SP348ORAL HEALTH STATUS IN PREDIALYSIS PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract

Introduction and Aims: Oral health status was reported as poor in haemodialyzed patients, with high prevalence of periodontal disease (PDD), associated with inflammation-malnutrition complex and higher mortality. Predialyzed patients with Chronic Kidney Disease (CKD) seem to have also impared oral health status, with possible impact on renal function and general health, but it was much less studied. This cross-sectional single center study aimed to assess the prevalence of PDD in predialysis CKD patients and its relationship with renal function, inflammation and nutritional status. Methods: All the 264 consecutive adult patients, with stage 3+ CKD (estimated GFR, 4-variableModification of Diet in Renal Disease formula < 60 mL/min per year), monitored for at least one year in a Nephrology clinic were assessed for eligibility during the scheduled visits in an enrollment period of 12 months. Demografic data, smoking status, parameters of renal function and of metabolic complications of CKD, markers of nutrition-inflammation (anthropometry, biochemistry, serum C-reactive protein) and haematologic data were recorded. Periodontal status was examined according to WHO recommendations by a single examiner and quantified based on loss of clinical attachment level (CAL): no/mild periodontitis (CAL<3mm), moderate or severe periodontitis (CAL 3-4 mm or ≥5mm, respectively). Results: Ninety-seven patients refused to participate before or during the examination or were involved in other clinical trials; 52 subjects (31%) were excluded for edentulism. One-hundred and fifteen patients were evaluated: 37% males, median age 58.0 (50.4-59.3) years, 45% smokers, eGFR 29.8 (28.2-38.4) mL/min, 33% with primary glomerulopathies, 31% vascular nephropathies, 22% interstitial diseases, 10% with diabetic nephropathy and 4% with other kidney diseases. Poor periodontal health status was shown by 71% of patients, 26% of them with severe PDD. Periodontal disease was significantly more frequent in smokers (91 versus 57%, p<0.001) and in diabetic patients (98 versus 69%, p<0.001). Patients with severe PDD were significantly older [57.3 (55.1-60.2) versus 51.5 (49.8-53.2) years, p=0.02] as compared to those with healthy oral status. The level of kidney function was similar in patients with severe PDD and those with normal periodontium [25.6 (19.4-28.4) versus 28.3 (25.9-31.2) mL/min], while proteinuria was significantly higher in subjects with severe PDD [2.1 (1.7-3.2) versus 0.6 (0.1-1.2) g/g creatininuria in normals, p=0.002]. Significantly higher percentages of patients with malnutrition (SGA B) and of those with inflammation (CRP>12 mg/L) had PDD: 97 versus 66% (p=0.04) and 97 versus 71% (p=0.02), respectivelly. Conclusions: Impaired periodontal health was highly prevalent in our cohort of predialysis CKD patients. PDD was more frequent in elderly, smokers and in diabetic patients and was associated with heavier proteinuria. PDD was more prevalent in malnourished and in inflammed patients. Interventional trials to evaluate the influence of periodontal disease on hard outcome end-points are required.