AMSTERDAM—Poor dental health is an independent risk factor for mortality in patients with end-stage renal disease, according to results released at the 51st Congress of the European Renal Association–European Dialysis and Transplant Association.
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In addition, specific oral hygiene practices improved survival, while periodontitis had no effect on survival in this population.
“The number one clinical message is ‘look at the oral health of your patients,’” advised Giovanni Strippoli, MD, PhD, Senior Vice-President of Scientific Affairs at Diaverum, a global kidney care provider. He is also Chairman of the Diaverum Academy. “We have thousands of patients in our kidney centers but no one ever asks them if they have seen a dentist or checks if they have teeth.”
Dr. Strippoli reported the new findings on behalf of the ORAL Diseases in hemodialysis (ORAL-D) study investigators. ORAL-D is an ongoing, prospective cohort examination of oral diseases among 4,320 adults on long-term hemodialysis treated at outpatient clinics in Europe and South America. It is the largest cohort study of oral disease in dialysis patients to date. Participants undergo a standardized oral examination and complete questionnaires about their preventive oral hygiene habits.
Oral disease is highly prevalent in the general population and is a preventable cause of poor health in dialysis patients, Dr. Strippoli said. Oral disease may, in fact, be more severe in dialysis patients than in the general population because of their lower uptake of dental services as well as increased malnutrition and inflammation. While it is important to identify modifiable determinants of health in dialysis patients, few studies have examined links between oral health and clinical outcomes in this group, including mortality and cardiovascular disease.
After controlling for age, gender, income, smoking, cardiovascular disease, diabetes, blood pressure, time on dialysis, and serum phosphate, the risk of death was increased in patients without teeth by 27%. In individuals with more than 14 decayed, missing, or filled teeth, the risk of death increased by 67%. Patients with no teeth had a 28% increase in the risk.
In dentate adults, brushing teeth, flossing, changing a toothbrush at least every 3 months, and spending two or more minutes on oral hygiene daily was associated with better survival.
In a separate analysis, the results showed that periodontitis, which was evaluated at baseline in all dentate patients, was not a risk factor for early mortality in ESRD patients, the opposite of what is observed in the general population. “We would expect that the risk would be the same if not worse in dialysis patients,” Dr. Strippoli said.
The clinical relevance of the findings is clear-cut, he observed. “Dental disease is an important prognostic factor in dialysis patients,” he said. “In particular, if your patients have no teeth or bad teeth, encourage them to intensity oral hygiene as oral hygiene measures are linked to a better outcome no matter what age patients initiate such measures. And finally, send your patients to a dentist.”
