Ruospo Marinella, Palmer Suetonia C, Craig Jonathan C, Gentile Giorgio, Johnson David W, Ford Pauline J, Tonelli Marcello, Petruzzi Massimo, De Benedittis Michele, Strippoli Giovanni F M
Diaverum Medical Scientific Office, Bari, Italy.
Nephrol Dial Transplant. 2014 Feb;29(2):364-75. doi: 10.1093/ndt/gft401. Epub 2013 Sep 29.
Oral disease may be increased in people with chronic kidney disease (CKD) and, due to associations with inflammation and malnutrition, represents a potential modifiable risk factor for cardiovascular disease and mortality. We summarized the prevalence of oral disease in adults with CKD and explored any association between oral disease and mortality.
We used systematic review of observational studies evaluating oral health in adults with CKD identified in MEDLINE (through September 2012) without language restriction. We summarized prevalence and associations with all-cause and cardiovascular mortality using random-effects meta-analysis. We explored for sources of heterogeneity between studies using meta-regression.
Eighty-eight studies in 125 populations comprising 11 340 adults were eligible. Edentulism affected one in five adults with CKD Stage 5D (dialysis) {20.6% [95% confidence interval (CI), 16.4-25.6]}. Periodontitis was more common in CKD Stage 5D [56.8% (CI, 39.3-72.8)] than less severe CKD [31.6% (CI, 19.0-47.6)], although data linking periodontitis with premature death were scant. One-quarter of patients with CKD Stage 5D reported never brushing their teeth [25.6% (CI, 10.2-51.1)] and a minority used dental floss [11.4% (CI, 6.2-19.8)]; oral pain was reported by one-sixth [18.7% (CI, 8.8-35.4)], while half of patients experienced a dry mouth [48.4% (CI, 37.5-59.5)]. Data for kidney transplant recipients and CKD Stages 1-5 were limited.
Oral disease is common in adults with CKD, potentially reflects low use of preventative dental services, and may be an important determinant of health in this clinical setting.
慢性肾脏病（CKD）患者的口腔疾病可能会增加，并且由于与炎症和营养不良相关，它是心血管疾病和死亡率的一个潜在可改变的危险因素。我们总结了CKD成人患者口腔疾病的患病率，并探讨了口腔疾病与死亡率之间的任何关联。
我们对在MEDLINE（截至2012年9月）中检索到的评估CKD成人患者口腔健康的观察性研究进行了系统评价，无语言限制。我们使用随机效应荟萃分析总结了患病率以及与全因死亡率和心血管死亡率的关联。我们使用荟萃回归探索了研究之间异质性的来源。
125个人群中的88项研究纳入了11340名成人，符合条件。无牙症影响五分之一的CKD 5D期（透析）成人{20.6%[95%置信区间（CI），16.4 - 25.6]}。牙周炎在CKD 5D期[56.8%（CI，39.3 - 72.8）]比病情较轻的CKD更为常见[31.6%（CI，19.0 - 47.6）]，尽管将牙周炎与过早死亡联系起来的数据很少。四分之一的CKD 5D期患者报告从不刷牙[25.6%（CI，10.2 - 51.1）]，少数人使用牙线[11.4%（CI，6.2 - 19.8）]；六分之一的患者报告有口腔疼痛[18.7%（CI，8.8 - 35.4）]，而一半的患者有口干症状[48.4%（CI，37.5 - 59.5）]。肾移植受者和CKD 1 - 5期的数据有限。
口腔疾病在CKD成人中很常见，可能反映了预防性牙科服务的低使用率，并且可能是这种临床情况下健康的一个重要决定因素。
