Periodontal disease linked to kidney function decline in Hispanic, Latino patients
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Specific markers of periodontal disease were associated with eGFR decline during a 6-year period, according to a study of Hispanic and Latino patients who underwent full dental examination at sites across the United States.
“In this large, prospective community-based cohort study of Hispanics/Latinos, we did not find consistent associations between periodontal disease and kidney disease outcomes. However, select periodontal measures (including >30% sites with probing depth 4 mm and absence of functional dentition) were associated with increased risk for incident low eGFR,” Stephanie M. Toth-Manikowski, MD, of the University of Illinois at Chicago, and colleagues wrote. “To our knowledge, this represents the first study in the U.S. to evaluate this association in a large and diverse cohort of Hispanics/Latinos.”
For the investigation, Toth-Manikowski and colleagues assessed data related to 7,732 participants in the Hispanic Community Health Study/Study of Latinos who did not have chronic kidney disease at baseline (mean age was 41.5 years; 45.2% were men).
All participants were required to complete a full periodontal examination, during which researchers noted the percentage of sites with clinical attachment loss of at least 3 mm, the percentage of sites with probing depth of at least 4 mm, the percentage of sites with bleeding on probing and functional dentition (considered absent if patients had less than 21 permanent teeth).
A follow-up visit assessing kidney function was conducted at a median of 5.9 years from baseline, wherein researchers considered incident low eGFR (defined as eGFR less than 60 mL/min/1.73 m2 and decline in eGFR at least 1 mL per min per year), incident albuminuria and the change in eGFR and albumin creatinine ratio.
Results of the dental exam showed that, of the entire study population, 11.7% had at least 30% of sites with clinical attachment loss of at least 3 mm, 5.1% had at least 30% of sites with probing depth of at least 4 mm, 30.7% had at least 50% of sites with bleeding on probing and 16.2% had absent functional dentition.
Periodontal disease severity (as assessed by the above markers) was associated with higher rates of incident low eGFR (mean change in eGFR was -0.39 mL/min/1.73 m2), with patients who had at least 30% of sites with probing depth of at least 4 mm or the absence of functional dentition at an increased risk (incident density ratios of 2.31 and 1.65, respectively).
No significant associations were observed between clinical attachment level status or percent of sites with bleeding on probing with incident low eGFR, nor was an association found between any of the measures and incident albuminuria. The results did not appear to be modified by age, sex or diabetes status, the researchers noted.
“Our findings are consistent with those from other studies, and may have potential public health significance for a population which experiences high rates kidney failure,” Toth-Manikowski and colleagues concluded. “Future work is needed to investigate the impact of treatment of periodontal disease on the prevention of CKD.”
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The Hispanic Community Health Study/Study of Latinos `is the first large-scale study to sample various ethnicities — representing Cuban, Dominican, Mexican, Puerto Rican, Central American and South American people — from diverse socioeconomic and acculturation backgrounds.
Investigators enrolled 16,415 participants from randomly selected households in four U.S. field centers — Bronx, NY, Chicago, Miami and San Diego — from 2008 to 2011. Comprehensive clinical examinations (which included medical, oral, behavioral and sociodemographic variables) were conducted and followed up by telephone interviews for 3 years after. Researchers used these data to conduct the observational cohort study referenced earlier, which sought to discover any connections between periodontal disease and reduced kidney function.
The findings by Stephanie M. Toth-Manikowski, MD, and colleagues indicate that specific markers of periodontal disease were associated with estimated glomerular filtration rate decline during a 6-year period.
These results supplement existing findings from a 2019 systematic review showing an increased incidence of periodontal disease in patients with CKD.
Periodontal disease, commonly known as “gum disease,” is a chronic inflammatory disease that destroys the soft and hard tissues that support and protect teeth. The prevalence of periodontal disease in the United States is highest among ethnic minorities, affecting 63.5% of Hispanic-Americans. The most severe form affects 11% of the world population, and its prevalence increases with age.
As a chronic inflammatory disease, its progression and severity is dependent on a variety of factors including genetics, age, behaviors (tobacco smoking, oral hygiene habits), stress, medications, obesity and nutrition. Healthy People 2030 lists oral health as one of the 23 leading health indicators, although many fail to recognize the importance of oral health and its impact on overall health and quality of life.
Chronic inflammatory diseases are the most significant cause of death in the world and the greatest threat to human health. Clearly, it is of vital importance to prevent periodontitis by educating the public and providing access to care for all.
Periodontal disease is preventable, and the Hispanic Dental Association (HDA) has long advocated for the funding of public programs that provide education and access to care to underserved populations — those who need it most.
Although this research furthers our understanding of periodontitis and overall systemic health, additional research (especially randomized control trials) is necessary in order to form more direct links between periodontitis and systemic, including, but not limited to, diabetes, cardiovascular disease, neurological disorders and mental health disorders.
Currently, the HDA is planning the creation of an institutional review board to provide opportunities for researchers to examine and discover the links between oral health and systemic health in Hispanic populations.
References:
Beck JD, et al. J Clin Periodontol. 2015;doi:10.1902/jop.2015.140520.
Deschamps‐Lenhardt S, et al. Oral Dis. 2019:doi:10.1111/odi.12834.
Eke PI, et al. Gum disease risk factors. American Academy of Periodontology.
www.perio.org/consumer/gum-disease-risk-factors
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions/evidence-based-resources
Furman D, et al. Nat Med. 2019:doi:10.1038/s41591-019-0675-0.
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