Serum markers of periodontal disease status and inflammation in hemodialysis patients.
BACKGROUND
Hemodialysis (HD) patients face a 25% annual mortality rate, with 50% of reported deaths attributed to cardiovascular disease. All-cause and cardiovascular mortality correlate with such acute-phase proteins as C-reactive protein (CRP). Hepatic CRP synthesis is upregulated by inflammation; however, elevated CRP values frequently are found in the absence of apparent infection or inflammation. Because destructive periodontal diseases have been associated with elevated CRP levels, we questioned whether destructive periodontal diseases could contribute to elevated CRP values in HD populations.


METHODS
Sera from 86 consecutive dentate HD patients were assayed for levels of immunoglobulin G (IgG) antibody to six periodontal species by means of an enzyme-linked immunosorbent assay.


RESULTS
CRP values for the subject population ranged from less than 6.9 to 159 mg/L (median, 8.2 mg/L). Univariate comparisons between subjects with or without elevated CRP levels (>10 mg/L) showed that CRP level elevation was associated significantly (P < 0.05) with greater doses of human recombinant erythropoietin and lower levels of hemoglobin, serum iron, transferrin saturation (TSat), albumin averaged over the 3 preceding months, total cholesterol, and triglycerides. Log serum IgG antibody levels to Porphyromonas gingivalis also were significantly greater in the group with elevated CRP levels (P = 0.013). Subsequent multivariate logistic regression showed that log serum antibody levels to P gingivalis remained significant (P = 0.02) after controlling for nonperiodontal sources of elevated CRP, hemoglobin, TSat, and triglyceride values.


CONCLUSIONS
These results suggest that elevated levels of IgG antibody to bacterial species associated with destructive periodontal diseases are associated with elevated CRP values in HD populations.
Rahmati
Margaret A
MA
Division of Nephrology, Beth Israel Medical Center, New York, NY, USA. mrahmati@blueyonder.co.uk
Craig
Ronald G
RG
Homel
Peter
P
Kaysen
George A
GA
Levin
Nathan W
NW
D000189:Actinobacillus Infections / Q000097:blood; D016976:Aggregatibacter actinomycetemcomitans / Q000276:immunology; D000907:Antibodies, Bacterial / Q000097:blood; D016866:Bacteroidaceae Infections / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002167:Campylobacter / Q000276:immunology; D002169:Campylobacter Infections / Q000097:blood; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage / Q000097:blood; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007249:Inflammation / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000097:blood* / Q000382:microbiology; D017861:Porphyromonas / Q000276:immunology; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D013045:Species Specificity
D000907:Antibodies, Bacterial; D015415:Biomarkers; D007074:Immunoglobulin G; D011994:Recombinant Proteins; D004921:Erythropoietin; D002097:C-Reactive Protein