Original Investigations: Dialysis Therapies
Serum markers of periodontal disease status and inflammation in hemodialysis patients*,**,★

Presented in abstract form at the American Society of Nephrology, 33rd Annual Meeting, Toronto, Canada, October 13-16, 2000, and the International Association for Dental Research Annual Meeting, 79th General Session, Chiba, Japan, June 27-30, 2001.
https://doi.org/10.1053/ajkd.2002.36330Get rights and content

Abstract

Background: Hemodialysis (HD) patients face a 25% annual mortality rate, with 50% of reported deaths attributed to cardiovascular disease. All-cause and cardiovascular mortality correlate with such acute-phase proteins as C-reactive protein (CRP). Hepatic CRP synthesis is upregulated by inflammation; however, elevated CRP values frequently are found in the absence of apparent infection or inflammation. Because destructive periodontal diseases have been associated with elevated CRP levels, we questioned whether destructive periodontal diseases could contribute to elevated CRP values in HD populations. Methods: Sera from 86 consecutive dentate HD patients were assayed for levels of immunoglobulin G (IgG) antibody to six periodontal species by means of an enzyme-linked immunosorbent assay. Results: CRP values for the subject population ranged from less than 6.9 to 159 mg/L (median, 8.2 mg/L). Univariate comparisons between subjects with or without elevated CRP levels (>10 mg/L) showed that CRP level elevation was associated significantly (P < 0.05) with greater doses of human recombinant erythropoietin and lower levels of hemoglobin, serum iron, transferrin saturation (TSat), albumin averaged over the 3 preceding months, total cholesterol, and triglycerides. Log serum IgG antibody levels to Porphyromonas gingivalis also were significantly greater in the group with elevated CRP levels (P = 0.013). Subsequent multivariate logistic regression showed that log serum antibody levels to P gingivalis remained significant (P = 0.02) after controlling for nonperiodontal sources of elevated CRP, hemoglobin, TSat, and triglyceride values. Conclusion: These results suggest that elevated levels of IgG antibody to bacterial species associated with destructive periodontal diseases are associated with elevated CRP values in HD populations. Am J Kidney Dis 40:983-989. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Subjects

The study was approved by the Beth Israel Medical Center Institutional Review Board, and all subjects included on the study signed informed consent forms. Subjects were recruited from an adult outpatient dialysis unit of Beth Israel Medical Center (New York, NY). All subjects underwent dialysis three times weekly using high-flux polysulfone dialyzers and ultrapure water. Average single-pool Kt/V for the unit was 1.55. Edentulous patients were not included on the study.

Study design

Patient demographics,

Demographic characteristics of the HD subject population

Mean age of subjects was 53.3 ± 16.1 years, with a median time on dialysis therapy of 22 months (range, 0 to 148 months). Forty-six subjects (54%) were men; 27 subjects (31%) reported their race as black; 30 subjects (35%), as white; and 29 subjects (34%), as other. Thirty-three subjects (38%) had diabetes; the majority (28 of 33 subjects; 85%) had type 2 diabetes. Ten subjects (12%) were current smokers, 8 subjects (9%) were former smokers, 39 subjects (45%) denied ever smoking, and smoking

Discussion

The primary objective of this study is to determine whether destructive periodontal diseases contribute to increased systemic inflammation, reflected by CRP values, in patients with ESRD on maintenance HD therapy. Elevated CRP level is known to be a robust risk factor for both cardiovascular and all-cause mortality in this population.2 IgG antibody level to P gingivalis was used as a serum marker of destructive periodontal disease because previous studies of the general adult population

References (44)

  • GD Slade et al.

    Acute phase inflammatory response to periodontal disease in the US population

    J Dent Res

    (2000)
  • MI Fredriksson et al.

    Effect of periodontitis and smoking on blood leukocytes and acute-phase proteins

    J Periodontol

    (1999)
  • BG Loos et al.

    Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients

    J Periodontol

    (2000)
  • B Noack et al.

    Periodontal infections contribute to elevated systemic C-reactive protein level

    J Periodontol

    (2001)
  • F DeStefano et al.

    Dental disease and risk of coronary heart disease and mortality

    BMJ

    (1989)
  • KJ Joshipura et al.

    Poor oral health and coronary heart disease

    J Dent Res

    (1996)
  • SJ Arbes et al.

    Association between extent of periodontal attachment loss and self-reported history of heart attack: An analysis of the NHANES III data

    J Dent Res

    (1999)
  • J Beck et al.

    Periodontal disease and cardiovascular disease

    J Periodontol

    (1996)
  • AD Haffajee et al.

    Microbial etiological agents of destructive periodontal diseases

    Periodontology

    (2000)
  • JL Dzink et al.

    The predominant microflora of active and inactive lesions of destructive periodontitis

    J Clin Periodontol

    (1988)
  • WE Moore et al.

    The microflora of periodontal sites showing active disease progression

    J Clin Periodontol

    (1991)
  • SS Socransky et al.

    Microbial complexes in dental plaque

    J Clin Periodontol

    (1998)

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    *

    Supported in part by award no. DE 10593 from The National Institutes of Health.

    **

    Address reprint requests to Margaret A. Rahmati, MB, MRCP, 2 City Heights, 82 Old Snow Hill, Birmingham, West Midlands, B4 6HW, UK. E-mail: [email protected]

    ★

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    Copyright © 2002 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.