|
 |
|
|||||||
|
|||||||||
DOI: 10.2337/dc06-1184
© 2007 by the American Diabetes Association
Pathophysiology/Complications |
Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes
1 Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
2 Department of Oral Biology, State University of New York at Buffalo, Buffalo, New York
3 Arizona School of Dentistry and Oral Health, Mesa, Arizona
Address correspondence and reprint requests to Dr. Wendy A. Shultis, National Institutes of Health, 1550 E. Indian School Rd., Phoenix, AZ 85014-4972. E-mail: shultisw{at}mail.nih.gov
OBJECTIVE—The purpose of this study was to investigate the effect of periodontitis on development of overt nephropathy, defined as macroalbuminuria, and end-stage renal disease (ESRD) in type 2 diabetes.
RESEARCH DESIGN AND METHODS—Individuals residing in the Gila River Indian Community aged 
25 years with type 2 diabetes, one or more periodontal examination, estimated glomerular filtration rate 60 ml/min per 1.73 m2, and no macroalbuminuria (urinary albumin-to-creatinine ratio 300 mg/g) were identified. Periodontitis was classified as none/mild, moderate, severe, or edentulous using number of teeth and alveolar bone score. Subjects were followed to development of macroalbuminuria or ESRD, defined as onset of renal replacement therapy or death attributed to diabetic nephropathy.
RESULTS—Of the 529 individuals, 107 (20%) had none/mild periodontitis, 200 (38%) had moderate periodontitis, 117 (22%) had severe periodontitis, and 105 (20%) were edentulous at baseline. During follow-up of up to 22 years, 193 individuals developed macroalbuminuria and 68 developed ESRD. Age- and sex-adjusted incidence of macroalbuminuria and ESRD increased with severity of periodontitis. After adjustment for age, sex, diabetes duration, BMI, and smoking in a proportional hazards model, the incidences of macroalbuminuria were 2.0, 2.1, and 2.6 times as high in individuals with moderate or severe periodontitis or those who were edentulous, respectively, compared with those with none/mild periodontitis (P = 0.01). Incidences of ESRD in individuals with moderate or severe periodontitis or in those who were edentulous were 2.3, 3.5, and 4.9 times as high, respectively, compared with those with none/mild periodontitis (P = 0.02).
CONCLUSIONS—Periodontitis predicts development of overt nephropathy and ESRD in individuals with type 2 diabetes. Whether treatment of periodontitis will reduce the risk of diabetic kidney disease remains to be determined.
Abbreviations: ACR, albumin-to-creatinine ratio • ARIC, Atherosclerosis Risk in Communities • ESRD, end-stage renal disease • GFR, glomerular filtration rate • MDRD, Modification of Diet in Renal Disease
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  C.W. Bassim, R.S. Redman, D.J. DeNucci, K.L. Becker, and E.S. Nylen Salivary Procalcitonin and Periodontitis in Diabetes J. Dent. Res., July 1, 2008; 87(7): 630 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. N. Varon Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes: Response to Shultis et al. Diabetes Care, December 1, 2007; 30(12): e138 - e138. [Full Text] [PDF]
|
|
|
|
|
|
W. A. Shultis, E. J. Weil, H. C. Looker, J. M. Curtis, M. Shlossman, R. J. Genco, W. C. Knowler, and R. G. Nelson Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes: Response to Varon Diabetes Care, December 1, 2007; 30(12): e139 - e139. [Full Text] [PDF]
|
|
|
|
 |
|
 K. New To Predict Diabetic Nephropathy, First Look at Gums DOC News, May 1, 2007; 4(5): 10 - 10. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |