Grubbs Vanessa, Vittinghoff Eric, Beck James D, Kshirsagar Abhijit V, Wang Wei, Griswold Michael E, Powe Neil R, Correa Adolfo, Young Bessie
Division of Nephrology, University of California-San Francisco, San Francisco, CA.
Division of Nephrology, San Francisco General Hospital, San Francisco, CA.
J Periodontol. 2015 Oct;86(10):1126-32. doi: 10.1902/jop.2015.150195. Epub 2015 Jun 25.
Chronic kidney disease (CKD) remains a prevalent public health problem that disproportionately affects African Americans, despite intense efforts targeting traditional risk factors. Periodontal disease, a chronic bacterial infection of the oral cavity, is both common and modifiable and has been implicated as a novel potential CKD risk factor. The authors seek to examine to what extent periodontal disease is associated with kidney function decline.
This retrospective cohort study examines 699 African American participants with preserved kidney function (defined by estimated glomerular filtration rate (eGFR) >60 mL/minute/1.73 m(2) at baseline) who underwent complete dental examinations as part of the Dental-Atherosclerosis Risk in Communities study (1996 to 1998) and subsequently enrolled in the Jackson Heart Study (2000 to 2004). Using multivariable Poisson regression, the authors examined the association of periodontal disease (severe versus non-severe) with incident CKD, defined as incident eGFR <60 mL/minute/1.73 m(2) and rapid (5% annualized) eGFR decline at follow-up among those with preserved eGFR at baseline.
Mean (± SD) age at baseline was 65.4 (± 5.2) years, and 16.3% (n = 114) had severe periodontal disease. There were 21 cases (3.0%) of incident CKD after a mean follow-up of 4.8 (± 0.6) years. Compared with participants with non-severe periodontal disease, those with severe periodontal disease had a four-fold greater rate of incident CKD (adjusted incidence rate ratio 4.18 [95% confidence interval 1.68 to 10.39], P = 0.002).
Severe periodontal disease is prevalent among a population at high risk for CKD and is associated with clinically significant kidney function decline. Further research is needed to determine if periodontal disease treatment alters the trajectory of renal deterioration.
尽管针对传统风险因素付出了巨大努力，但慢性肾脏病（CKD）仍然是一个普遍存在的公共卫生问题，对非裔美国人的影响尤为严重。牙周病是一种口腔慢性细菌感染，既常见又可改变，并且被认为是一种新的潜在CKD风险因素。作者试图研究牙周病与肾功能下降的关联程度。
这项回顾性队列研究调查了699名肾功能正常的非裔美国参与者（基线时估计肾小球滤过率（eGFR）>60 mL/分钟/1.73 m²定义），他们作为社区牙科动脉粥样硬化风险研究（1996年至1998年）的一部分接受了全面的牙科检查，随后参加了杰克逊心脏研究（2000年至2004年）。作者使用多变量泊松回归分析，研究了牙周病（重度与非重度）与新发CKD的关联，新发CKD定义为基线时eGFR正常的参与者在随访时出现eGFR<60 mL/分钟/1.73 m²以及eGFR快速（年化5%）下降。
基线时的平均（±标准差）年龄为65.4（±5.2）岁，16.3%（n = 114）患有重度牙周病。平均随访4.8（±0.6）年后，有21例（3.0%）新发CKD。与非重度牙周病参与者相比，重度牙周病参与者新发CKD的发生率高出四倍（调整后的发病率比为4.18 [95%置信区间1.68至10.39]，P = 0.
