Periodontitis case definition affects the association with renal function in kidney transplant recipients

Abstract

Aim The aim of this analysis is to investigate the association between periodontal status and renal allograft function in a cohort of renal transplant patients using different periodontitis case definitions. Material & Methods 58 kidney transplant patients were included. The subjects were classified into two groups, deterioration or stable/improvement of renal allograft function as expressed by the difference in glomerular filtration rate (GFR) between two time points at least 6 months apart. Chronic periodontitis was defined as: 1) two or more interproximal sites with CAL≥4mm or two or more interproximal sites with PD≥5mm (DEF1); 2) PD≥5 or CAL ≥ 4 in at least 6 proximal sites (DEF2); and 3) PD≥5 or CAL ≥ 4 in at least 2 proximal sites in each quadrant (DEF3). Results In a multivariate linear regression model, none of the continuous periodontal variables were significantly associated with deterioration of allograft function. Of the three definitions of chronic periodontitis only DEF2 emerged as significantly more prevalent in subjects with GFR deterioration and was a statistically significant predictor of GFR deterioration over time. Conclusion These findings underscore the importance of periodontitis “case definition” in the observed statistical associations between periodontitis and systemic disease.

Periodontal Disease, Renal Dysfunction and Heightened Leukocytosis

“…Similar to previous studies in dialysis patients, we did not observe an association between periodontal disease measures and CRP in our CKD study participants (as opposed to subjects without CKD) [29,43]. Ioannidou et al [44] found an association between a modified definition of periodontitis with mild elevation of CRP (>0.3 mg/dl) in subjects with CKD but not based on the standard AAP/CDC definition. These previous studies did not explore the association between leukocytosis and periodontitis in subjects with CKD.…”

Caracterização da saúde bucal de indivíduos renais crônicos aptos a transplante

“…Salienta-se a necessidade de melhor abordagem para saúde bucal pré-transplante, visto associação com o aumento do risco cardiovascular 11 e a redução da sobrevida do enxerto renal 10 .…”

“…Estudos demonstram que a doença periodontal também atinge a DRC, incluindo a deteriorização mais rápida da função renal nos enxertos [10][11][12] . Micro-organismos relacionados à periodontite afetam a reologia sanguínea e contribuem para aceleração de doenças sistêmicas ou locais que levam à mortalidade prematura em pacientes em diálise 13 .…”

Disparities in Periodontitis Prevalence among Chronic Kidney Disease Patients

“…First, compared with previous studies (Kshirsagar et al ., 2005; Fisher et al ., 2008), we used a more recent periodontitis case definition (Page and Eke, 2007), which has been adopted in official US public health publications on national prevalence of periodontitis (Dye et al ., 2007). Our group has shown previously that the choice of periodontitis case definition could affect associations with renal function (Ioannidou et al ., 2010). Furthermore, unlike prior studies (Fisher et al ., 2008), we limited our analysis to dentate adults, since we were unable to determine the edentulism frequency attributed to periodontitis.…”