Evaluation of periodontal condition and risk in patients with chronic kidney disease on hemodialysis

ABSTRACT Objective To establish a profile of periodontal conditions in chronic kidney disease patients on hemodialysis and their periodontal risk. Methods We included 115 patients on hemodialysis. Clinical periodontal parameters assessed were: plaque index, gingival index, probing depth and clinical attachment level. Patients were classified according to presence/absence and severity of periodontal disease and periodontal risk. Results In 107 dentate patients (93%) the plaque index was 1.53±0.78, the gingival index was 0.95±0.85, the probing depth was 2.2±0.6mm and the clinical attachment level was 3.18±1.75mm. We observed that 1 patient (0.94%) did not have periodontal disease, 55 patients (51.40%) had slight, 28 (26.17%) moderate and 23 (21.49%) severe periodontal disease. Among 107 patients, 37 (34.58%) had low risk, 35 (32.71%) moderate risk and 35 (32.71%) high risk. Patients with severe periodontal disease showed 104.5 more chance of high risk compared with low risk individuals (odds ratio: 104.5; 95%CI: 10.7-1017.2; p<0.0001). Conclusion Most of patients with chronic renal disease presented periodontal disease, indicating the presence of chronic inflammatory and infection process that may influence in systemic conditions. A prevention and interventionist approach in this population is needed, especially to emphasize the importance of oral health. The periodontal risk assessment is a useful tool to create individualized periodontal therapies and to improve general health condition.

摘要 研究目的：建立接受血液透析（hemodialysis）的慢性肾脏病（chronic kidney disease）患者的牙周状况及其牙周风险特征。
方法：本研究纳入115名血液透析患者，评估的临床牙周参数包括：菌斑指数（plaque index）、牙龈指数（gingival index）、探诊深度（probing depth）及临床附着水平（clinical attachment level）。根据牙周疾病的有无、严重程度及牙周风险对患者进行分类。
结果：在107名有牙患者（占比93%）中，菌斑指数为1.53±0.78，牙龈指数为0.95±0.85，探诊深度为2.2±0.6mm，临床附着水平为3.18±1.75mm。本研究观察到，1名患者（0.94%）无牙周疾病，55名患者（51.40%）患有轻度牙周疾病，28名（26.17%）为中度，23名（21.49%）为重度牙周疾病。在107名有牙患者中，37名（34.58%）为低风险，35名（32.71%）为中度风险，35名（32.71%）为高风险。与低风险个体相比，重度牙周疾病患者发生高风险的概率高出104.5倍（优势比（odds ratio）：104.5；95%置信区间（95%CI）：10.7~1017.2；p<0.0001）。
结论：大多数慢性肾脏病患者均存在牙周疾病，提示可能存在影响全身状况的慢性炎症与感染过程。该人群亟需采取预防与干预措施，尤其需强调口腔健康的重要性。牙周风险评估是制定个体化牙周治疗方案、改善全身健康状况的有效工具。