Original Investigation
Pathogenesis and Treatment of Kidney Disease
Periodontal Disease and Other Nontraditional Risk Factors for CKD

https://doi.org/10.1053/j.ajkd.2007.09.018Get rights and content

Background

Chronic kidney disease, undiagnosed in a significant number of adults, is a public health problem. Given the systemic inflammatory response to periodontal disease, we hypothesized that periodontal disease could be associated with chronic kidney disease.

Study Design

Cross-sectional.

Setting & Participants

We identified 12,947 adults 18 years or older with information for kidney function and at least one risk factor in the Third National Health and Nutrition Examination Survey.

Predictor

The main predictor was periodontal status. Other nontraditional and traditional risk factors included socioeconomic status, health status, health behavior, biomarker levels, anthropometric assessment, and health care utilization.

Outcomes & Measurements

Chronic kidney disease was defined using the Kidney Disease Outcomes Quality Initiative stages 3 and 4 with a moderate to severe decrease in kidney function (glomerular filtration rate, 15 to 59 mL/min/1.73 m2). Univariable and multivariable logistic regression models assessed the associations between chronic kidney disease and periodontal disease and other nontraditional risk factors.

Results

Chronic kidney disease prevalence was 3.6%; periodontal disease prevalence was 6.0%; and edentulism prevalence was 10.5%. Adults with periodontal disease and edentulous adults were twice as likely to have chronic kidney disease (adjusted odds ratio, 1.60; 95% confidence interval, 1.16 to 2.21; adjusted odds ratio, 1.85; 95% confidence interval, 1.34 to 2.56, respectively) after simultaneously adjusting for other traditional and nontraditional risk factors.

Limitations

Temporal association is unknown.

Conclusions

Periodontal disease and its severe consequence, edentulism, were independently associated with chronic kidney disease after adjusting for other traditional and nontraditional risk factors. This model could contribute to identifying individuals at risk of chronic kidney disease and reduce its burden.

Section snippets

Study Population

This cross-sectional study was deemed exempt by the institutional review board, and all investigators complied with the Data Use Restrictions for the NHANES III public-use data set collected by the National Center for Health Statistics, Centers for Disease Control and Prevention. NHANES III, 1988-1994, is a complex, multistage, stratified, clustered sample of the civilian noninstitutionalized US population representative of the US population. NHANES includes questionnaire, laboratory-assay, and

Overall Descriptive Summary

Table 1 presents important characteristics of the study population and their unadjusted association with CKD. Overall, 3.6% of the study population had CKD, 6.0% had periodontal disease, 10.5% were edentulous, 23.5% were hypertensive, and 36.4% were obese. The univariable models reported in Table 1 are similar to the typical approach that reports a single risk factor without adjusting for potential confounders. For example, an adult with the nontraditional risk factor edentulism was over 10

Discussion

In our US population-based study, periodontal disease and edentulism, as well as the nontraditional risk factors that included having an annual physician visit and being hospitalized in the past year, were independently associated with CKD after simultaneously adjusting for the following traditional risk factors: age, race/ethnicity, gender, smoking status, income, hypertension, macroalbuminuria, total cholesterol level, and high-density lipoprotein cholesterol level. Our univariable unadjusted

Acknowledgements

Support: This study was supported by grants DE016031-03 and DE016031-04 from the National Institutes of Health.

Financial Disclosure: None.

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