Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study

被引：53

作者：

Palmer, Suetonia C. ^{[1
]}

Ruospo, Marinella ^{[2
,3
]}

Wong, Germaine ^{[4
]}

Craig, Jonathan C. ^{[4
]}

Petruzzi, Massimo ^{[5
]}

De Benedittis, Michele ^{[6
]}

Ford, Pauline ^{[7
]}

Johnson, David W. ^{[7
,8
]}

Tonelli, Marcello ^{[9
]}

Natale, Patrizia ^{[2
]}

Saglimbene, Valeria ^{[2
]}

Pellegrini, Fabio ^{[10
]}

Celia, Eduardo ^{[2
]}

Gelfman, Ruben ^{[2
]}

Leal, Miguel R. ^{[2
]}

Torok, Marietta ^{[2
]}

Stroumza, Paul ^{[2
]}

Bednarek-Skublewska, Anna ^{[2
,11
]}

Dulawa, Jan ^{[2
,12
]}

Frantzen, Luc ^{[2
]}

Ferrari, Juan Nin ^{[2
]}

del Castillo, Domingo ^{[2
]}

Bernat, Amparo G. ^{[2
]}

Hegbrant, Jorgen ^{[2
]}

Wollheim, Charlotta ^{[2
]}

Gargano, Letizia ^{[2
]}

Bots, Casper P. ^{[13
]}

Strippoli, Giovanni F. M. ^{[2
,4
,5
,14
]}

机构：

[1] Univ Otago, Christchurch, New Zealand

[2] Diaverum Med Sci Off, Lund, Sweden

[3] Amedeo Avogadro Univ Eastern Piedmont, Novara, Italy

[4] Univ Sydney, Sydney, NSW 2006, Australia

[5] Univ Bari, Bari, Italy

[6] Univ Piemonte Orientale, Vercelli, Italy

[7] Univ Queensland, Brisbane, Qld 4072, Australia

[8] Translat Res Inst, Brisbane, Qld, Australia

[9] Univ Calgary, Calgary, AB, Canada

[10] Global Med Biogen Idec, Cambridge, MA USA

[11] Med Univ Lublin, Lublin, Poland

[12] Med Univ Silesia, Silesia, Poland

[13] Acad Ctr Dent Amsterdam, Oral Biochem, NL-1066 EA Amsterdam, Netherlands

[14] Diaverum Acad, Lund, Sweden

来源：

AMERICAN JOURNAL OF KIDNEY DISEASES | 2015年 / 66卷 / 04期

关键词：

Renal failure; end-stage kidney disease; hemodialysis; oral health; oral hygeine; dental disease; all-cause mortality; cardiovascular mortality; modifiable risk factor; ORAL-D (Oral Diseases in Hemodialysis) Study; ORAL EPITHELIAL-CELLS; RENAL-DISEASE; PERIODONTAL-DISEASE; GLOBAL BURDEN; ASSOCIATION; PREVALENCE; THERAPY; ADULTS; INFLAMMATION; METAANALYSIS;

D O I：

10.1053/j.ajkd.2015.04.051

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design: Prospective multinational cohort. Setting & Participants: 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors: Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes: All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements: Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results: During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score >= 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations: Convenience sample of clinics. Conclusions: In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival. (C) 2015 The Authors. Published by Elsevier Inc.

引用

页码：666 / 676

页数：11

共 37 条

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