title: Association Between Periodontal Disease and Kidney Function Decline in African Americans: The Jackson Heart Study.
abstract: BACKGROUND
  Chronic kidney disease (CKD) remains a prevalent public health problem that disproportionately affects African Americans, despite intense efforts targeting traditional risk factors. Periodontal disease, a chronic bacterial infection of the oral cavity, is both common and modifiable and has been implicated as a novel potential CKD risk factor. The authors seek to examine to what extent periodontal disease is associated with kidney function decline.
  
  
  METHODS
  This retrospective cohort study examines 699 African American participants with preserved kidney function (defined by estimated glomerular filtration rate (eGFR) >60 mL/minute/1.73 m(2) at baseline) who underwent complete dental examinations as part of the Dental-Atherosclerosis Risk in Communities study (1996 to 1998) and subsequently enrolled in the Jackson Heart Study (2000 to 2004). Using multivariable Poisson regression, the authors examined the association of periodontal disease (severe versus non-severe) with incident CKD, defined as incident eGFR <60 mL/minute/1.73 m(2) and rapid (5% annualized) eGFR decline at follow-up among those with preserved eGFR at baseline.
  
  
  RESULTS
  Mean (± SD) age at baseline was 65.4 (± 5.2) years, and 16.3% (n = 114) had severe periodontal disease. There were 21 cases (3.0%) of incident CKD after a mean follow-up of 4.8 (± 0.6) years. Compared with participants with non-severe periodontal disease, those with severe periodontal disease had a four-fold greater rate of incident CKD (adjusted incidence rate ratio 4.18 [95% confidence interval 1.68 to 10.39], P = 0.002).
  
  
  CONCLUSIONS
  Severe periodontal disease is prevalent among a population at high risk for CKD and is associated with clinically significant kidney function decline. Further research is needed to determine if periodontal disease treatment alters the trajectory of renal deterioration.
authors.affiliation: Division of Nephrology, University of California-San Francisco, San Francisco, CA.|Division of Nephrology, San Francisco General Hospital, San Francisco, CA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.affiliation: Department of Epidemiology and Biostatistics, University of California-San Francisco.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC.
authors.forename: James D
authors.initials: JD
authors.lastname: Beck
authors.affiliation: Division of Nephrology and Hypertension, University of North Carolina-Chapel Hill.
authors.forename: Abhijit V
authors.initials: AV
authors.lastname: Kshirsagar
authors.affiliation: Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Griswold
authors.affiliation: Department of Medicine, San Francisco General Hospital.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.affiliation: Department of Medicine, University of Mississippi Medical Center.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.affiliation: Kidney Research Institute, Division of Nephrology, Veterans Affairs Puget Sound, University of Washington, Seattle, WA.
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000175:diagnosis; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000145:classification / Q000150:complications; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D007182:Income; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000145:classification / Q000150:complications; D010510:Periodontal Diseases / Q000145:classification / Q000150:complications*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification / Q000150:complications; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking
chemical_list: D003404:Creatinine
keywords: African Americans; chronic; disease progression; health status disparities; periodontal disease; renal insufficiency; risk factors