Ying-Hsuan Tai1,2, Jui-Tai Chen1,2, Hsien-Cheng Kuo1,2, Wei-Jen Chang3,4, Mei-Yi Wu5,6,7, Ying-Xiu Dai8,9, Wan-Chi Liu1,2, Tzeng-Ji Chen9,10, Hsiang-Ling Wu9,11, Yih-Giun Cherng12,13. 1. Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan. 2. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 3. Department of Dentistry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 4. School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan. 5. Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 6. Division of Nephrology, Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan. 7. TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan. 8. Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan. 9. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. 10. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 11. Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan. 12. Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan. stainless@s.tmu.edu.tw. 13. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. stainless@s.tmu.edu.tw.
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.
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.
Authors: Suetonia C Palmer; Marinella Ruospo; Germaine Wong; Jonathan C Craig; Massimo Petruzzi; Michele De Benedittis; Pauline Ford; David W Johnson; Marcello Tonelli; Patrizia Natale; Valeria Saglimbene; Fabio Pellegrini; Eduardo Celia; Ruben Gelfman; Miguel R Leal; Marietta Torok; Paul Stroumza; Luc Frantzen; Anna Bednarek-Skublewska; Jan Dulawa; Domingo Del Castillo; Amparo G Bernat; Jorgen Hegbrant; Charlotta Wollheim; Staffan Schon; Letizia Gargano; Casper P Bots; Giovanni F M Strippoli Journal: Nephrol Dial Transplant Date: 2015-12-29 Impact factor: 5.992
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