title: Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study.
abstract: BACKGROUND
  Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown.
  
  
  METHODS
  Prospective multinational cohort.
  
  
  METHODS
  4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study).
  
  
  METHODS
  Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation.
  
  
  RESULTS
  All-cause and cardiovascular mortality at 12 months after dental assessment.
  
  
  METHODS
  Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries.
  
  
  RESULTS
  During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar.
  
  
  CONCLUSIONS
  Convenience sample of clinics.
  
  
  CONCLUSIONS
  In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.
authors.affiliation: University of Otago, Christchurch, New Zealand.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden; Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.affiliation: University of Sydney, Sydney, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: University of Sydney, Sydney, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: University of Bari, Bari, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Petruzzi
authors.affiliation: Universita' del Piemonte Orientale, Vercelli, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Benedittis
authors.affiliation: University of Queensland, Brisbane, Australia.
authors.forename: Pauline
authors.initials: P
authors.lastname: Ford
authors.affiliation: University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: University of Calgary, Calgary, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Natale
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Valeria
authors.initials: V
authors.lastname: Saglimbene
authors.affiliation: Global Medical Biogen Idec, Cambridge, MA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Celia
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Ruben
authors.initials: R
authors.lastname: Gelfman
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Leal
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Marietta
authors.initials: M
authors.lastname: Torok
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Paul
authors.initials: P
authors.lastname: Stroumza
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden; Medical University of Lublin, Lublin.
authors.forename: Anna
authors.initials: A
authors.lastname: Bednarek-Skublewska
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden; Medical University of Silesia, Silesia, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Dulawa
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Luc
authors.initials: L
authors.lastname: Frantzen
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Juan Nin
authors.initials: JN
authors.lastname: Ferrari
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Domingo
authors.initials: D
authors.lastname: Del Castillo
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Amparo G
authors.initials: AG
authors.lastname: Bernat
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Hegbrant
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Wollheim
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Letizia
authors.initials: L
authors.lastname: Gargano
authors.affiliation: Academic Centre for Dentistry Amsterdam (ACTA), Oral Biochemistry, Amsterdam, the Netherlands.
authors.forename: Casper P
authors.initials: CP
authors.lastname: Bots
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden; University of Sydney, Sydney, Australia; University of Bari, Bari, Italy; Diaverum Academy, Lund, Sweden. Electronic address: gfmstrippoli@gmail.com.
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D038622:Internationality; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009909:Oral Health; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: ORAL-D (Oral Diseases in Hemodialysis) Study; Renal failure; all-cause mortality; cardiovascular mortality; dental disease; end-stage kidney disease; hemodialysis; modifiable risk factor; oral health; oral hygeine