title: Periodontal status, inflammation, and malnutrition in hemodialysis patients - is there a link?
abstract: BACKGROUND
  Periodontal disease (PDD) was associated with inflammation, malnutrition, and higher mortality in hemodialysis (HD) patients.
  
  
  OBJECTIVE
  Cross-sectional observational study, aiming to assess the prevalence of PDD and the possible relationship among PDD, inflammation, and malnutrition in HD patients.
  
  
  METHODS
  Single HD center, 263 patients (age: 57.4 ± 12.3 years; 60% males; HD vintage 6.6 ± 4.9 years; the primary renal diseases were mainly primary glomerular nephropathies in 34% cases, with 11% diabetic nephropathy).
  
  
  METHODS
  Oral health status was assessed by the Silness and Loe plaque index, loss of clinical attachment level, periodontal pocket depth according to World Health Organization recommendations, by a single examiner. Patients were stratified by periodontal pocket depth (PPD): normal oral status/mild PDD (PPD < 4 mm), moderate PDD (PPD 4-5 mm), and severe PDD (PPD ≥ 6 mm). Demographic, smoking status, hematologic, dialysis-related data and parameters of the nutritional (Subjective Global Assessment score, anthropemetrical, and biochemical) and inflammatory status were collected.
  
  
  RESULTS
  Poor periodontal status was shown by 75% of patients, 23% of them with severe PDD. Patients with PDD were older; higher percentages of them were smokers, diabetics, had malnutrition, and inflammation. Subjects with severe PDD had higher HD vintage, lower hemoglobin, and required higher darbepoetin doses than those with healthy periodontium. Darbepoetin resistance index was higher in patients with severe PDD than in those with normal periodontium. Models of multivariable linear logistic regression for the potential promoters and for the consequences of PDD revealed smoking and HD duration as significant contributors; increased C-reactive protein was associated with severe PDD.
  
  
  CONCLUSIONS
  Cross-sectional observational design.
  
  
  CONCLUSIONS
  Impaired periodontal health is highly prevalent in HD patients. PDD is more frequent in elderly diabetic smokers and in those with longer HD vintage; smoking and HD duration seems to be the most important determinants. The prevalence is higher in malnourished and in inflamed patients; inflammation seems to accompany PDD and to influence anemia response to treatment.
authors.affiliation: Department of Nephrology and Internal Medicine, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Nephrology Department, "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania. Electronic address: lilianagarna@yahoo.com.
authors.forename: Liliana
authors.initials: L
authors.lastname: Garneata
authors.affiliation: Department of Preventive Dentistry, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Oana
authors.initials: O
authors.lastname: Slusanschi
authors.affiliation: Department of Mobile Prosthetics, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Elena
authors.initials: E
authors.lastname: Preoteasa
authors.affiliation: Nephrology Department, "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Corbu-Stancu
authors.affiliation: Department of Nephrology and Internal Medicine, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Nephrology Department, "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mircescu
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000453:epidemiology*; D007674:Kidney Diseases / Q000628:therapy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D010510:Periodontal Diseases / Q000097:blood / Q000453:epidemiology*; D015995:Prevalence; D006435:Renal Dialysis
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin; D002097:C-Reactive Protein