Periodontal Disease and Risks of Kidney Function Decline and Mortality in Older People: A Community-Based Cohort Study.
BACKGROUND
The association between periodontal disease and chronic kidney disease in older people is controversial, and evidence for a causal link between kidney function decline and subsequent mortality risk is limited.


METHODS
Longitudinal, observational, community-based cohort study.


METHODS
Participants were citizens 65 years or older who received the Taipei City Government-sponsored Annual Elderly Health Examination Program during 2005 to 2010, including dental status assessment and biochemical examinations.


METHODS
Participants with periodontal disease defined by the World Health Organization Community Periodontal Index of Treatment Need criteria.


RESULTS
All-cause and cardiovascular mortality and estimated glomerular filtration rate (eGFR) decline ≥ 30% over 2 years.


RESULTS
Of 100,263 study participants, 13,749 (13.7%) had periodontal disease. In a mean follow-up of 3.8 years, all-cause and cardiovascular mortality rates in those with periodontal disease (11.5% and 2.6%, respectively) were higher compared with those without periodontal disease (6.7% and 1.6%, respectively). After adjustment for demographic characteristics, comorbid conditions, and biochemistry data, adjusted HRs for all-cause and cardiovascular mortality were 1.34 (95% CI, 1.26-1.42) and 1.25 (95% CI, 1.13-1.41), respectively. The frequency of eGFR decline ≥ 30% over 1-, 2-, and 3-years' follow-up in those with periodontal disease was 1.8%, 3.7%, and 4.0%, respectively. In a logistic regression model, adjusted ORs of the detrimental effect of periodontal disease on 30% eGFR decline in participants over 1-, 2-, or 3-years' follow-up were 1.03 (95% CI, 0.85-1.25), 1.62 (95% CI, 1.41-1.87), and 1.59 (95% CI, 1.37-1.86), respectively. In subgroup analyses according to age, sex, and comorbid conditions, risks for eGFR decline and mortality remained consistent.


CONCLUSIONS
Results may not be generalizable to other non-Asian ethnic populations.


CONCLUSIONS
The results indicate that periodontal disease is a risk factor for all-cause and cardiovascular mortality and eGFR decline ≥ 30% over 2 to 3 years in older people.
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan.
Yung-Tai
YT
Chen
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan.
Chia-Jen
CJ
Shih
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Shuo-Ming
SM
Ou
Division of Nephrology, Taipei Tzu Chi Hospital, Taipei, Taiwan.
Szu-Chun
SC
Hung
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Microbiology and Immunology, National Yang-Ming University, Taipei, Taiwan.
Chi-Hung
CH
Lin
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan. Electronic address: dctarng@vghtpe.gov.tw.
Der-Cherng
DC
Tarng
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D010510:Periodontal Diseases / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
D003404:Creatinine
CKD progression; Periodontal disease; cardiovascular mortality; chronic kidney disease (CKD); dental status; estimated glomerular filtration rate (eGFR); mortality; older people; renal function