Indicator Details — Emerging Topics: All-Cause and Cardiovascular Mortality Among Adults with CKDa
Data Sources
 
Stratification and Year Choices:

  Source
  • NHANES III

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Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

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Footnotes:
a Hazard ratios were adjusted for age, gender, race/ethnicity, education, annual income, diabetes, hypertension, smoking, CVD, BMI, family history of premature CVD, HbA1c, total cholesterol and systolic BP.




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
FieldData
Description of MeasureHazard ratios for all-cause mortality and cardiovascular mortality
Data SourceNCHS/CDC
Type of Data SourcePublic
Data SetNHANES III
Health Care System DataNo
Regional or National?National
Demographic groupNoninstitutionalized U.S. residents aged 18 years or older
NumeratorRisk 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
DenominatorRisk of all-cause or cardiovascular mortality in NHANES III adults (≥18 years) with CKD who completed a periodontal assessment
Definition of CKDEstimated 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
Primary Data Source IndicatorAll-cause and cardiovascular mortality
Primary Indicator Method of MeasurementMortality was determined by the NCHS by matching NHANES III participants and National Death Index death certificate records
Secondary Data Source IndicatorPeriodontal disease status
Secondary Indicator Method of MeasurementPeriodontal 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
Frequency of Measurement (primary)Once (at baseline)
Period Currently Available1988–1994
Pending DataNone
U.S. Region Covered by Primary VariableAll
Additional Data Items of InterestStage of CKD, other stratification variables of interest (race/ethnicity, educational attainment, smoking by self-report, diabetes, BMI, hypertension, CVD by self-report)
Limitations of IndicatorPossible 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
Analytical ConsiderationsAppropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES III
References and Sources:
  • 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
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd