Dental health and mortality in people with end-stage kidney disease treated with hemodialysis: a multinational cohort study

Palmer, Suetonia C., Ruospo, Marinella, Wong, Germaine, Craig, Jonathan C., Petruzzi, Massimo, De Benedittis, Michele, Ford, Pauline, Johnson, David W., Tonelli, Marcello, Natale, Patrizia, Saglimbene, Valeria, Pellegrini, Fabio, Celia, Eduardo, Gelfman, Ruben, Leal, Miguel R., Torok, Marietta, Stroumza, Paul, Bednarek-Skublewska, Anna, Dulawa, Jan, Frantzen, Luc, Ferrari, Juan Nin, del Castillo, Domingo, Bernat, Amparo G., Hegbrant, Jorgen, Wollheim, Charlotta, Gargano, Letizia, Bots, Casper P., Strippoli, Giovanni F. M. and on behalf of the ORAL-D Study Investigators (2015) Dental health and mortality in people with end-stage kidney disease treated with hemodialysis: a multinational cohort study. American Journal of Kidney Diseases, 66 4: 666-676. doi:10.1053/j.ajkd.2015.04.051

Author Palmer, Suetonia C.
Ruospo, Marinella
Wong, Germaine
Craig, Jonathan C.
Petruzzi, Massimo
De Benedittis, Michele
Ford, Pauline
Johnson, David W.
Tonelli, Marcello
Natale, Patrizia
Saglimbene, Valeria
Pellegrini, Fabio
Celia, Eduardo
Gelfman, Ruben
Leal, Miguel R.
Torok, Marietta
Stroumza, Paul
Bednarek-Skublewska, Anna
Dulawa, Jan
Frantzen, Luc
Ferrari, Juan Nin
del Castillo, Domingo
Bernat, Amparo G.
Hegbrant, Jorgen
Wollheim, Charlotta
Gargano, Letizia
Bots, Casper P.
Strippoli, Giovanni F. M.
on behalf of the ORAL-D Study Investigators
Title Dental health and mortality in people with end-stage kidney disease treated with hemodialysis: a multinational cohort study
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 1523-6838
Publication date 2015
Sub-type Article (original research)
DOI 10.1053/j.ajkd.2015.04.051
Open Access Status DOI
Volume 66
Issue 4
Start page 666
End page 676
Total pages 11
Place of publication Maryland Heights, United States
Publisher W. B. Saunders [Elsevier]
Collection year 2016
Language eng
Formatted abstract
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.
Keyword Renal failure
End-stage kidney disease
Oral health
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Dentistry Publications
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