title: Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study.
abstract: BACKGROUND
  Periodontitis, a chronic bacterial infection of the oral cavity, is a novel risk factor for atherosclerotic cardiovascular disease (CVD). Given the numerous shared risk factors for CVD and chronic kidney disease (CKD), we hypothesized that periodontitis also is associated with renal insufficiency in the Dental Atherosclerosis Risk in Communities study.
  
  
  METHODS
  We conducted a cross-sectional study of 5,537 middle-aged black and white men and women. Periodontitis was determined by using an independent clinically derived definition and categorized as healthy/gingivitis, initial, and severe. Renal insufficiency is defined as glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2 . Multivariable logistic regression models were used to estimate odds ratios and 95% confidence intervals for renal insufficiency using healthy/gingivitis as the referent group.
  
  
  RESULTS
  A total of 2,276 individuals had initial periodontitis, and 947 individuals had severe periodontal disease. One hundred ten individuals (2%) had a GFR less than 60 mL/min/1.73 m2 . Compared with healthy/gingivitis, initial and severe periodontal disease were associated with a GFR less than 60 mL/min/1.73 m2 (odds ratio, 2.00; 95% confidence interval, 1.23 to 3.24) for initial periodontal disease and an odds ratio of 2.14 for severe disease (95% confidence interval, 1.19 to 3.85) after adjustment for important risk factors for CVD and CKD. Sensitivity analysis showed that initial and severe periodontitis were each associated with an elevated serum creatinine level (men, >1.4 mg/dL [>124 micromol/L]; women, >1.2 mg/dL [>106 micromol/L]; odds ratio, 3.21; 95% confidence interval, 1.32 to 7.76 and odds ratio, 5.39; 95% confidence interval, 2.08 to 13.99, respectively).
  
  
  CONCLUSIONS
  This is the first study to show an association of periodontal disease with prevalent renal insufficiency. A prospective study is necessary to determine the exact nature of the observed relationship.
authors.affiliation: Division of Nephrology and Hypertension, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. sagar@med.unc.edu
authors.forename: Abhijit V
authors.initials: AV
authors.lastname: Kshirsagar
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Moss
authors.forename: John R
authors.initials: JR
authors.lastname: Elter
authors.forename: James D
authors.initials: JD
authors.lastname: Beck
authors.forename: Steve
authors.initials: S
authors.lastname: Offenbacher
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Falk
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001161:Arteriosclerosis / Q000453:epidemiology; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003753:Dental Health Surveys; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D005891:Gingivitis / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D010518:Periodontitis / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D003404:Creatinine