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Gum Disease Predicts Kidney Problems for Those With Diabetes

Periodontitis — an infection of the gums that destroys the tissue and bone supporting the teeth — is associated with the development of kidney disease and end-state renal disease (ESRD) in patients with type 2 diabetes, doctors report. Dr. Wendy A. Shultis, of the National Institutes of Health, Phoenix, Arizona, and studied 529 type 2 diabetics living in the Gila River Indian Community who were at least 25 years of age and had at least one periodontal examination.

Of the 529 subjects in the study, 107 (20 percent) had none/mild periodontitis, 200 (38 percent) had moderate periodontitis, and 117 (22 percent) had severe periodontitis, and 105 subjects (20 percent) were toothless at the start of the study.
A total of 193 subjects showed signs of kidney disease, within a median follow-up period of 9.4 years. During a median follow-up of 14.9 years, 68 subjects developed full-blown renal disease.

Moderate and severe periodontitis and toothlessness predicted the development of kidney disease a dose-dependent manner. In adjusted analyses, people with moderate gum disease had a 2-fold increased risk of kidney disease and those with severe gum disease had a 2.1-fold increased risk. Toothless participants had a 2.6-fold increased risk of developing kidney disease.
Periodontitis also predicted the development of "end-stage renal disease."

A proposed mechanism for the effect of gum disease on the development of kidney disease is inflammation, Shultis and colleagues explain.

"Both periodontitis and kidney disease are associated with inflammatory markers such as C-reactive protein," they explain, "and chronic low-level inflammation associated with periodontitis may lead to endothelial dysfunction, which plays a role in the pathogenesis of kidney disease."
Diabetes Care February 2007.

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