Abstract
Periodontal disease (POD) is associated with the risk of atherosclerotic vascular disease in patients on hemodialysis (HD). The association between POD treatment and cardiovascular diseases (CVDs) is still unknown. A total of 3613 patients who received HD and intensive POD treatment between 1 January 1998, and 31 December 2011 were identified from the National Health Insurance Research Database as the treatment cohort. The comparison cohort comprised patients without POD treatment who were matched to the patients in the treatment cohort at a 1:1 ratio by the propensity score. All CVDs defined by International Classification of Diseases, Ninth Revision (International Classification of Diseases, Ninth Revision (ICD-9)) codes were ascertained by hospital records for nonfatal events. The first CVD was used to define incidence. Relative risks were estimated by hazard ratios from the Cox proportional hazard model with adjustment for demographic variables and cardiovascular risk factors. Compared with the comparison cohort, the adjusted hazard ratio of hospitalization for CVDs was 0.78 (95% confidence interval = 0.73–0.84, p < 0.001) in the treatment cohort The treatment cohort exhibited significantly lower cumulative incidences of CVDs (log-rank test p < 0.001) and mortality (log-rank test p < 0.001). Intensive POD treatment was associated with reduced risks of CVDs and overall mortality in patients on HD.
Highlights
Cardiovascular disease (CVD) accounts for approximately 50% of deaths in patients on dialysis
Periodontal disease (POD) treatment was associated with a significantly lower overall CVD risk than that of the untreated group in the multivariate analysis model before propensity score matching(adjusted hazard ratio = 0.78, 95% confidence intervals (CIs) = 0.73–0.84, p < 0.001; Table 2)
As we demonstrated that intensive POD therapy plays a role in the primary prevention of CVDs and has benefits for survival, we recommend that the diagnosis and management of POD not be overlooked in high-risk patients on dialysis
Summary
Cardiovascular disease (CVD) accounts for approximately 50% of deaths in patients on dialysis. Therapeutic interventions have been taken for secondary prevention and reduction of mortality in patients on dialysis. These include adequate dialysis [6]; measures to reduce recovery time after dialysis sessions [7]; adequate nutrition [8]; anemia treatment [9]; management of diabetes, hypertension, and dyslipidemia [10]; and the use of phosphate binders [11]. No pharmacologic agents are recommended to reduce chronic inflammation and modify outcomes in patients with kidney disease. Inflammation resulting from an ongoing occult infection should be aggressively treated
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