Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan.
Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Nephrol. 2022 Jan;35(1):191-199. doi: 10.1007/s40620-021-00987-2. Epub 2021 Feb 22.
Tooth brushing is important for maintaining oral health and preventing periodontal diseases (PDs), which commonly arise in patients with chronic kidney disease (CKD). However, the association between tooth brushing frequency and kidney function decline remains unclear.
We conducted a retrospective longitudinal study at St Luke's International Hospital, Japan, and participants who underwent health examinations at the Centre for Preventive Medicine from 2005 to 2011 were included. Participants' tooth brushing frequencies were assessed; multivariate analyses were conducted using a generalized estimating equation to evaluate the association between tooth brushing frequency and a composite renal outcome-composed of a 25% estimated glomerular filtration rate (eGFR) reduction, an eGFR of < 15 mL/min/1.73 m, and a requirement for regular dialysis-after adjusting for potential covariates. We also stratified participants by baseline CKD risk category to perform sub-analyses.
Overall, 76,472 participants were included (mean age of 45.9 years) and 38,233 (50%) were male. During follow-up, 8219 participants (10.8%) experienced composite renal outcomes. Brushing teeth at least once to twice a day was associated with significantly lower incidences of composite renal outcomes than brushing teeth less frequently (adjusted odds ratio [OR] 0.26; 95% confidence interval [CI] 0.24-0.28 for once to twice a day; adjusted OR 0.65; 95% CI 0.62-0.69 for after every meal). In our sub-analyses, brushing at least once to twice a day related to a decreased likelihood of composite renal outcomes; however, this effect was only observed within the low and moderate baseline risk groups.
Frequent tooth brushing benefits oral health and may be associated with slower kidney function decline, which could have implications for other systemic diseases. However, a longitudinal cohort study is required to confirm whether tooth brushing and overall oral health can haver a role in improving renal outcomes.
刷牙对于维护口腔健康和预防牙周病（PDs）很重要，而 PDs 在慢性肾脏病（CKD）患者中很常见。然而，刷牙频率与肾功能下降之间的关联尚不清楚。
我们在日本圣卢克国际医院进行了一项回顾性纵向研究，纳入了 2005 年至 2011 年在预防医学中心接受健康检查的参与者。评估了参与者的刷牙频率；使用广义估计方程进行多变量分析，以评估刷牙频率与复合肾脏结局（由肾小球滤过率（eGFR）降低 25%、eGFR<15 mL/min/1.73 m 和需要定期透析组成）之间的关联，在调整了潜在的混杂因素后。我们还按基线 CKD 风险类别对参与者进行分层，以进行亚组分析。
共有 76472 名参与者（平均年龄 45.9 岁），其中 38233 名（50%）为男性。在随访期间，8219 名参与者（10.8%）发生了复合肾脏结局。与刷牙频率较低者相比，每天刷牙至少一次到两次与复合肾脏结局的发生率显著降低（调整后的优势比[OR]0.26；95%置信区间[CI]0.24-0.28 为每天一次到两次；调整后的 OR 0.65；95%CI 0.62-0.69 为每次餐后）。在我们的亚组分析中，每天刷牙至少一次到两次与复合肾脏结局发生的可能性降低有关；然而，这种效应仅在低和中基线风险组中观察到。
频繁刷牙有益于口腔健康，可能与肾功能下降速度较慢有关，这可能对其他系统性疾病有影响。然而，需要进行纵向队列研究来确认刷牙和整体口腔健康是否可以在改善肾脏结局方面发挥作用。
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