Periodontal Pocket Depth, Hyperglycemia, and Progression of Chronic Kidney Disease: A Population-Based Longitudinal Study.
BACKGROUND
No large epidemiological study has been conducted to investigate the interaction and joint effects of periodontal pocket depth and hyperglycemia on progression of chronic kidney disease in patients with periodontal diseases.


METHODS
Periodontal pocket depth was utilized for the grading severity of periodontal disease in 2831 patients from January 2002 to June 2013. Progression of chronic kidney disease was defined as progression of color intensity in glomerular filtration rate and albuminuria grid of updated Kidney Disease-Improving Global Outcomes guidelines. Multivariable-adjusted hazard ratios (aHR) in various models were presented across different levels of periodontal pocket depth and hemoglobin A1c (HbA1c) in forest plots and 3-dimensional histograms.


RESULTS
During 7621 person-years of follow-up, periodontal pocket depth and HbA1C levels were robustly associated with incremental risks for progression of chronic kidney disease (aHR 3.1; 95% confidence interval [CI], 2.0-4.6 for periodontal pocket depth >4.5 mm, and 2.5; 95% CI, 1.1-5.4 for HbA1C >6.5%, respectively). The interaction between periodontal pocket depth and HbA1C on progression of chronic kidney disease was strong (P <.01). Patients with higher periodontal pocket depth (>4.5 mm) and higher HbA1C (>6.5%) had the greatest risk (aHR 4.2; 95% CI, 1.7-6.8) compared with the lowest aHR group (periodontal pocket depth ≤3.8 mm and HbA1C ≤6%).


CONCLUSIONS
Our study identified combined periodontal pocket depth and HbA1C as a valuable predictor of progression of chronic kidney disease in patients with periodontal diseases. While considering the interaction between periodontal diseases and hyperglycemia, periodontal survey and optimizing glycemic control are warranted to minimize the risk of worsening renal function.
Department of Internal Medicine, En Chu Kong Hospital, New Taipei City, Taiwan; Ph.D. Program in Nutrition and Food Science, College of Human Ecology; Graduate Institution of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. Electronic address: cjf6699@yahoo.com.tw.
Jia-Feng
JF
Chang
Department of Dentistry, Far Eastern Memorial Hospital, Taipei, Taiwan; School of Dentistry, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei.
Jih-Chen
JC
Yeh
Department of Dentistry, Far Eastern Memorial Hospital, Taipei, Taiwan.
Ya-Lin
YL
Chiu
Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Taiwan; Graduate Institute of Clinical Medicine Jointly Appointed, Kaohsiung Medical University, Taiwan.
Jian-Chiun
JC
Liou
Department of Dentistry, Far Eastern Memorial Hospital, Taipei, Taiwan.
Jing-Ru
JR
Hsiung
Faculty of Public Health, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan. Electronic address: ch2876@chgh.org.tw.
Tao-Hsin
TH
Tung
D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010514:Periodontal Pocket / Q000150:complications*; D051436:Renal Insufficiency, Chronic / Q000209:etiology*; D012720:Severity of Illness Index
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Chronic kidney disease; Diabetes; Hyperglycemia; Periodontal disease