Clinical and serologic markers of periodontal infection and chronic kidney disease.
BACKGROUND
Chronic kidney disease and its concomitant sequelae represent a major public health problem. Recent data suggest periodontal infection contributes to chronic kidney disease.


METHODS
This United States population-based study of 4,053 adults > or =40 years of age investigated the association between chronic kidney disease and clinical measures and serologic markers of periodontal infection. Chronic kidney disease was defined as moderate-to-severe reduction of kidney function with glomerular filtration rate of 15 to 59 ml/minute/1.73 m(2) based on stages 3 and 4 of the Kidney Disease Outcome Quality Initiative. Chronic oral inflammatory burden was measured as 1) clinical periodontal infection categorized as no periodontal disease, periodontal disease (at least one tooth with > or =4 mm loss of attachment and bleeding on probing as an indicator of inflammation), or edentulism and 2) serum immunoglobulin G antibody response to Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) and Porphyromonas gingivalis. Multiple logistic regression modeling quantified the association between chronic kidney disease and chronic inflammatory burden and other risk factors.


RESULTS
Nine percent of the study population had chronic kidney disease, 22% had high A. actinomycetemcomitans antibody titer, 24% had high P. gingivalis antibody titer, 9% had periodontal disease, and 17% were edentulous. After simultaneously adjusting for recognized risk factors, adults with a high A. actinomycetemcomitans titer were less likely to have chronic kidney disease (adjusted odds ratio [OR(Adj)] = 0.67; 95% confidence interval [CI]: 0.46 to 0.98), and adults with edentulism were more likely to have chronic kidney disease (OR(Adj) = 1.64; 95% CI: 1.11 to 2.44).


CONCLUSIONS
These results support considering edentulism and low serum titer to A. actinomycetemcomitans as risk indicators for chronic kidney disease.
Fisher
Monica A
MA
Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
Taylor
George W
GW
Papapanou
Panos N
PN
Rahman
Mahboob
M
Debanne
Sara M
SM
D000328:Adult; D000368:Aged; D016976:Aggregatibacter actinomycetemcomitans / Q000276:immunology; D000907:Antibodies, Bacterial / Q000097:blood; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D050171:Dyslipidemias / Q000150:complications; D005884:Gingival Hemorrhage / Q000150:complications; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D007074:Immunoglobulin G / Q000097:blood; D007674:Kidney Diseases / Q000097:blood / Q000150:complications*; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000150:complications; D017622:Periodontal Attachment Loss / Q000150:complications; D010510:Periodontal Diseases / Q000097:blood / Q000150:complications*; D011159:Population Surveillance; D016966:Porphyromonas gingivalis / Q000276:immunology; D012307:Risk Factors; D012907:Smoking; D014481:United States
D000907:Antibodies, Bacterial; D007074:Immunoglobulin G