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Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study

2015; Elsevier BV; Volume: 66; Issue: 4 Linguagem: Inglês

10.1053/j.ajkd.2015.04.051

1523-6838

Suetonia C. Palmer, Marinella Ruospo, Germaine Wong, Jonathan C. Craig, Massimo Petruzzi, Michele De Benedittis, Pauline Ford, David W. Johnson, Marcello Tonelli, Patrizia Natale, Valeria Saglimbene, Fabio Pellegrini, Eduardo Celia, Rubén Gelfman, Miguel Leal, Mariëtta Török, Paul Stroumza, Anna Bednarek-Skublewska, Jan Duława, L. Frantzen, Juan Nin Ferrari, Domingo del Castillo, Amparo Bernat, Jörgen Hegbrant, Charlotta Wollheim, Letizia Gargano, Casper P. Bots, Giovanni FM Strippoli, S. Raña, Miguel Mas Serrano, Silvia Claros, María Fernanda Arenas Arias, L. Petracci, Mercedes Arana, Pasquale De Rosa, Alicia Hernández, Marcia Simon, Valentín Fabián Vergara, M. Tosi, Manuela Cernadas, Inmaculada Ros Vilamajó, D. Gravac, M. Paulón, L. Penayo, Gabriela Carrizo, Marco Ghiani, George Perez, O. Da Cruz, D. Galarce, Marı́a Clara Gravielle, Ester Del Vescovo, R. Paparone, Cristina Mira, Edgardo Mojico, Osvaldo Hermida, D. Florio, M. Yucoswky, W. Labonia, D Mesa Rubio, Giulia Di Napoli, A. Fernández, H.J. Altman, J Rodriguez, Sergio E. Serrano, Guido Valle, Marek Łobos, V. Acosta, G. Corpacci, M. Josefina Jofré, L. Gianoni, Gustavo Ignacio Chiesura, M. Capdevila, Jesús Lechuga Montenegro, J. Bequi, Julie-Anne Dayer, Ana María Gómez, Caterina Calderón, E. Abrego, C. Cechín, Jesús Manuel Esteban García, Javier Corral, Marcela Natiello, Ana Fuentes Coronel, Marília C Muniz, Víctor Muñiz-Sánchez, Aurelio Bonelli, Francesca Sánchez, Salvador E. Maestre Pérez, Susana Olivera, M. Constanza Camargo, Viviana Avalos, E. Geandet, Mario Sánchez‐Canteli, Antonio Escobar, Elisama Araújo de Sena, Silvia Tirado, A. Peñalba, Gustavo Neme, Miguel Cisneros, R. Oliszewski, V. Nascar, María Laura Daud, S. Mansilla, A. Paredes Álvarez, L. Gamín, M. Arijón, Mike Coombes, M. Zapata, C. Boriceanu, S. Frantzen-Trendel, K. Albert, I. Csaszar, Éva Kiss, Dezider Kosa, Andrea Orosz, J. Redl, Lajos Kovács, E.‐M. Varga, Melinda Zsuzsanna Szabó, Karl P. Magyar, G. Kriza, E. Zajko, A. Bereczki, János Csikós, Abayomi Ibrahim Kuti, A. Mike, Kevin L. Steiner, Elizabeta Nemeth, K. Tolnai, Attila Tóth, J. Vinczene, S.z. Szummer, E. Tanyi, Russell Toth, M. Szilvia, N. Dambrosio, Giulia Paparella, M. Sambati, Christopher Donatelli, F. Pedone, V.A. Cagnazzo, R. Antinoro, Ferruccio Torsello, C. Saturno, Giacomo Giannoccaro, S. Maldera, Edda Boccia, Michele Mantuano, R. Di Toro Mammarella, M. Meconizzi, P.F. Steri, Carla Riccardi, Alessia Flammini, L. Moscardelli, Marco Murgo, N. San Filippo, Sabrina Pagano, G. Marino, Giuseppe Montalto, S. Cantarella, B. Salamone, Giorgio Randazzo, D. Rallo, Alessio Maniscalco, M. Fici, A. Lupo, P. L. Pellegrino, R. Fichera, Angela D’Angelo, N. Falsitta, E Bocheńska-Nowacka, Andrzej Jaroszyński, Józef Drabik, Magdalena Birecka, Dorota Daniewska, M Drobisz, Krzysztof Doskocz, Grazyna Wyrwicz, L. Inchaustegui, Cristina Outerelo, D. Sousa Mendes, A. Mendes, Juliana de Lima Lopes, J. Barbas, Carolina Madeira, Alice Fortes, Ricardo Vizinho, A. Cortesão, Edgar Almeida, Amparo Bernat, Beatriz De la Torre, Álvaro Marchán-López, Jeffrey N. Martin, Genoveva Cuesta, Robert M. Rodriguez, F. Ros, M Garcia, E. Orero, Emilio Ros, André Caetano, K. B. MacGregor, Miguel Santos, S. Silva Pinheiro, L. Martins, D. Leitão, Catarina Izidoro, G Bava, Adem Bora, H. Gorena, T. Calderón, René-Jean Dupuy, N. Alonso, Vincenzo Iorio Siciliano, S. Frantzen-Trendel, K. Nagy, Ö. Bajusz, Ildikó Pinke, Gábor Decsi, L. Gyergyoi, Zs. Jobba, Zs. Zalai, Ádám Zsedényi, Gábor Kiss, Matthias Pinter, Márk Keresztúri, Massimo Petruzzi, Michele De Benedittis, Jacek Szkutnik, Jarosław Sieczkarek, António Capelo, M. Gallart, Carlos Alberto Mendieta Pino,

Dental Health and Care Utilization

Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown.Prospective multinational cohort.4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study).Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation.All-cause and cardiovascular mortality at 12 months after dental assessment.Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries.During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar.Convenience sample of clinics.In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.