1. Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study
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L. Penayo, A. Gutierrez, S. Serrano, Anna Bednarek-Skublewska, C. Riccardi, Letizia Gargano, M. Simon, B. De la Torre, G. Kriza, Patrizia Natale, V. Acosta, M. Yucoswky, G. Decsi, Á. Zsedenyi, V. Nascar, M. Drobisz, Pauline J. Ford, G. Bava, Sz. Szummer, J. Barbas, N. Alonso, Ruben Gelfman, A. Gómez, Jörgen Hegbrant, Jennifer H. Martin, E. Kiss, M. Ghiani, G. Corpacci, C. Saturno, A. Bonelli, N. San Filippo, M. Garcia Gallart, B. Salamone, E. Sena, Germaine Wong, J. Dayer, Jan Duława, A. Mendes, A. Maniscalco, J. Montenegro, L. Kovacs, A. Fernandez, A. Peñalba, M. Cernadas, F. Torsello, J. Csikos, O. Da Cruz, N. Falsitta, V. Avalos, M. Serrano, C. Mato Mira, K. Magyar, Amparo G. Bernat, D. Kosa, G. Carrizo, P. Pellegrino, D. Florio, M. Jofre, A. D’Angelo, R. Vizinho, A. Fortes, R. Fichera, A. Toth, Maria Teresa Botti Rodrigues Santos, G. Cuesta, M. Zapata, M. Lobos, D. Galarce, T. Calderón, A. Caetano, G. Paparella, E. Tanyi, K. Tolnai, Giovanni F.M. Strippoli, G. Di Napoli, E. Boccia, W. Labonia, S. Maestre, Paul Stroumza, A. Paredes Álvarez, D. Rallo, D. Gravac, P.F. Steri, M. De Benedittis, S. Pagano, I. Pinke, M. Paulón, R. Antinoro, Marcello Tonelli, H. Gorena, A. Bereczki, J. Rodriguez, E. Abrego, C. Izidoro, K. Steiner, A. Capelo, Fabio Pellegrini, J. Lopes, Saleem Muhammad Rana, E. Geandet, E. Varga, V. Muñiz, M. Tosi, A. Bora, D. Rubio, Jonathan C. Craig, A. Escobar, J. Redl, O. Hermida, Luc Frantzen, Suetonia C. Palmer, M. Szabo, M. Pinter, V.A. Cagnazzo, Manuel Arias, L. Martins, M. Gravielle, Ö. Bajusz, M. Szilvia, M. Petruzzi, G. Marino, G. Randazzo, R. Di Toro Mammarella, L. Inchaustegui, L. Gianoni, A. Bernat, H. Altman, Zs. Jobba, A. Jaroszynski, E. Zajko, L. Gamín, C. Donatelli, A. Mike, Marinella Ruospo, Charlotta Wollheim, M. Mantuano, C. Madeira, E. Nemeth, L. Moscardelli, Eliete Rodrigues de Almeida, Casper P. Bots, F. Pedone, F. Ros, D. Sousa Mendes, David W. Johnson, S. Claros, M. Meconizzi, Marietta Török, K. Doskocz, Valeria Saglimbene, J. Corral, M. Cisneros, M. Kereszturi, N. Dambrosio, Juan Nin Ferrari, S. Frantzen-Trendel, R. Paparone, A. Lupo, R. Dupuy, Alan D. Lopez, M. Natiello, P. De Rosa, A. Cortesão, J. Vinczene, L. Petracci, C. Boriceanu, M. Camargo, V. Vergara, M. Canteli, L. Gyergyoi, C. Mendieta, R. Toth, G. Chiesura, M. Fici, Michele De Benedittis, Massimo Petruzzi, Zs. Zalai, K. MacGregor, E. Vescovo, J. Szkutnik, R.M. Rodriguez, M. Arijón, A. Kuti, M. Coombes, M. Capdevila, S. Maldera, E. Orero, J. Sieczkarek, Marco Murgo, Domingo Del Castillo, S. Silva Pinheiro, M. Muñiz, A. Coronel, I. Csaszar, Germán Santana Pérez, E. Bochenska-Nowacka, M. Arana, Maria C. Garcia, F. Sanchez, S. Olivera, C. Calderón, C. Cechín, E. Ros, G. Wyrwicz, G. Giannoccaro, A. Flammini, G. Montalto, J. Drabik, K. Albert, S. Cantarella, G. Neme, S. Mansilla, D. Leitão, S. Tirado, V. Siciliano, E. Mojico, R. Oliszewski, Miguel Leal, M. Daud, I. Vilamajó, C. Outerelo, G. Kiss, D. Daniewska, M. Sambati, M. Birecka, Eduardo Celia, G. Valle, K. Nagy, A. Orosz, J. Bequi, and J. García
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Male ,Internationality ,medicine.medical_treatment ,Dentistry ,Oral Health ,modifiable risk factor ,Cohort Studies ,cardiovascular mortality ,Cause of Death ,end-stage kidney disease ,Medicine ,Prospective Studies ,Prospective cohort study ,Aged, 80 and over ,hemodialysis ,Age Factors ,Middle Aged ,Treatment Outcome ,Nephrology ,ORAL-D (Oral Diseases in Hemodialysis) Study ,Cardiovascular Diseases ,Cohort ,all-cause mortality ,Female ,Hemodialysis ,Cohort study ,medicine.medical_specialty ,Renal failure ,dental disease ,Oral hygiene ,Risk Assessment ,Sex Factors ,stomatognathic system ,Predictive Value of Tests ,Renal Dialysis ,Internal medicine ,Oral and maxillofacial pathology ,Confidence Intervals ,Humans ,Aged ,Proportional Hazards Models ,business.industry ,Proportional hazards model ,ORAL-D (Oral Diseases in Hemodialysis) Study, Renal failure, all-cause mortality, cardiovascular mortality, dental disease, end-stage kidney disease, hemodialysis, modifiable risk factor, oral health, oral hygiene ,oral hygiene ,medicine.disease ,Survival Analysis ,oral hygeine ,stomatognathic diseases ,Multivariate Analysis ,Kidney Failure, Chronic ,business ,Kidney disease - Abstract
Background 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. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors 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. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results 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. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.
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- 2015