Kapellas Kostas, Singh Ankur, Bertotti Maitê, Nascimento Gustavo G, Jamieson Lisa M
Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia.
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Nephrology (Carlton). 2019 Feb;24(2):202-212. doi: 10.1111/nep.13225.
Chronic kidney disease (CKD) and kidney failure is increasing globally and evidence from observational studies suggest periodontal disease may contribute to kidney functional decline.
Electronic searches of the PubMed, EMBASE, Web of Science, Scopus and Cochrane Library databases were conducted for the purposes of conducting a systematic review. Hand searching of reference lists was also performed. Meta-analysis of observational studies involving periodontal disease and chronic kidney disease in adults was performed.
A total of 17 studies was selected from an initial 4055 abstracts. Pooled estimates indicated the odds of having CKD were 60% higher among patients with periodontitis: pooled OR 1.60 (95% CI 1.44-1.79, I 35.2%, P = 0.11) compared to those without. Conversely, a similar magnitude but non-significant higher odds of having periodontal disease was found among people with CKD 1.69 (95% CI: 0.84, 3.40, I = 89.8%, P < 0.00) versus non-CKD. Meta-regression revealed study quality based on the Newcastle-Ottawa Scale and statistical adjustment for potential confounders explained almost 35% of the heterogeneity in the studies investigating the association between CKD and periodontitis.
Moderate evidence for a positive association between periodontitis and CKD exists. Evidence for the opposite direction is extremely weak based on significant heterogeneity between studies.
慢性肾脏病（CKD）和肾衰竭在全球范围内呈上升趋势，观察性研究的证据表明牙周疾病可能导致肾功能下降。
为进行系统评价，对PubMed、EMBASE、科学网、Scopus和Cochrane图书馆数据库进行了电子检索。还对手检参考文献列表进行了检索。对涉及成人牙周疾病和慢性肾脏病的观察性研究进行了荟萃分析。
从最初的4055篇摘要中总共筛选出17项研究。汇总估计表明，牙周炎患者患CKD的几率比未患牙周炎的患者高60%：汇总比值比为1.60（95%置信区间1.44 - 1.79，I² = 35.2%，P = 0.11）。相反，在CKD患者中发现患牙周疾病的几率有类似幅度但无统计学意义的升高，为1.69（95%置信区间：0.84，3.40，I² = 89.8%，P < 0.00），而在非CKD患者中则未发现。荟萃回归显示，基于纽卡斯尔 - 渥太华量表的研究质量以及对潜在混杂因素的统计调整解释了研究CKD与牙周炎之间关联的研究中近35%的异质性。
牙周炎与CKD之间存在正相关的中等证据。基于研究之间显著的异质性，相反方向的证据极其薄弱。
