title: Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study.
abstract: BACKGROUND
  Periodontitis may add to the systemic inflammatory burden in individuals with chronic kidney disease (CKD), thereby contributing to an increased mortality rate. This study aimed to determine the association between periodontitis and mortality rate (all-cause and cardiovascular disease-related) in individuals with stage 3-5 CKD, hitherto referred to as "CKD".
  
  
  METHODS
  Survival analysis was carried out using the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data. Cox proportional hazards regression was employed to assess the association between periodontitis and mortality, in individuals with CKD. This association was compared with the association between mortality and traditional risk factors in CKD mortality (diabetes, hypertension and smoking).
  
  
  RESULTS
  Of the 13,784 participants eligible for analysis in NHANES III, 861 (6%) had CKD. The median follow-up for this cohort was 14.3 years. Adjusting for confounders, the 10-year all-cause mortality rate for individuals with CKD increased from 32% (95% CI: 29-35%) to 41% (36-47%) with the addition of periodontitis. For diabetes, the 10-year all-cause mortality rate increased to 43% (38-49%).
  
  
  CONCLUSIONS
  There is a strong, association between periodontitis and increased mortality in individuals with CKD. Sources of chronic systemic inflammation (including periodontitis) may be important contributors to mortality in patients with CKD.
authors.affiliation: Periodontal Research Group, School of Dentistry, University of Birmingham, Birmingham, UK.
authors.forename: Praveen
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Periodontal Research Group, School of Dentistry, University of Birmingham, Birmingham, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Dietrich
authors.affiliation: Department of Nephrology, University Hospital Birmingham, Birmingham, UK.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Ferro
authors.affiliation: Department of Nephrology, University Hospital Birmingham, Birmingham, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
authors.affiliation: Periodontal Research Group, School of Dentistry, University of Birmingham, Birmingham, UK.
authors.forename: Iain L C
authors.initials: IL
authors.lastname: Chapple
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010518:Periodontitis; D051436:Renal Insufficiency, Chronic; D012307:Risk Factors
keywords: NHANES; chronic kidney disease; periodontitis; survival