Periodontitis and early mortality among adults treated with hemodialysis: a multinational propensity-matched cohort study

Marinella Ruospo, Suetonia C Palmer, Germaine Wong, Jonathan C Craig, Massimo Petruzzi, Michele De Benedittis, Pauline Ford, David W Johnson, Marcello Tonelli, Patrizia Natale, Valeria Saglimbene, Fabio Pellegrini, Eduardo Celia, Ruben Gelfman, Miguel R Leal, Marietta Torok, Paul Stroumza, Anna Bednarek-Skublewska, Jan Dulawa, Luc Frantzen, Domingo del Castillo, Staffan Schon, Amparo G Bernat, Jorgen Hegbrant, Charlotta Wollheim, Letizia Gargano, Casper P. Bots, Giovanni FM Strippoli, on behalf of the ORALD Investigators

Periodontitis is associated with cardiovascular mortality in the general population and adults with chronic diseases. However, it is unclear whether periodontitis predicts survival in the setting of kidney failure. ORAL-D was a propensity matched analysis in 3338 dentate adults with end-stage kidney disease treated in a hemodialysis network in Europe and South America designed to examine the association between periodontitis and all-cause and cardiovascular-related mortality in people on long-term hemodialysis. Participants were matched 1:1 on their propensity score for moderate to severe periodontitis assessed using the World Health Organization Community Periodontal Index. A random-effects Cox proportional hazards model was fitted with shared frailty to account for clustering of mortality risk within countries. Among the 3338 dentate participants, 1355 (40.6%) had moderate to severe periodontitis at baseline. After using propensity score methods to generate a matched cohort of participants with periodontitis similar to those with none or mild periodontal disease, moderate to severe periodontitis was associated with a lower risk of all-cause (9.1 versus 13.0 per 100 person years, hazard ratio 0.74, 95% confidence interval 0.61 to 0.90) and cardiovascular (4.3 versus 6.9 per 100 person years, hazard ratio 0.67, 0.51 to 0.88) mortality. These associations were not changed substantially when participants were limited to those with 12 or more natural teeth and when accounting for competing causes of cardiovascular death. In contrast to the general population, periodontitis does not appear to be associated with an increased risk of early death in adults treated with hemodialysis.