Poor oral health correlates with risk of peritonitis in patients with kidney failure
Among patients with kidney failure, poor oral health is independently associated with increased risks of peritonitis and death, according to the results of this study.
Further, data revealed that one in four patients with kidney failure also have poor oral health.
“Several studies show that kidney failure patients have higher rates of decayed, missing, and filled teeth, dental plaque, loss of attachment, xerostomia, gingivitis, periodontitis, as well as mouth and jaw-bone lesions, than the general population. Moreover, the consequences of poor oral health are worse for kidney failure patients due to advanced age, diabetes, polypharmacy and impaired immune function,” Sirirat Purisinsith, DDS, MPH, from the health department at Bangkok Metropolitan administration in Thailand, and colleagues wrote. “Nevertheless, oral health evaluation is often not a high priority in the peritoneal dialysis (PD) care setting.”
In a prospective cohort study, researchers randomly selected 675 patients from the Peritoneal Dialysis Outcomes and Practice Patterns Study to investigate the relationship between poor oral hygiene and clinical outcomes among patients receiving peritoneal dialysis. Patients received PD from 22 participating centers in Thailand and were enrolled from May 2016 to December 2019.
Each patient completed the short form of the 49-item Oral Health Impact Profile that measures limitation, discomfort and disability resulting from oral conditions. For the purpose of this study, patients only answered 14 items in the form.
Researchers evaluated patient outcomes using Kaplan-Meier analyses. Using Cox proportional hazards model regression, researchers calculated correlations between overall oral health-related quality of life and clinical outcomes.
Overall, the median follow-up was 3.5 years. Researchers observed a correlation between poor oral health and lower educational levels, diabetes, older age, marriage and worse nutritional indicators, such as lower time-averaged serum albumin and phosphate concentrations. Compared with patients who had good oral health, those with poor oral health experienced increased risks for peritonitis and all-cause mortality, but not hemodialysis transfer.
“These associations may have important clinical implications for clinicians by using a simple oral health assessment to predict PD patients at risk of peritonitis and death and prioritizing them for full dental assessment and intervention,” Purisinsith and colleagues wrote. “Further exploration of whether poor oral health is a proxy of overall personal hygiene and provides valuable guidance for prioritizing home visits and more intensive PD training is warranted.”
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