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
|Description of Measure||Hazard ratios for all-cause mortality and cardiovascular mortality|
|Type of Data Source||Public|
|Data Set||NHANES III|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic group||Noninstitutionalized U.S. residents aged 18 years or older|
|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|
|Denominator||Risk of all-cause or cardiovascular mortality in NHANES III adults (≥18 years) with CKD who completed a periodontal assessment|
|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|
|Primary Data Source Indicator||All-cause and cardiovascular mortality|
|Primary Indicator Method of Measurement||Mortality was determined by the NCHS by matching NHANES III participants and National Death Index death certificate records|
|Secondary Data Source Indicator||Periodontal disease status|
|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|
|Frequency of Measurement (primary)||Once (at baseline)|
|Period Currently Available||1988–1994|
|U.S. Region Covered by Primary Variable||All|
|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)|
|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|
|Analytical Considerations||Appropriate 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.