San Francisco General Hospital, Division of Nephrology, University of California, San Francisco, USA.
BMC Nephrol. 2012 Apr 2;13:16. doi: 10.1186/1471-2369-13-16.
As several studies have shown an association between periodontal disease and chronic kidney disease (CKD), regular dental care may be an important strategy for reducing the burden of CKD. Access to dental care may be limited in the US public health system.
In this retrospective cohort study of 6,498 adult patients with (n = 2,235) and without (n = 4,263) CKD and at least 12 months of follow-up within the San Francisco Department of Public Health Community Health Network clinical databases, we examined the likelihood of having a dental visit within the observation period (2005-2010) using Cox proportional hazards models. To determine whether dental visits reflected a uniform approach to preventive service use in this setting, we similarly examined the likelihood of having an eye visit among those with diabetes, for whom regular retinopathy screening is recommended. We defined CKD status by average estimated glomerular filtration rate based on two or more creatinine measurements ≥ 3 months apart (no CKD, ≥ 60 ml/min/1.73 m2; CKD, < 60 ml/min/1.73 m2).
Only 11.0% and 17.4% of patients with and without CKD, respectively, had at least one dental visit. Those with CKD had a 25% lower likelihood of having a dental visit [HR = 0.75, 95% CI (0.64-0.88)] than those without CKD after adjustment for confounders. Among the subgroup of patients with diabetes, 11.8% vs. 17.2% of those with and without CKD had a dental visit, while 58.8% vs. 57.8% had an eye visit.
Dental visits, but not eye visits, in a US public healthcare setting are extremely low, particularly among patients with CKD. Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population.
多项研究表明牙周病与慢性肾脏病（CKD）之间存在关联，因此定期进行口腔护理可能是降低 CKD 负担的重要策略。然而，在美国公共卫生系统中，获得口腔护理的机会可能有限。
本研究为一项回顾性队列研究，纳入了 San Francisco 公共卫生部门社区卫生网络临床数据库中至少有 12 个月随访记录的 6498 名成年患者，其中 2235 名患有 CKD，4263 名无 CKD。我们使用 Cox 比例风险模型来评估患者在观察期（2005-2010 年）内进行口腔检查的可能性。为了确定在这种情况下，口腔检查是否反映了一种统一的预防服务使用方法，我们同样检查了在患有糖尿病的患者中进行眼部检查的可能性，因为糖尿病患者需要定期进行视网膜病变筛查。我们根据两次或两次以上相隔至少 3 个月的肌酐测量值计算平均估计肾小球滤过率（eGFR）来定义 CKD 状态（无 CKD：≥60ml/min/1.73m2；CKD：<60ml/min/1.73m2）。
患有 CKD 和无 CKD 的患者中，分别只有 11.0%和 17.4%至少进行了一次口腔检查。在调整混杂因素后，患有 CKD 的患者进行口腔检查的可能性比无 CKD 的患者低 25%（HR=0.75，95%CI：0.64-0.88）。在患有糖尿病的亚组患者中，有 CKD 的患者中有 11.8%进行了口腔检查，而无 CKD 的患者中有 17.2%进行了口腔检查；同时，有 CKD 的患者中有 58.8%进行了眼部检查，而无 CKD 的患者中有 57.8%进行了眼部检查。
在美国公共医疗保健环境中，口腔检查（而非眼部检查）的比例极低，尤其是在患有 CKD 的患者中。鉴于口腔健康与 CKD 之间存在新的关联，解决阻碍口腔护理的因素可能对降低该人群中 CKD 的差异负担很重要。
