Resumen de Surgical Treatment for Patients With Periodontal Disease Reduces Risk of End-Stage Renal Disease: A Nationwide Population-Based Retrospective Cohort Study
Background: The association between periodontal disease treatment and end-stage renal disease (ESRD) remains unclear. This study aims to determine whether surgical periodontal treatment reduces ESRD risk.
Methods: From the insurance claims data of patients with periodontal disease who were free of ESRD from 1997 to 2009, 35,496 patients were identified who underwent surgery for subgingival curettage and/or periodontal flap and are considered the treatment cohort. For comparison, 141,824 patients who did not undergo these treatments were considered the no-treatment cohort. Follow-ups were performed until the end of 2009 to estimate the incidence and risk of ESRD in these two cohorts. Cox proportional hazard regression was used to estimate the related hazard ratio (HR) and 95% confidence interval (CI) of ESRD.
Results: The incidence of ESRD was lower in the treatment cohort than in the no-treatment cohort (4.66 versus 7.38 per 10,000 person-years), with an adjusted HR of 0.59 (95% CI = 0.46 to 0.75). Sex- and age-specific analysis showed that the incidence rate ratio of the treatment cohort to the no-treatment cohort was higher for women than for men and declined with age. The risks of ESRD were consistently lower in the treatment cohort even when compared by comorbidity.
Conclusions: Patients with periodontal disease who undergo procedures for subgingival curettage and/or periodontal flap have a remarkably decreased risk of ESRD.
Various forms of periodontal disease impair human health, in addition to being evidenced by bone loss and tooth mobility.1,2 These dental diseases are highly prevalent, affecting up to 90% of the worldwide population.1 In Taiwan, approximately 91% of adults are affected.3 Periodontal disease is the destructive inflammatory reaction of surrounding tooth tissues such as periodontal ligament, cementum, alveolar bone, and gingival tissue. As disease progresses, a deep gingival pocket develops, and eventually, tooth loosening and loss occurs. The main risk factors of periodontal disease are poor oral hygiene, presence of oral plaque microorganisms, genetics, tobacco and alcohol consumption, improper nutrition, stress, and impaired host immune response.4 Some systemic diseases, such as diabetes mellitus, cardiovascular disease, hematologic disease, and psychosomatic disease, may contribute to periodontal disease.3 End-stage renal disease (ESRD) is the most severe type of chronic renal failure, requiring replacement therapies such as hemodialysis, peritoneal dialysis, or renal transplantation. ESRD has been reportedly associated with periodontal disease.4-7 The prevalence of chronic renal disease is increasing in Western and Asian counties. Chronic kidney disease and chronic periodontitis (CP) might share significant mutual etiological factors.6,8 CP is suggested to contribute to the overall systemic inflammatory burden and affect the management of patients with ESRD undergoing hemodialysis therapy.2,4,7 However, the relationship between periodontal disease management and hemodialysis progress is not clear. No large population-based study is available on the difference in ESRD risks between treated and untreated patients with periodontal disease. The present study determines whether the treatment of periodontal disease with subgingival curettage and/or periodontal flap surgery reduces ESRD risk. Insurance claims data were obtained from the National Health Insurance system of Taiwan to establish periodontal disease cohorts with and without treatment.9 The difference in ESRD risk between the two cohorts was then compared.
