title: Vulnerable populations and the association between periodontal and chronic kidney disease.
abstract: OBJECTIVE
  Recent studies suggest an overall association between chronic kidney disease (CKD) and periodontal disease, but it is unknown whether this association is similar across various subpopulations.
  
  
  METHODS
  This study was a cross-sectional analysis of 2001 to 2004 National Health and Nutrition Examination Survey data. CKD was defined as a urinary albumin-to-creatinine ratio ≥30 mg/g or estimated GFR of 15 to 59 ml/min per 1.73 m(2). Adjusted odds ratios were calculated using multivariable logistic regression with U.S. population-based weighting.
  
  
  RESULTS
  These analyses included 6199 dentate adult participants (aged 21 to 75 years) with periodontal exams. The estimated prevalences of moderate/severe periodontal disease and CKD were 5.3% and 10.6%, respectively. Periodontal disease was associated with >2-fold higher risk of CKD that was moderately attenuated after adjustment for age, gender, race/ethnicity, tobacco use, hypertension, diabetes, educational attainment, poverty index ratio, and dental care use. There were no statistically significant interactions between periodontal disease and race/ethnicity, educational attainment, or poverty status. Less-than-recommended dental care use was associated with periodontal disease and CKD and was increasingly prevalent among nonwhites, lower educational attainment, and lower poverty status.
  
  
  CONCLUSIONS
  The association between periodontal disease and CKD is not significantly different among subgroups. However, because nonwhites, those with a lower educational level, and the poor less frequently report use of recommended dental care, the association between periodontal disease and kidney function over time may become stronger among these groups and warrants further investigation.
authors.affiliation: Division of Nephrology, University of California-San Francisco/San Francisco General Hospital Renal Center, Box 1341, 1001 Potrero Avenue, Building 100, Room 342, San Francisco, CA 94110, USA. grubbsv@medsfgh.ucsf.edu
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Deidra C
authors.initials: DC
authors.lastname: Crews
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.forename: Michael
authors.initials: M
authors.lastname: Heung
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
authors.forename: Nilka Ríos
authors.initials: NR
authors.lastname: Burrows
authors.forename: Kristina L
authors.initials: KL
authors.lastname: Ernst
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications* / Q000453:epidemiology