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This Article Full Text Full Text (PDF) All Versions of this Article: CJN.02420706v1 2/2/239    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kshirsagar, A. V. Articles by Falk, R. J. Search for Related Content PubMed PubMed Citation Articles by Kshirsagar, A. V. Articles by Falk, R. J. Related Collections Related Articles

Severe Periodontitis Is Associated with Low Serum Albumin among Patients on Maintenance Hemodialysis Therapy

Abhijit V. Kshirsagar^*, Ronald G. Craig, James D. Beck, Kevin Moss, Steven Offenbacher, Peter Kotanko^||, Maki Yoshino^||, Nathan W. Levin^||, Julie K. Yip, Khalid Almas, Eva Lupovici, and Ronald J. Falk^*

^* Division of Nephrology and Hypertension, University of North Carolina Kidney Center, School of Medicine, and Department of Dental Ecology and Department of Periodontology and Center for Oral and Systemic Disease, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Departments of Basic Sciences/Craniofacial Biology and Periodontics, New York University College of Dentistry, New York University, and ^|| Renal Research Institute, New York, New York

Address correspondence to: Dr. Abhijit V. Kshirsagar, Division of Nephrology and Hypertension, UNC Kidney Center, Department of Medicine, CB 7155 7017 Burnett-Womack Hall, Chapel Hill, NC 27599-7155. Phone: 919-966-2561 ext. 258; Fax: 919-966-4251; E-mail: sagar{at}med.unc.edu

The relationship between periodontitis and two measures of systemic inflammation, serum albumin and C-reactive protein (CRP), were examined among patients who were receiving chronic outpatient hemodialysis. Adult patients at two locations, North Carolina and New York City, were evaluated by dentist examiners. Six sites per tooth (up to 32 teeth per patient) were examined. A periodontitis case was defined as 60% of sites with attachment level 4 mm. Multivariable logistic regression was used to determine the association of periodontitis with low serum albumin, defined as <3.5 mg/dl, and with high CRP, defined as >3.0 mg/dl. A total of 154 patients completed the study. The mean age was 54.6 yr (SD 13.3), and average duration of dialysis was 4.0 yr (3 mo to 16 yr). Eighty-six (54.6%) were men, and 89 (58.2%) were black. Common causes of end-stage kidney disease were hypertension (12.3%), diabetes (22.1%), glomerulonephritis (7.1%), and other (58.4%). The average number of teeth was 20.3 (SD 8.4). Thirty-five (23%) patients were periodontitis cases. Severe periodontitis was associated with low serum albumin (odds ratio 8.20; 95% confidence interval 1.61 to 41.82; P = 0.01) compared with individuals without severe periodontitis disease after adjustment for age, gender, race, diabetes, hypertension, body mass index, smoking, study site, total cholesterol, serum calcium, serum phosphorus, and normalized protein catabolic rate. There was no observed association of severe periodontitis with CRP. Investigation of the potential contribution of periodontitis to serum albumin and possibly to morbidity and mortality among patients with end-stage kidney disease seems warranted.

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