A Retrospective Case-Control Analysis of the Outpatient Expenditures for Western Medicine and Dental Treatment Modalities in CKD Patients in Taiwan

Abstract

BackgroundTo determine if expenditures for dentistry (DENT) correlate with severity of chronic kidney disease (CKD).MethodsA total of 10,457 subjects were enrolled from January 2008 to December 2010, divided into three groups: healthy control (HC) group (n = 1,438), high risk (HR) group (n = 3,392), and CKD group (n = 5,627). Five stages were further categorized for the CKD group. OPD utilization and expenditures for western medicine (WM), DENT, and TCM (traditional Chinese medicine) were analyzed retrospectively (2000–2008) using Taiwan's National Health Insurance Research Database. Three major areas were analyzed among groups CKD, HR and HC in this study: 1) demographic data and medical history; 2) utilization (visits/person/year) and expenditures (9-year cumulative expenditure, expenditure/person/year) for OPD services in WM, DENT, and TCM; and 3) utilization and expenditures for dental OPD services, particularly in dental filling, root canal and periodontal therapy.ResultsOPD utilization and expenditures of WM increased significantly for the CKD group compared with the HR and HC groups, and increased steadily along with the severity of CKD stages. However, overall DENT and TCM utilization and expenditures did not increase for the CKD group. In comparison among different CKD stages, the average expenditures and utilization for DENT including restorative filling and periodontal therapy, but not root canal therapy, showed significant decreases according to severity of CKD stage, indicating less DENT OPD utilization with progression of CKD.ConclusionsPatients with advanced CKD used DENT OPD service less frequently. However, the connection between CKD and DENT service utilization requires further study.

Dental restorative treatment expenditure and resource utilization in patients with chronic kidney disease: A nationwide population-based study

“…This nationwide hospital-based study recruited individuals from National Health Insurance Research Database (NHIRD), released by the National Health Research Institutes (NHRI). Taiwan launched its National Health Insurance Program (NHIP) on 1st March 1995, and by 2009, a coverage rate of the program had reached 99% of the population 8, 15. The NHIRD contains complete medical information of all insured individuals, including diagnoses, healthy services and claims records for reimbursement.…”

“…Although the exact causal associations between diseases is complicated, 5 it is widely accepted that CKD can affect the oral health status; likewise, poor oral health has influence on the progression of CKD 4, 5, 6, 7. Accordingly, these findings would justify an greater attention and awareness to dental care in CKD patients 4, 8…”

“…Moreover, recent publications on healthcare expenditures in CKD have concentrated mainly on hospitalization costs9, 10, 11 and individual co-morbidities12, 13, 14 rather than dental care. Apart from our previous study investigating the possible correlation between utilization of dental services and CKD outcomes; 8 no other links between the dental restorative treatment modalities and the progression of kidney disease in CKD population have been studied. Furthermore, there are no existing large, and well-designed population-based studies that provide better scientific evidence to discuss the causation of dental restorative treatment expenditures and resource utilization for CKD patients.…”

The Connotation of Kidney Stores Essence Theory and Kidney Endocrine Substance

“…For example, the risk of fracture is significantly higher in chronic kidney disease (CKD) patients than in the general population [21]. The expenditures of oral problems also increased steadily along with the severity of CKD stages [22]. Homeostasis of calcium and phosphate maintain the development of bones.…”

Salivary Nitro-Oxidative Stress and Matrix Metalloproteinase-9 in Chronic Kidney Disease with Periodontitis

“…In CKD patients salivary cytokines and secretion rates are signi icantly decreased (Thorman et al, 2010). Structural equation models exploring the bidirectional relationship of CKD and periodontitis suggested that CKD may have direct effect on moderate periodontitis, and that individuals with moderate periodontitis were more likely to have CKD (Ioannidou et al, 2011b;Pradeep et al, 2012;Dağ et al, 2010;Huang et al, 2014).…”