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. Am J Kidney Dis. 57(2):276-282. (C) 2011 by the National Kidney Foundation, Inc.