Gum Disease Linked to Reduced Survival in ESRD

Dialysis patients with periodontal disease are at higher risk of death from cardiovascular causes, suggests a study in Kidney International.

The retrospective analysis included 168 patients at dialysis centers in New York City and North Carolina. Dental examination revealed moderate to severe periodontal disease—defined as 2 or more teeth with at least 6 mm of interproximal attachment loss—in 68 patients. The remaining 100 patients had mild or no periodontal disease. Dialysis registry data were used to compare rates of death from cardiovascular disease and from all causes.

There were more women in the periodontal disease group. Of 22 deaths during an 18-month follow-up period, 14 were from cardiovascular causes. Patients in the periodontal disease group were at significantly higher risk of cardiovascular death, with a hazard ratio of 5.0. The association was not weakened by adjustment for other factors, including dialysis center, smoking, diabetes, and hypertension. All-cause mortality was similar between groups.

If confirmed, the results suggest that periodontal disease is a strong risk factor for death from cardiovascular disease in ESRD patients receiving dialysis. More study is needed to determine whether periodontal treatment can reduce cardiovascular mortality [Kshirsagar AV, Craig RG, Moss KL, Beck JD, Offenbacher S, Kotanko P, Klemmer PJ, Yoshino M, Levin NW, Yip JK, Almas K, Lupovici EM, Usvyat LA, Falk RJ: Periodontal disease adversely affects the survival of patients with end stage renal disease. Kidney Int 2009; 75:746–751.