Association among oral health parameters, periodontitis, and its treatment and mortality in patients undergoing hemodialysis.
BACKGROUND
Chronic periodontitis (CP) is a continuous, reversible source of inflammation with a potential impact on mortality in patients undergoing hemodialysis (HD). This study investigates the impact of oral health indicators, CP, and its treatment on survival rates in a group of patients undergoing HD.


METHODS
Clinically stable patients undergoing HD were referred for a dental examination. All patients were prospectively followed in the dialysis clinic, and all-cause mortality was recorded. Three groups of patients were analyzed: those who received CP treatment, those who did not, and patients without CP as a control group.


RESULTS
A total of 122 patients (79 males and 43 females, aged 23 to 77 years; mean age: 50 years; range: 23 to 77 years) were enrolled. Forty percent reported having rarely been evaluated by a dentist, and 59% had CP. There were 34 fatal events during a mean follow-up time of 64.1 ± 11.2 months. Oral factors associated with death in the univariate analysis were decreased frequency of dental visits; non-use of dental floss; increased decayed, missing, and filled teeth index; presence of CP; and absence of CP treatment. Patients with CP had a higher risk of death from all causes compared with patients without CP in the univariate analysis for untreated patients (hazard ratio 2.65 [95% confidence interval 1.06 to 6.59]; P = 0.036) and to a lesser extent for treated patients (2.36 [1.01 to 5.59]; P = 0.047). These significant differences were not maintained after adjustments for confounders in the multivariate model.


CONCLUSIONS
These results suggest that poor oral health, including CP, is a common finding in patients undergoing HD. The results of this study call for intervention trials to test the hypothesis that treatment of CP improves survival in maintenance of patients undergoing HD.
School of Health and Biosciences, Pontifical Catholic University of Parana, Curitiba, Brazil.
Cleber M
CM
de Souza
Ana Paula R
AP
Braosi
Sônia M
SM
Luczyszyn
Márcia
M
Olandoski
Peter
P
Kotanko
Ronald G
RG
Craig
Paula C
PC
Trevilatto
Roberto
R
Pecoits-Filho
D000328:Adult; D000367:Age Factors; D000368:Aged; D055113:Chronic Periodontitis / Q000150:complications* / Q000628:therapy; D004245:DMF Index; D003728:Dental Calculus / Q000145:classification; D003729:Dental Care / Q000706:statistics & numerical data; D003742:Dental Devices, Home Care / Q000706:statistics & numerical data; D003774:Dental Plaque Index; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D009911:Oral Hygiene Index; D017622:Periodontal Attachment Loss / Q000145:classification; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D012737:Sex Factors; D055815:Young Adult
Inflammation; kidney diseases; oral health; periodontal diseases; renal dialysis; survival