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Periodontitis as the risk factor of chronic kidney disease: Mediation analysis
Author(s) -
Lertpimonchai Attawood,
Rattanasiri Sasivimol,
Tamsailom Suphot,
Champaiboon Chantrakorn,
Ingsathit Atiporn,
Kitiyakara Chagriya,
Limpianunchai Anusorn,
Attia John,
Sritara Piyamitr,
Thakkinstian Ammarin
Publication year - 2019
Publication title -
journal of clinical periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.456
H-Index - 151
eISSN - 1600-051X
pISSN - 0303-6979
DOI - 10.1111/jcpe.13114
Subject(s) - periodontitis , medicine , diabetes mellitus , kidney disease , incidence (geometry) , odds ratio , risk factor , cohort , gastroenterology , endocrinology , physics , optics
Abstract Aim To determine sequences and magnitude of causality among periodontitis, diabetes and chronic kidney disease (CKD) by mediation analysis. Methods Ten‐year‐data were retrieved from the Electric Generation Authority of Thailand (EGAT) study. A cohort of 2,635 subjects was identified with no CKD at baseline. The interested outcome was CKD incidence defined as glomerular filtration rate <60 ml/min/1.73 m 2 . The percentage of proximal sites with clinical attachment loss ≥5 mm was used to represent periodontitis. Mediation analysis with 1,000‐replication bootstrapping was applied to two causal diagrams, diagram A (Periodontitis → Diabetes → CKD) and diagram B (Diabetes → Periodontitis → CKD) . Results The cumulative incidence of CKD was 10.3 cases per 100 persons during 10‐year period. In diagram A , each increasing percentage of proximal sites with severe periodontitis increased the adjusted odds ratio of CKD 1.010 (95% CI: 1.005, 1.015) and 1.007 (95% CI: 1.004, 1.013), by direct and indirect effect through diabetes, respectively. In diagram B , diabetes increased the odds of CKD twofold, with 6.5% of this effect mediated via periodontitis. Conclusions Periodontitis had significant direct effect, and indirect effect through diabetes, on the incidence of CKD. Awareness about systemic morbidities from periodontitis should be emphasized.