Association Between Periodontitis, Renal & Vascular-Function In Chronic Kidney Disease

Objectives: Patients with chronic kidney disease (CKD) experience a higher rate of mortality, mainly through cardiovascular events. These events are associated with declining renal function and increased vascular stiffness, in patients with CKD. Declining renal function is also associated with increased morbidity as in end-stage-renal-disease, patients may need dialysis or kidney transplants. Periodontitis may contribute to the systemic inflammatory or oxidative stress burden in patients with CKD and hence act as a co-morbid factor in the morbidity and mortality associated with CKD.
We aim to investigate the association between measures of periodontitis and estimated glomerular filtration rate (eGFR) and pulse wave velocity (PWV), a measure of vascular stiffness.
Methods: Results are presented from an on-going longitudinal observational cohort study of patients with high-risk CKD. Over 700 patients underwent a detailed medical and dental examination including a periodontal examination (interproximal sites of all teeth). eGFR was calculated using the 4v-MDRD equation. The carotid-femoral PWV was assessed as a measure of vascular stiffness (surrogate marker of cardiovascular risk) using the Vicorder system.
Multiple linear regression models were used to determine the association between various periodontal measures and eGFR and PWV, accounting for age, sex, ethnicity, diabetic and smoking status, albumin-creatinine ratio, BMI, blood pressure and socio-economic status.
Results: The mean age of this cohort (N=678) was 64 (S.D.16; Range19-92) with 60% males, 13% current smokers and 36% diabetic. 16% were edentulous, 42% had severe periodontitis and only 4% were periodontally healthy (CDC/AAP classification, 2007). Measures of active periodontal disease (mean probing depth, bleeding on probing and periodontal inflamed surface area) were significantly associated with declining renal function and increasing PWV in a dose-dependent fashion. This association was not significant in patients with severe periodontist compared to whose with healthy/moderate periodontitis.
Conclusions: Measures of active periodontal disease correlate with declining eGFR and increasing PWV in CKD patients. It remains to be seen if periodontal health of patients at baseline has an impact on CKD progression and increased.