The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients
The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients
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DOI：
10.1093/ndt/gfl676
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发表时间：
2007-02-01
影响因子：
6.1
通讯作者：
Mysliwiec, Michal
中科院分区：
文献类型：
--
作者：
Borawski, Jacek;Wilczynska-Borawska, Magdalena;Mysliwiec, Michal
背景。牙周炎有助于全身性炎症和全身性疾病的发展，包括动脉粥样硬化和心血管疾病。它在维持性血液透析（HD）患者中的程度是有争议的，在持续动态腹膜透析（CAPD）和透析前慢性肾脏疾病（CKD）患者中的程度尚不清楚。来自波兰东北部的106例患者（35例HD，平均年龄56岁；33例CAPD，平均年龄51岁；38例透析前CKD 2-5期，平均年龄51岁）被纳入研究。透析受试者从141例HD和61例CAPD患者中招募。两个对照组由26名需要专门治疗的健康晚期牙周炎患者和30名普通人群组成。按照WHO推荐标准测定牙龈指数（GI）、乳头状出血指数（PBI）、菌斑指数（PI）、临床附着丧失水平（CAL）和社区牙周治疗需求指数（CPITN）。HD、CAPD、透析前CKD、晚期牙周炎和普通人群的指数平均值分别为：GI-1.37、0.95、1、2、1；PBI-1.45, 0,0,2.20和1；PI-2.05, 1.59, 1,2, 1；CAL损失分别为5.11、3.47、2.50、4.68和1.40 mm。CPITN分别作为社区牙周指数和牙周治疗需求进行分析，进一步表明与普通人群相比，所有肾衰竭组的牙周炎严重程度较高。这种疾病在维持性HD患者中最为严重——与完全症状形式的牙周炎相当；然后在CAPD和透析前CKD受试者中依次降低。牙周病在肾衰竭患者中普遍、严重且未得到充分认识。预防和早期牙科治疗应加强在这些科目，并可能是跨学科的重要性。
Background. Periodontitis contributes to generalized inflammation and development of systemic diseases, including atherosclerosis and cardiovascular disease. Its extent in maintenance haemodialysis (HD) patients is disputable and not known in continuous ambulatory peritoneal dialysis (CAPD) and pre-dialysis chronic kidney disease (CKD) patients.Methods. One hundred and six patients (35 on HD, mean age, 56 years; 33 on CAPD, mean age 51 years; and 38 pre-dialysis CKD stage 2-5, mean age 51 years) from north-eastern Poland were enrolled. Dialysis subjects were recruited from a cohort of 141 HD and 61 CAPD patients. Two control groups comprised 26 generally healthy individuals with advanced periodontitis requiring specialized treatment, and 30 subjects from general population. Gingival index (GI), papillary bleeding index (PBI), plaque index (PI), loss of clinical attachment level (CAL) and community periodontal index of treatment needs (CPITN) were determined according to WHO recommendations.Results. Average values of the indices in HD, CAPD, pre-dialysis CKD, advanced periodontitis and general population subjects were as follows: GI-1.37, 0.95, 1, 2 and 1; PBI-1.45, 0, 0, 2.20 and 1; PI-2.05, 1.59, 1, 2 and 1; and CAL loss-5.11, 3.47, 2.50, 4.68 and 1.40 mm, respectively. CPITN, analysed separately as community periodontal index and periodontal treatment needs, further indicated a high severity of periodontitis in all renal failure groups as compared with general population subjects. The disease was most advanced in maintenance HD patients-comparable to the full-symptomatic form of periodontitis; then it was successively diminished in CAPD and pre-dialysis CKD subjects.Conclusions. Periodontal disease is prevalent, severe and under recognized in renal failure patients. Prophylaxis and early dental treatment should be intensified in these subjects, and may be of interdisciplinary importance.