대한치위생과학회지 (Journal of Korean Dental Hygiene Science)

대한치과위생학회 & 한국치위생과학회 (The Korean Academy of Dental Hygiene & The Korean Society of Dental Hygiene Science)
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치주질환과 신장질환 발생과의 연관성: 후향적 코호트 연구

The Association between Periodontal Disease and Renal Disease Occurrence : A Retrospective Cohort Study

  • 심선주 (백석대학교 치위생학과) ;
  • 홍민희 (백석대학교 치위생학과) ;
  • 문자영 (충북재활원) ;
  • 신혜선 (동남보건대학교 치위생학과)
  • Seon-Ju Sim (Department of Dental Hygiene, University of Baekseok) ;
  • MinHee Hong (Department of Dental Hygiene, University of Baekseok) ;
  • Ja-Young Moon (Chungbuk rehabilitation center) ;
  • Hye-Sun Shin (Department of Dental Hygiene, Dongnam Health University)
  • 투고 : 2024.06.07
  • 심사 : 2024.06.26
  • 발행 : 2024.06.30
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초록

연구배경: 치주질환 상태와 신장질환과의 연관성에 대한 연구는 아직 명확한 근거가 없는 실정이다. 본 연구에서는 건강보험공단자료를 이용하여 치주질환이 신장질환 발생을 증가시키는지 여부를 후향적 코호트 연구설계로 분석하였다. 연구방법: 국민건강보험공단 표본코호트 데이터를 이용하여 203,538명의 국내 성인을 대상으로 2002년부터 2015년까지의 자료를 활용하였다. 치주질환의 정의는 치과의사에 의해 진단된 치주질환 여부 변수와 치주질환으로 인해 치과를 방문한 횟수(0회, 1회, 2회, 3회 방문)를 주 독립변수로 설정하였다. 신장질환은 국제질병분류 10차 개정판 코드를 사용하여 진단된 급성 신장질환과 유전성 신장질환을 제외한 신장질환을 포함하였다. 연구의 기초조사는 3년(2002년-2004년)으로 설정하였고, 추적조사기간은 11년(2005년-2015년)으로 설정하였다. 연구결과: 11년의 추적기간동안, 전체 203,538명 중 19,868명이 발생하였다. 나이, 성별, 수입, 음주, 흡연, 신체활동, 당뇨병, 고혈압, 비만, 고지혈증, 허혈성 심장질환, 치주치료를 보정한 결과, 치주질환은 신장질환 발생위험을 1.04배 증가시켰다. (adjusted hazard ratio [aHR] = 1.04, 95% CI = 1.01 to 1.08). 또한 치주질환으로 인한 치과 방문 빈도가 많을수록 신장질환 발생 위험이 증가하는 용량-반응 경향을 보였다 (aHR = 1.02, 95% CI = 1.00 to 1.06 for 1회 방문; aHR = 1.08, 95% CI = 1.04 to 1.13 for 2회 방문; aHR = 1.11, 95% CI = 1.03 to 1.21 for 3회 방문). 결론: 본 후향적 코호트 연구 결과 치주질환은 신장질환의 위험을 발생시킨다는 결과를 보여주었다.

Background: Research on the association between renal disease and periodontal conditions has yet to yield definitive results. In this study, we analyzed whether periodontal disease increases the risk of developing renal disease using Korean national cohort data over a period of 11 years. Methods: From 2002 to 2015, a retrospective follow-up investigation was conducted on the 203,538 Korean population using the National Health Insurance Service-National Sample Cohort. Periodontal disease and renal disease were identified through diagnoses using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes. The assessment of periodontal status involved considering the number of dental visits related to periodontal disease during the baseline 3-year period. Results: During the 11-year follow-up period, renal disease occurred in 19,868 out of the total 203,538 individuals. After adjusting for age, gender, income, smoking, drinking, physical activity, diabetes, hypertension, obesity, hypercholesterolemia, ischemic heart disease, and advanced periodontal treatment, periodontal disease increased the risk of renal disease occurrence by 1.04 times (adjusted hazard ratio [aHR] = 1.04, 95% CI = 1.01 to 1.08). Additionally, a higher frequency of dental visits attributed to periodontal disease was associated with an increased risk of renal disease,exhibiting a dose-response trend (aHR = 1.02, 95% CI = 1.00 to 1.06 for once; aHR = 1.08, 95% CI = 1.04 to 1.13 for two times; aHR = 1.11, 95% CI = 1.03 to 1.21 for three times). Conclusions: Our data confirmed that periodontal disease is associated witha higher incidence of renal disease.

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참고문헌

  1. Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet 2021;398:786-802. https://doi.org/10.1016/S0140-6736(21)00519-5.
  2. Collaboration. GCKD. Global, regional, and national burden of chronic kidney disease, 1990- 2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020;395:709-733. https://doi.org/10.1016/S0140-6736(20)30045-3.
  3. The Korean Society of nephrology. Chronic Kidney Disease in Korea. Available at: https://ksn.or.kr/bbs/index.php?code=Factsheet. Accessed: 07, 2022.
  4. Stengel B, Tarver-Carr ME, Powe NR, Eberhardt MS, Brancati FL. Lifestyle factors, obesity and the risk of chronic kidney disease. Epidemiology 2003;14:479-487. https://doi.org/10.1097/01.EDE.0000071413.55296.c4.
  5. Craig RG. Interactions between chronic renal disease and periodontal disease. Oral Dis 2008;14:1-7. https://doi.org/10.1111/j.1601-0825.2007.01430.x.
  6. Lertpimonchai A, Rattanasiri S, Tamsailom S, et al. Periodontitis as the risk factor of chronic kidney disease: Mediation analysis. J Clin Periodontol 2019;46:631-639. https://doi.org/10.1111/jcpe.13114.
  7. Kshirsagar AV, Moss KL, Elter JR, Beck JD, Offenbacher S, Falk RJ. Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study. Am J Kidney Dis 2005;45:650-657. https://doi.org/10.10 53/j.ajkd.2004.12.009. https://doi.org/10.1053/j.ajkd.2004.12.009
  8. Iwasaki M, Taylor GW, Nesse W, Vissink A, Yoshihara A, Miyazaki H. Periodontal disease and decreased kidney function in Japanese elderly. Am J Kidney Dis 2012;59:202-209. https://doi.org/10.1053/j.ajkd.2011.08.027.
  9. Tai YH, Chen JT, Kuo HC, et al. Periodontal disease and risk of mortality and kidney function decline in advanced chronic kidney disease: a nationwide population-based cohort study. Clin Oral Investig 2021;25:6259-6268. https://doi.org/10.1007/s00784-021-03924-6.
  10. Franca LFC, Vasconcelos A, da Silva FRP, et al. Periodontitis changes renal structures by oxidative stress and lipid peroxidation. J Clin Periodontol 2017;44:568-576. https://doi.org/10.1111/jcpe.12729.
  11. Galeno JG, Franca LFC, da Silva FRP, et al. Renal alterations caused by ligature-induced periodontitis persist after ligature removal in rats. J Periodontal Res 2021;56:306-313. https://doi.org/10.1111/jre.12822.
  12. Wyatt RJ, Julian BA. IgA nephropathy. N Engl J Med 2013;368:2402-2414. https://doi.org/10.1056/NEJMra1206793.
  13. Pettersson E. IgA nephropathy: 30 years on. J Intern Med 1997;242:349-353. https:// doi.org/10.1046/j.1365-2796.1997.00194.x.
  14. Nair R, Walker PD. Is IgA nephropathy the commonest primary glomerulopathy among young adults in the USA? Kidney Int 2006;69:1455-1458. https://doi.org/10. 1038/sj.ki.5000292. https://doi.org/10.1038/sj.ki.5000292
  15. The Korean Society of Nephrology. Glomerular disease in Korea. Available at: https://ksn.or.kr/bbs/?code=Factsheet. Accessed: 08.25, 2022.
  16. Nagasawa Y, Iio K, Fukuda S, et al. Periodontal disease bacteria specific to tonsil in IgA nephropathy patients predicts the remission by the treatment. PLoS One 2014;9:e81636. https://doi.org/10.1371/journal.pone.0081636.
  17. Nagasawa Y, Nomura R, Misaki T, et al. Relationship between IgA Nephropathy and Porphyromonas gingivalis; Red Complex of Periodontopathic Bacterial Species. Int J Mol Sci 2021;22:13022. https://doi.org/10.3390/ijms222313022.
  18. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999;4:1-6. https://doi.org/10.1902/annals.1999.4.1.1.
  19. Cho HJ, Shin MS, Song Y, Park SK, Park SM, Kim HD. Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study. J Dent Res 2021;100:706-713. https://doi.org/10.1177/0022034520986097.
  20. Choi YY, Lee KH. Periodontitis as a Risk Factor for Rheumatoid Arthritis: a Matched-Cohort Study. Int Dent J 2021;71:516-521. https://doi.org/10.1016/j.identj. 20 21.01.006.
  21. Kim SJ, Kim K, Choi S, et al. Chronic periodontitis and community-acquired pneumonia: a population-based cohort study. BMC Pulm Med 2019;19:268. https://doi.org/10.1186/s12890-019-1017-1.
  22. Shin HS, Hong MH, Moon JY, Sim SJ. Periodontal disease could be a potential risk factor for non-alcoholic fatty liver disease: An 11-year retrospective follow-up study. Clin Oral Investig 2022;26:5503-5514. https://doi.org/10.1007/s00784-022-045 18-6.
  23. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-163. https://doi.org/10.1016/S0140-6736(03)15268-3.
  24. Experet Panel on Detection E, and Treatment of High Blood Cholesterol in Adults,. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497. https://doi.org/10.1001/jama.285.19.2486.
  25. Grubbs V, Vittinghoff E, Beck JD, et al. Association Between Periodontal Disease and Kidney Function Decline in African Americans: The Jackson Heart Study. J Periodontol 2015;86:1126-1132. https://doi.org/10.1902/jop.2015.150195.
  26. Grubbs V, Vittinghoff E, Taylor G, et al. The association of periodontal disease with kidney function decline: a longitudinal retrospective analysis of the MrOS dental study. Nephrol Dial Transplant 2016;31:466-472. https://doi.org/10.1093/ndt/gfv312.
  27. Graziani F, Cei S, La Ferla F, Vano M, Gabriele M, Tonetti M. Effects of non-surgical periodontal therapy on the glomerular filtration rate of the kidney: an exploratory trial. J Clin Periodontol 2010;37:638-643. https://doi.org/10.1111/j.1600- 051X.2010.01578.x.
  28. Wehmeyer MM, Kshirsagar AV, Barros SP, et al. A randomized controlled trial of intensive periodontal therapy on metabolic and inflammatory markers in patients With ESRD: results of an exploratory study. Am J Kidney Dis 2013;61:450-458. https://doi.org/10.1053/j.ajkd.2012.10.021.
  29. Tonetti MS, D'Aiuto F, Nibali L, et al. Treatment of periodontitis and endothelial function. N Engl J Med 2007;356:911-920. https://doi.org/10.1056/NEJMoa063186.
  30. Ismail G, Dumitriu HT, Dumitriu AS, Ismail FB. Periodontal disease: a covert source of inflammation in chronic kidney disease patients. Int J Nephrol 2013;2013:515796. https://doi.org/10.1155/2013/515796.
  31. Sharma P, Fenton A, Dias IHK, et al. Oxidative stress links periodontal inflammation and renal function. J Clin Periodontol 2021;48:357-367. https://doi.org/10.1111/jcpe. 13414.
  32. Fang F, Wu B, Qu Q, et al. The clinical response and systemic effects of non-surgical periodontal therapy in end-stage renal disease patients: a 6-month randomized controlled clinical trial. J Clin Periodontol 2015;42:537-546. https://doi.org/ 10.1111/jcpe.12411.
  33. Chung YH, Kuo HC, Liu HY, et al. Association between Dental Scaling and Reduced Risk of End-Stage Renal Disease: A Nationwide Matched Cohort Study. Int J Environ Res Public Health 2021;18. https://doi.org/10.3390/ijerph18178910.
  34. Chambrone L, Foz AM, Guglielmetti MR, et al. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J Clin Periodontol 2013;40:443-456. https://doi.org/10.1111/jcpe.12067.
  35. Deschamps-Lenhardt S, Martin-Cabezas R, Hannedouche T, Huck O. Association between periodontitis and chronic kidney disease: Systematic review and meta-analysis. Oral Dis 2019;25:385-402. https://doi.org/10.1111/odi.12834.
  36. Zhao D, Khawaja AT, Jin L, et al. Effect of non-surgical periodontal therapy on renal function in chronic kidney disease patients with periodontitis: a systematic review and meta-analysis of interventional studies. Clin Oral Investig 2020;24:1607-1618. https://doi.org/10.1007/s00784-019-03066-w.