American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Periodontal Pocket Depth, Hyperglycemia, and Progression of Chronic Kidney Disease

(A) Comparison of structures of periodontal tissues in health and disease. (B) Measurement of periodontal pocket depth using a periodontal probe. (C) Illustration of measurement method and pathologic landmarks of periodontal diseases. A = alveolar bone; BP = bottom of the periodontal pocket; C = calculus; CAL = clinical attachment loss; CEJ = cemento-enamel junction; D = destructive alveolar bone; E = epithelium; G = gingival sulcus; GR = gingival recession; H = healthy gingiva; I = inflammatory gingiva; P = periodontal pocket; PPD = periodontal pocket depth; PD = periodontal disease; R = root.

(A) Comparison of structures of periodontal tissues in health and disease. (B) Measurement of periodontal pocket depth using a periodontal probe. (C) Illustration of measurement method and pathologic landmarks of periodontal diseases. A = alveolar bone; BP = bottom of the periodontal pocket; C = calculus; CAL = clinical attachment loss; CEJ = cemento-enamel junction; D = destructive alveolar bone; E = epithelium; G = gingival sulcus; GR = gingival recession; H = healthy gingiva; I = inflammatory gingiva; P = periodontal pocket; PPD = periodontal pocket depth; PD = periodontal disease; R = root.

No large epidemiological study has been conducted to investigate the interaction and joint effects of periodontal pocket depth and hyperglycemia on progression of chronic kidney disease in patients with periodontal diseases.

Methods

Periodontal pocket depth was utilized for the grading severity of periodontal disease in 2831 patients from January 2002 to June 2013. Progression of chronic kidney disease was defined as progression of color intensity in glomerular filtration rate and albuminuria grid of updated Kidney Disease-Improving Global Outcomes guidelines. Multivariable-adjusted hazard ratios (aHR) in various models were presented across different levels of periodontal pocket depth and hemoglobin A1c (HbA1c) in forest plots and 3-dimensional histograms.

Results

During 7621 person-years of follow-up, periodontal pocket depth and HbA1C levels were robustly associated with incremental risks for progression of chronic kidney disease (aHR 3.1; 95% confidence interval [CI], 2.0-4.6 for periodontal pocket depth >4.5 mm, and 2.5; 95% CI, 1.1-5.4 for HbA1C >6.5%, respectively). The interaction between periodontal pocket depth and HbA1C on progression of chronic kidney disease was strong (P <.01). Patients with higher periodontal pocket depth (>4.5 mm) and higher HbA1C (>6.5%) had the greatest risk (aHR 4.2; 95% CI, 1.7-6.8) compared with the lowest aHR group (periodontal pocket depth ≤3.8 mm and HbA1C ≤6%).

Conclusion

Our study identified combined periodontal pocket depth and HbA1C as a valuable predictor of progression of chronic kidney disease in patients with periodontal diseases. While considering the interaction between periodontal diseases and hyperglycemia, periodontal survey and optimizing glycemic control are warranted to minimize the risk of worsening renal function.

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-Jia-Feng Chang, MD, Jih-Chen Yeh, DDS1, Ya-Lin Chiu, DDS, Jian-Chiun Liou, PhD, Jing-Ru Hsiung, DDS, Tao-Hsin Tung, PhD

This article originally appeared in the January 2017 issue of The American Journal of Medicine.

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