Periodontal Disease and Risk of Major Cardiovascular Events in Patients with Stage 5 CKD

New Orleans—Patients with stage 5 chronic kidney disease (CKD) are at increased risk for mortality due to cardiovascular disease morbidity. Patients with stage 5 CKD also have a high prevalence of periodontal disease. There are few data available on whether the rate of major cardiovascular events in patients with CKD stage 5 may be decreased with periodontal examination and treatment of incidentally found periodontal disease.

Jose Lima, MD, and colleagues conducted an analysis to test that hypothesis in a cohort of patients with CKD stage 5. Results of the analysis were reported during a poster session at ACC.19 in a poster titled Treatment of Periodontal Disease Significantly Affects the Rate of Cardiovascular Events in Patients with Chronic Kidney Disease.

The analysis included 409 patients with CKD stage 5. The patients were stratified into two groups; patients who underwent periodontal examination and treatment of periodontal disease by debridement and/or tooth extraction (intervention group, n=206) were compared with a group of patients who did not undergo periodontal examination (historical control group, n=203). Follow-up continued for 24 months or until death or kidney transplantation.

In the patients in the periodontal examination/treatment group, the prevalence of moderate-to-severe periodontal disease was 74%. Compared with the historical control cohort, patients in the intervention group were younger (52.6 years vs 55.2 years; P=.02), and had longer duration on dialysis (24 months vs 17 months; P=.01). Patients in the intervention group also had higher event-free survival rates of major cardiovascular events (94% vs 83%, P=.009), coronary events (97% vs 89%, P=.009), and cardiovascular death (96% vs 87%, P=.037). There was no difference between the two groups in rates of all-cause death.

Results of multivariate analyses by Cox proportional hazard models adjusted for age, sex, smoking status, dyslipidemia, diabetes, cardiovascular disease, time on dialysis, and previous coronary intervention demonstrated associations between periodontal examination and treatment of periodontal disease and reduction in cardiovascular events (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.22-0.87; P=.019), coronary events (HR, 0.31; 95% CI, 0.12-0.83; P=.02), and cardiovascular death (HR, 0.43; 95% CI, 0.19-0.98; P=.045). Smoking was not a predictor of cardiovascular death (HR, 2.31; 95% CI, 1.09-4.88; P=.03).

In summary, the authors said, “The prevalence of periodontal disease in patients with CKD stage 5 is high. Periodontal examination and treatment of incidentally found periodontal disease reduced the 24-month risk of major cardiovascular events, including coronary-related events and cardiovascular death, but not all-cause mortality, thus suggesting a specific role of periodontal disease on cardiovascular prognosis in patients on dialysis. Based on our data, we propose that periodontal disease should be routinely screened for (and treated accordingly) in patients with CKD stage 5.”

Source: Lima J. Treatment of periodontal disease significantly affects the rate of cardiovascular events in patients with chronic kidney disease. Abstract of a poster (1231-390) presented at the American College of Cardiology ACC.19 68th Scientific Session and Expo, March 17, 2019, New Orleans, Louisiana.