Periodontal Disease Care in CKD Cuts Cardiovascular Risks

Treatment of periodontal disease in patients on hemodialysis is associated with a decreased risk for major cardiovascular (CV) events, according to study findings presented at the American College of Cardiology 68th Annual Scientific Session and Expo, held March 16-18, 2019 in New Orleans, Louisiana, and published in the Journal of the American College of Cardiology.

To determine the impact of periodontal care on the incidence of major adverse cardiac events (MACE) and death, José Jayme G. De Lima, MD, and colleagues, from the University of São Paulo Medical School in Brazil compared 206 patients on hemodialysis who underwent periodontal examination and treatment of periodontal disease with 203 patients on hemodialysis who did not undergo periodontal examination (historical controls).

The investigators followed up with patients for 24 months or until death or transplantation.

The intervention arm had a 74% prevalence of moderate or severe periodontal disease. Compared with the historical controls, patients in the intervention group were significantly younger (52.6 vs 55) and had been on hemodialysis for significantly longer (24 vs 17 months). Patients in the intervention arm had significantly higher rates of MACE-free survival (94% vs 83%) and coronary event-free survival (97% vs 89%). They were also more likely not to die from CV causes (96% vs 87%). The 2 groups did not differ with respect to all-cause mortality.

On multivariate analysis, the intervention was associated with a significant, 57% decreased risk for MACE, 69% decreased risk for coronary events, and 57% decreased risk for CV death. The investigators adjusted for age, sex, smoking status, dyslipidemia, time on dialysis, and other potential confounders. Smoking was associated with a significant, 2.3-fold increased risk for CV death.

“In this study of a high-risk population with an increased prevalence of periodontitis, treatment was associated with a reduction in the incidence of atherosclerotic CV events,” Dr De Lima told Cardiology Advisor. “Thus, identifying individuals at higher risk for CV events by dental examination may be of clinical significance. Based on our data, we suggest that periodontal disease screening and eventual treatment may be considered in patients with advanced renal disease. Randomized trials are needed to clarify this important subject,” he added.

The new study builds on previous research examining the links between periodontal disease in patients with chronic kidney disease (CKD) with increased mortality. A meta-analysis published in 2017 in BMC Nephrology demonstrated that periodontal disease in patients with CKD was associated with an increased risk for all-cause mortality but not CV mortality. In an analysis of data from the Third National Health and Nutrition Examination Survey published in BMC Nephrology in 2015, investigators found that individuals with CKD alone had significant, 1.7- and 1.5-fold increased risks for CV and all-cause mortality, respectively, compared with individuals who had neither CKD nor periodontal disease, in fully adjusted models. Periodontal disease alone was associated with a significant 1.4-fold increased risk of all-cause mortality, but was not associated with CV mortality. The presence of both CKD and periodontal was associated with a significant 2-fold increased risk of CV and all-cause mortality.

Reference

Santos-Paul MA, Neves RS, Gowdak LHW, et al. Treatment of periodontal disease significantly affects the rate of cardiovascular events in patients with chronic kidney disease. Presented at: American College of Cardiology’s 68th Annual Scientific Sessions & Expo; March 16-18, 2019; New Orleans, LA. Abstract 1231-390.