Effect of chronic kidney disease on progression of clinical attachment loss in older adults: A 4‐year cohort study

Abstract

Background People with chronic kidney disease (CKD) may have an increased risk of periodontal disease, but longitudinal evidence is sparse. Methods This 4‐year cohort study assessed the association between CKD and changes in periodontal health status, defined by attachment loss (AL) progression, among older adults. Participants were 388 community‐dwelling Japanese adults who were 70 years old at baseline with 7053 teeth. Estimated glomerular filtration rate (eGFR) was calculated by using baseline serum creatinine concentration. AL at six sites for every tooth was recorded at baseline and follow‐up examinations. Multilevel logistic regression models estimated the tooth‐specific risk of AL progression (≥1 site exhibiting a ≥3 mm increase in AL) with baseline CKD (eGFR < 60 mL/min/1.73 m2) as the principal exposure. Results At baseline, 27.8% of the study population (108/388 participants) had CKD. After 4 years, 21.8% of the studied teeth (1537/7053 teeth) exhibited AL progression. After applying inverse probability weighting and adjusting for potential confounders, including sex, use of devices for interdental cleaning, smoking, diabetes, tooth location, abutment for a removable denture, and highest AL, CKD was associated with significantly higher odds of AL progression (adjusted odds ratio: 1.73; 95% confidence interval: 1.15–2.60). Conclusions The results suggest that CKD increases the risk of periodontal disease progression in older community‐dwelling Japanese adults. Additional studies with more complete information, as well as in other geographic areas and age groups, are necessary to further generalize the findings.

Periodontitis exacerbates the renal degenerative effects of obesity in rats

“…Similar results were found in another study performed on rats, and therapeutic agents such as melatonin that can control oxidative stress were shown to limit these effects 12 . In a clinical study on an elderly population, Iwasaki et al showed that chronic kidney disease can increase periodontal destruction 10 . In a cohort study, Sharma et al 15 reported that the prevalence and severity of periodontitis were higher in patients with kidney disease.…”

“…Similarly, Zeng et al 26 reported that serum levels of creatinine, the most commonly used marker of glomerular filtration rate, was increased in the obese group, and a greater increase was observed in the obese group with periodontitis 26 . Similar to animal studies, in human studies, 10,52 periodontitis alone was shown to cause significant increases in these parameters and loss of kidney function. The results of experimental studies performed in obese rats have been inconsistent with clinical studies, 53–55 which may have been due to the periodontitis models used.…”

“…[4][5][6] It also may cause the development and progression of chronic kidney diseases via direct or indirect mechanisms 7 including the actions of periodontal pathogens, antigens, endotoxins, and chronic inflammatory burden created by secreted cytokines. 7,8 In the literature, the relationship between periodontitis and kidney diseases was sought to be explained by clinical [9][10][11] and experimental [12][13][14] studies. In some of these studies, 12,13 it was shown that periodontitis may increase the susceptibility to chronic kidney disease while in others, 10,15 it was shown that kidney diseases may possibly increase the risk and prevalence of periodontitis.…”

“…7,8 In the literature, the relationship between periodontitis and kidney diseases was sought to be explained by clinical [9][10][11] and experimental [12][13][14] studies. In some of these studies, 12,13 it was shown that periodontitis may increase the susceptibility to chronic kidney disease while in others, 10,15 it was shown that kidney diseases may possibly increase the risk and prevalence of periodontitis. In a study on rats, França et al 13 reported that periodontitis may lead to a predisposition to kidney disease, which may be mediated by increased oxidative stress.…”

Introductory Chapter: The Importance of Gingival Treatment and Prevention

“…The dentist after navigating the impact of systemic disturbances on the periodontium will definitely find that usual scaling and root planning is only a relief but not a cure in many cases. Therefore, it is mandatory to detect and uncover the systemic disorders which aggravate gingival inflammation in order to provide a comprehensive and definite treatment [18]. In addition, when the dentist investigates the gingival and periodontal diseases as the first manifestation of many systemic disorders, great numbers of serious illnesses will be early diagnosed.…”