodontology, Karolinska Institute, Huddinge, Sweden. 3. Abdominal Center, Nephrology, Helsinki University Hospital, Helsinki, Finland. 4. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Abstract
BACKGROUND: Factors related to mortality of patients with chronic kidney disease (CKD) were investigated to find out whether oral disease inflammatory burden or different etiology (diabetes nephropathy vs. other etiologies) of CKD could be associated with mortality. METHODS: This prospective cohort study comprised 144 adults at the predialysis stage. Clinical oral and radiologic examination was made from 2000 to 2005. Patients were followed up until August 2015 (complete follow-up time: 157 months). Cause of death could be verified from 62 of 65 patients. Clinical health data were combined with mortality records obtained from the Finland national statistics database. Number of teeth, total dental index (TDI), and periodontal inflammatory burden index were calculated to describe degree of oral inflammation. RESULTS: Primary causes of death were cardiovascular diseases, infection, and cancer. There was a statistically significant difference in survival between diabetic nephropathy (23.8%) and other patients with CKD (59.9%; log-rank test P <0.001). A Cox regression model showed fewer teeth, higher age, and diabetes mellitus were statistically significant independent risk factors for death. Deceased patients had fewer teeth (P <0.001) and higher TDI (P <0.05). CONCLUSIONS: Risk of death was higher among patients with diabetic nephropathy. The deceased had fewer teeth and more oral infections. However, indices used failed to show independent association with survival.
BACKGROUND: Factors related to mortality of patients with chronic kidney disease (CKD) were investigated to find out whether oral disease inflammatory burden or different etiology (diabetes nephropathy vs. other etiologies) of CKD could be associated with mortality. METHODS: This prospective cohort study comprised 144 adults at the predialysis stage. Clinical oral and radiologic examination was made from 2000 to 2005. Patients were followed up until August 2015 (complete follow-up time: 157 months). Cause of death could be verified from 62 of 65 patients. Clinical health data were combined with mortality records obtained from the Finland national statistics database. Number of teeth, total dental index (TDI), and periodontal inflammatory burden index were calculated to describe degree of oral inflammation. RESULTS: Primary causes of death were cardiovascular diseases, infection, and cancer. There was a statistically significant difference in survival between diabetic nephropathy (23.8%) and other patients with CKD (59.9%; log-rank test P <0.001). A Cox regression model showed fewer teeth, higher age, and diabetes mellitus were statistically significant independent risk factors for death. Deceased patients had fewer teeth (P <0.001) and higher TDI (P <0.05). CONCLUSIONS: Risk of death was higher among patients with diabetic nephropathy. The deceased had fewer teeth and more oral infections. However, indices used failed to show independent association with survival.