title: The association of periodontal disease with kidney function decline: a longitudinal retrospective analysis of the MrOS dental study.
abstract: BACKGROUND
  Identifying modifiable risk factors for chronic kidney disease (CKD) is essential for reducing its burden. Periodontal disease is common, modifiable and has been implicated as a novel potential CKD risk factor, but evidence of its association with kidney function decline over time is limited.
  
  
  METHODS
  In a longitudinal retrospective cohort of 761 elderly men with preserved kidney function [estimated glomerular filtration rate > 60 mL/min/1.73 m(2) using a calibrated creatinine and cystatin C (eGFRcr-cys) equation] at baseline, we performed multivariable Poisson's regression to examine the association of severe periodontal disease with incident CKD, defined as incident eGFRcr-cys <60 mL/min/1.73 m(2) and rapid (>5% annualized) eGFRcr-cys decline. Severe periodontal disease was defined in two ways: (i) ≥5 mm proximal attachment loss in 30% of teeth examined (European Workshop in Periodontology Group C, European Workshop); and (ii) 2+ interproximal sites with attachment loss ≥6 mm and 1+ interproximal sites with probing depth ≥5 mm (Centers for Disease Control/American Academy of Periodontology, CDC/AAP).
  
  
  RESULTS
  At baseline, the mean age was 73.4 (SD 4.8) years, the median eGFRcr-cys was 82.4 mL/min/1.73 m(2), and 35.5 and 25.4% of participants had severe periodontal disease by European Workshop and CDC/AAP criteria, respectively. After a mean follow-up of 4.9 years (SD 0.3), 56 (7.4%) participants had incident CKD. Severe periodontal disease was associated with a 2-fold greater rate of incident CKD [incidence rate ratio (IRR) 2.01 (1.21-3.44), P = 0.007] after adjusting for confounders compared with not severe periodontal disease by European Workshop criteria but did not reach statistical significance by CDC/AAP criteria [IRR 1.10 (0.63-1.91), P = 0.9].
  
  
  CONCLUSIONS
  Severe periodontal disease may be associated with incident clinically significant kidney function decline among a cohort of elderly men.
authors: Division of Nephrology, University of California, San Francisco/San Francisco General Hospital, San Francisco, CA, USA.
authors: Vanessa
authors: V
authors: Grubbs
authors: Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
authors: Eric
authors: E
authors: Vittinghoff
authors: Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco,San Francisco, CA, USA.
authors: George
authors: G
authors: Taylor
authors: Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, USA.
authors: Donna
authors: D
authors: Kritz-Silverstein
authors: Department of Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, CA, USA.
authors: Neil
authors: N
authors: Powe
authors: Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors: Kirsten
authors: K
authors: Bibbins-Domingo
authors: Division of Nephrology, University of Minnesota, Minneapolis, MN, USA.
authors: Areef
authors: A
authors: Ishani
authors: San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
authors: Steven R
authors: SR
authors: Cummings
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D010510:Periodontal Diseases / Q000453:epidemiology / Q000209:etiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: chronic kidney disease; periodontal disease; renal function decline; risk factors