The association of periodontal disease with kidney function decline

A longitudinal retrospective analysis of the MrOS dental study

Vanessa Grubbs, Eric Vittinghoff, George Taylor, Donna Kritz-Silverstein, Neil Powe, Kirsten Bibbins-Domingo, Areef Ishani, Steven R. Cummings

Research output: Contribution to journalArticle

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 m2 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 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 m2, 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.

Original languageEnglish (US)
Pages (from-to)466-472
Number of pages7
JournalNephrology Dialysis Transplantation
Volume31
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Periodontal Diseases
Tooth
Chronic Renal Insufficiency
Kidney
Centers for Disease Control and Prevention (U.S.)
Education
Cystatin C
Incidence
Glomerular Filtration Rate
Creatinine

Keywords

  • chronic kidney disease
  • periodontal disease
  • renal function decline
  • risk factors

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Grubbs, V., Vittinghoff, E., Taylor, G., Kritz-Silverstein, D., Powe, N., Bibbins-Domingo, K., ... Cummings, S. R. (2016). The association of periodontal disease with kidney function decline: A longitudinal retrospective analysis of the MrOS dental study. Nephrology Dialysis Transplantation, 31(3), 466-472. https://doi.org/10.1093/ndt/gfv312

The association of periodontal disease with kidney function decline : A longitudinal retrospective analysis of the MrOS dental study. / Grubbs, Vanessa; Vittinghoff, Eric; Taylor, George; Kritz-Silverstein, Donna; Powe, Neil; Bibbins-Domingo, Kirsten; Ishani, Areef; Cummings, Steven R.

In: Nephrology Dialysis Transplantation, Vol. 31, No. 3, 01.03.2016, p. 466-472.

Research output: Contribution to journalArticle

Grubbs, V, Vittinghoff, E, Taylor, G, Kritz-Silverstein, D, Powe, N, Bibbins-Domingo, K, Ishani, A & Cummings, SR 2016, 'The association of periodontal disease with kidney function decline: A longitudinal retrospective analysis of the MrOS dental study', Nephrology Dialysis Transplantation, vol. 31, no. 3, pp. 466-472. https://doi.org/10.1093/ndt/gfv312
Grubbs, Vanessa ; Vittinghoff, Eric ; Taylor, George ; Kritz-Silverstein, Donna ; Powe, Neil ; Bibbins-Domingo, Kirsten ; Ishani, Areef ; Cummings, Steven R. / The association of periodontal disease with kidney function decline : A longitudinal retrospective analysis of the MrOS dental study. In: Nephrology Dialysis Transplantation. 2016 ; Vol. 31, No. 3. pp. 466-472.
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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 m2 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 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 m2, 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.",
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AU - Vittinghoff, Eric

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AU - Powe, Neil

AU - Bibbins-Domingo, Kirsten

AU - Ishani, Areef

AU - Cummings, Steven R.

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N2 - 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 m2 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 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 m2, 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.

AB - 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 m2 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 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 m2, 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.

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