In fully adjusted models, when compared with participants with no periodontal disease and CKD, those with periodontal disease and CKD had an increased risk of all-cause mortality (HR 1.55; 95 % CI, 1.30-1.84, vs. HR 2.07; 1.65-2.59, respectively). Additionally, when compared with participants with no periodontal disease and CKD, those with periodontal disease and CKD had an increased risk of cardiovascular mortality (HR 1.74; 95% CI, 1.41-2.15 vs. 2.11; 1.52-2.94).
Chart Explanation: Periodontal disease has been implicated as a novel risk factor for CKD. Recent evidence suggests that it is also associated with an increased risk of all-cause and cardiovascular mortality in the CKD population. In fully adjusted models, the all-cause and cardiovascular mortality among U.S. adult residents with CKD and periodontal disease in 1988-1994 was associated with a hazard ratio of 2.07 (95% CI, 1.65-2.59) for all-cause mortality, and 2.11 (95% CI, 1.52-2.94) for cardiovascular mortality. Among the CKD population, participants with periodontal disease has an increased risk of all-cause mortality when compared wtih participants with no periodontal disease (HR 2.07; 95 % CI, 1.65-2.59, vs. 1.55; 1.30-1.84, respectively). Additionally, among the CKD population, participants with peridontal disease had an increased risk of cardiovascular mortality when compared with participants with no periodontal disease (HR 2.11; 95% CI, 1.52-2.94 vs. 1.74; 1.41-2.15).
The National Health and Nutrition Examination Survey III (NHANES III) is an earlier version of today’s continuous NHANES; this third iteration of the National Health Examination Survey was conducted from 1988-1994. NHANES III focused on oversampling many groups within the U.S. population that were 2 months and older. These oversampled groups included children aged 2 months to 5 years, individuals 60 years or older, Mexican-Americans and non-Hispanic blacks. This survey also concentrated on health and nutrition but additionally began to collect environmental exposure and infectious disease data.
This indicator is based upon analysis in published literature: Ricardo AC, Athavale A, Chen J, et al. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey.
BMC Nephrol. 2015;16:97.
http://www.ncbi.nlm.nih.gov/pubmed/26149680
| Field | Data |
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| Description of Measure | Hazard ratios for all-cause mortality and cardiovascular mortality |
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| Data Source | NCHS/CDC |
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| Type of Data Source | Public |
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| Data Set | NHANES III |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic group | Noninstitutionalized U.S. residents aged 18 years or older |
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| Numerator | Risk of all-cause or cardiovascular mortality in NHANES III adults (≥18 years) men and non-pregnant women with CKD and periodontal disease who completed the periodontal assessment |
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| Denominator | Risk of all-cause or cardiovascular mortality in NHANES III adults (≥18 years) with CKD who completed a periodontal assessment |
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| Definition of CKD | Estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, using the CKD epidemiology collaboration (CKD-EPI) equation for creatinine or the presence of urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g |
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| Primary Data Source Indicator | All-cause and cardiovascular mortality |
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| Primary Indicator Method of Measurement | Mortality was determined by the NCHS by matching NHANES III participants and National Death Index death certificate records |
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| Secondary Data Source Indicator | Periodontal disease status |
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| Secondary Indicator Method of Measurement | Periodontal disease was defined on the basis of the Centers for Disease Control and Prevention (CDC) criteria as follows: moderate periodontal disease as at least 2 mesial sites with > 4 mm attachment loss or at least 2 mesial sites with 5 mm pocket depth (not on the same tooth), and severe periodontal disease as at least 2 mesial sites with > 6 mm attachment loss and one or more mesial sites with > 5 mm pocket depth. For the purposes of this study, individuals with either moderate or severe disease were classified as having periodontal disease |
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| Frequency of Measurement (primary) | Once (at baseline) |
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| Period Currently Available | 1988–1994 |
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| Pending Data | None |
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| U.S. Region Covered by Primary Variable | All |
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| Additional Data Items of Interest | Stage of CKD, other stratification variables of interest (race/ethnicity, educational attainment, smoking by self-report, diabetes, BMI, hypertension, CVD by self-report) |
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| Limitations of Indicator | Possible misclassification of CKD (CKD was defined in study by single measurement of eGFR and albuminuria); periodontal disease status determined by assessment of only half of the mouth; definition of periodontal disease used might underestimate prevalence; periodontal disease development during follow-up was not taken into consideration |
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| Analytical Considerations | Appropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES III |
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References and Sources:
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Ricardo AC, Athavale A, Chen J, et al. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey. BMC Nephrol. 2015;16:97.
http://www.ncbi.nlm.nih.gov/pubmed/26149680