Relationship Between Periodontal Disease and Mortality in Patients Treated With Maintenance Hemodialysis

Background

The relationship between periodontitis and outcomes in patients treated with long-term hemodialysis is controversial. Our previous work suggests that periodontitis is associated with malnutrition and inflammation. Here, we hypothesize that periodontitis is associated with mortality in hemodialysis patients.

Study Design

Prospective observational study.

Setting & Participants

253 patients undergoing hemodialysis at a single hospital-based dialysis facility.

Predictor

Severity of periodontal disease (mild, moderate, or severe based on oral examination of 6 teeth).

Outcomes & Measurements

All-cause and cardiovascular mortality during a 6-year follow-up after an oral health examination of index teeth.

Results

During the 6-year follow-up, 102 patients died. Death occurred in 70.6%, 41.8%, and 24.0% of patients with severe, moderate, and mild/no periodontitis, respectively. Using mild/no periodontitis as the reference group and adjustment for demographic characteristics, comorbid conditions, and selected laboratory values, HRs for all-cause mortality were 1.39 (95% CI, 0.83-2.34) and 1.83 (95% CI, 1.04-3.24) for moderate and severe periodontitis, respectively. HRs for cardiovascular mortality were not statistically significant.

Limitations

Single assessment of periodontal disease severity.

Conclusions

For patients undergoing long-term hemodialysis, periodontitis is associated with increased risk of death. Clinical trials are required to determine whether treatment of periodontitis decreases mortality.

Index Words: Periodontitis, mortality, dialysis, malnutrition and inflammation