Oral Health and Mortality in Patients With Chronic Kidney Disease

Objectives: We investigated factors related to the mortality of patients with chronic kidney disease (CKD) to find out whether oral disease inflammatory burden could be associated with mortality.
Methods: This study comprised 144 adults with CKD at the predialysis stage. Their clinical oral and radiological examination was made during the years 2000 - 2005. The patients were followed up until august 2015 (complete follow-up time157 months). The cause of death could be verified from 62 out of 65 deceased patients. Clinical oral health data was combined to mortality records obtained from the national Statistics Finland database. Number of teeth, Total Dental Index (TDI) and Periodontal Inflammatory Burden Index (PIBI) were calculated to describe the degree of oral inflammation.
Results: The primary causes of death were cardiovascular diseases, infection and cancer. There was a statistically significant difference in survival between diabetic nephropathy patients (23.8%) and other CKD patients (59.9%; log-rank test P<0.001). However, no statistically significant difference could be found in PIBI, gender, or smoking status between the groups . A Cox regression model showed that male gender, higher age and diabetes were statistically significant independent risk factors for death. Deceased patients had less teeth (P<0.001) and higher TDI score (P<0.05).
Conclusions: Poor oral health indeed associated with increased mortality of CKD patients. Risk to die was higher among patients with diabetic nephropathy. Since poor oral health is known to associate with systemic diseases in general, regular oral examination, accurate diagnosis and proper treatment of oral infectious foci is mandatory in reducing systemic inflammation among CKD patients in every stage of the disease.