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Periodontal Pocket Depth, Hyperglycemia, and Progression of Chronic Kidney Disease: A Population-Based Longitudinal Study - 18/04/17

Doi : 10.1016/j.amjmed.2016.08.024 
Jia-Feng Chang, MD a, b, ⁎, 1 , Jih-Chen Yeh, DDS c, d, 1, Ya-Lin Chiu, DDS c, Jian-Chiun Liou, PhD e, f, Jing-Ru Hsiung, DDS c, Tao-Hsin Tung, PhD g, h, ⁎
a Department of Internal Medicine, En Chu Kong Hospital, New Taipei City, Taiwan 
b Ph.D. Program in Nutrition and Food Science, College of Human Ecology; Graduate Institution of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 
c Department of Dentistry, Far Eastern Memorial Hospital, Taipei, Taiwan 
d School of Dentistry, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 
e Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Taiwan 
f Graduate Institute of Clinical Medicine Jointly Appointed, Kaohsiung Medical University, Taiwan 
g Faculty of Public Health, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 
h Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan 

∗Requests for reprints should be addressed to Jia-Feng Chang, MD, Department of Internal Medicine, En- Chu- Kong Hospital; Ph.D. Program in Nutrition and Food Science, College of Human Ecology; Graduate Institution of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.Department of Internal MedicineEn- Chu- Kong Hospital; Ph.D. Program in Nutrition and Food ScienceCollege of Human Ecology; Graduate Institution of Biomedical and Pharmaceutical ScienceCollege of Medicine, Fu Jen Catholic UniversityNew Taipei CityTaiwan∗∗Tao-Hsin Tung, PhD, Department of Medical Research and Education, Cheng Hsin General Hospital and Fu Jen Catholic University, Faculty of Public Health, College of Medicine, New Taipei City, Taiwan.Department of Medical Research and EducationCheng Hsin General Hospital and Fu Jen Catholic UniversityFaculty of Public Health, College of MedicineNew Taipei CityTaiwan

Abstract

Background

No large epidemiological study has been conducted to investigate the interaction and joint effects of periodontal pocket depth and hyperglycemia on progression of chronic kidney disease in patients with periodontal diseases.

Methods

Periodontal pocket depth was utilized for the grading severity of periodontal disease in 2831 patients from January 2002 to June 2013. Progression of chronic kidney disease was defined as progression of color intensity in glomerular filtration rate and albuminuria grid of updated Kidney Disease-Improving Global Outcomes guidelines. Multivariable-adjusted hazard ratios (aHR) in various models were presented across different levels of periodontal pocket depth and hemoglobin A1c (HbA1c) in forest plots and 3-dimensional histograms.

Results

During 7621 person-years of follow-up, periodontal pocket depth and HbA1C levels were robustly associated with incremental risks for progression of chronic kidney disease (aHR 3.1; 95% confidence interval [CI], 2.0-4.6 for periodontal pocket depth >4.5 mm, and 2.5; 95% CI, 1.1-5.4 for HbA1C >6.5%, respectively). The interaction between periodontal pocket depth and HbA1C on progression of chronic kidney disease was strong (P <.01). Patients with higher periodontal pocket depth (>4.5 mm) and higher HbA1C (>6.5%) had the greatest risk (aHR 4.2; 95% CI, 1.7-6.8) compared with the lowest aHR group (periodontal pocket depth ≤3.8 mm and HbA1C ≤6%).

Conclusion

Our study identified combined periodontal pocket depth and HbA1C as a valuable predictor of progression of chronic kidney disease in patients with periodontal diseases. While considering the interaction between periodontal diseases and hyperglycemia, periodontal survey and optimizing glycemic control are warranted to minimize the risk of worsening renal function.

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Keywords : Chronic kidney disease, Diabetes, Hyperglycemia, Periodontal disease


Plan


 Funding: The Ministry of Science and Technology (MOST), 104-2220-E-151-001.
 Conflict of Interest: All authors would like to declare that they have no conflicts of interest.
 Authorship: All authors had access to the data and participated in writing the manuscript.


© 2016  Elsevier Inc. Tous droits réservés.
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Vol 130 - N° 1

P. 61 - janvier 2017 Retour au numéro
Article précédent Article précédent
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