title: Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey.
abstract: BACKGROUND
  Periodontal disease is associated with increased mortality in the general population, however its prognostic significance in chronic kidney disease (CKD) is not known. We evaluated the joint effect of periodontal disease and CKD on all-cause and cardiovascular mortality.
  
  
  METHODS
  Prospective observational study of 10,755 adult participants in the National Health and Nutrition Examination Survey, 1988-1994 (NHANES III). CKD was defined as estimated glomerular filtration rate < 60 ml/minute/1.73 m(2) or albumin-to-creatinine ratio ≥ 30 mg/g. Periodontal disease was defined as moderate (> 4 mm attachment loss in ≥ 2 mesial sites or 5 mm pocket depth in ≥ 2 mesial sites), or severe (> 6 mm attachment loss in ≥ 2 mesial sites and > 5 mm pocket depth in ≥ 1 mesial site). All-cause and cardiovascular mortality were evaluated using Cox proportional hazards models.
  
  
  RESULTS
  There were 1,813 deaths over a median follow-up of 14 years. In multivariate analyses, as compared to participants with neither periodontal disease nor CKD, those with periodontal disease only or CKD only had increased all-cause mortality (HR 1.39; 95 % CI, 1.06-1.81 and 1.55; 1.30-1.84, respectively). The presence of both periodontal disease and CKD was associated with HR (95 % CI) 2.07 (1.65-2.59) for all-cause mortality, and 2.11 (1.52-2.94) for cardiovascular mortality. We found no evidence of multiplicativity or additivity between periodontal disease and CKD. In stratified analyses limited to individuals with CKD, periodontal disease (vs. not) was associated with adjusted HR (95 % CI) 1.35 (1.04-1.76) for all-cause, and 1.36 (0.95-1.95) for cardiovascular mortality.
  
  
  CONCLUSIONS
  These findings confirm the well-established association between periodontal disease and increased mortality in the general population, and provide new evidence of this association among individuals with CKD.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA. aricar2@uic.edu.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.affiliation: Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA. dr.ambarish@yahoo.com.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Athavale
authors.affiliation: Institute of Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA. jinsongc@uic.edu.
authors.forename: Jinsong
authors.initials: J
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA. hhampole@uic.edu.
authors.forename: Hemanth
authors.initials: H
authors.lastname: Hampole
authors.affiliation: Institute of Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA. garside@uic.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Garside
authors.affiliation: School of Dentistry, Oregon Health and Science University, Portland, OR, USA. marucha@ohsu.edu.
authors.forename: Phillip
authors.initials: P
authors.lastname: Marucha
authors.affiliation: Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA. jplash@uic.edu.
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D010510:Periodontal Diseases / Q000453:epidemiology; D010518:Periodontitis / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D003404:Creatinine