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. 2022 Aug 6;7(10):2207-2218.
doi: 10.1016/j.ekir.2022.07.008. eCollection 2022 Oct.

Oral Health-Related Quality of Life, A Proxy of Poor Outcomes in Patients on Peritoneal Dialysis

Sirirat Purisinsith  1 , Patnarin Kanjanabuch  2 , Jeerath Phannajit  3   4 , Talerngsak Kanjanabuch  4   5   6   7 , Pongpratch Puapatanakul  4   7 , David W Johnson  8   9   10 , Krit Pongpirul  7   11   12 , Jeffrey Perl  13 , Bruce Robinson  12 , Kriang Tungsanga  4 ; Thailand PDOPPS Steering Committee
Collaborators, Affiliations

Oral Health-Related Quality of Life, A Proxy of Poor Outcomes in Patients on Peritoneal Dialysis

Sirirat Purisinsith et al. Kidney Int Rep. .

Abstract

Introduction: We sought to evaluate the associations of poor oral health hygiene with clinical outcomes in patients receiving peritoneal dialysis (PD).

Methods: As part of the multinational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 participating PD centers throughout Thailand were enrolled from May 2016 to December 2019. The data were obtained from questionnaires that formed part of the PDOPPS. Oral health-related quality of life (HRQoL) used in this study was the short form of the oral health impact profile (oral health impact profile [OHIP]-14, including 7 facets and 14 items). Patient outcomes were assessed by Kaplan-Meier analysis. Cox proportional hazards model regression was used to estimate associations between oral HRQoL and clinical outcomes.

Results: Of 5090 PD participants, 675 were randomly selected, provided informed consent, and completely responded to the OHIP-14 questionnaire. The median follow-up time of the study was 3.5 (interquartile range = 2.7-5.1 months) years. Poor oral health was associated with lower educational levels, diabetes, older age, marriage, and worse nutritional indicators (including lower time-averaged serum albumin and phosphate concentrations). After adjusting for age, sex, comorbidities, serum albumin, shared frailty by study sites, and PD vintage, poor oral health was associated with increased risks of peritonitis (adjusted hazard ratio [HR] = 1.45, 95% confidence interval [CI]: 1.06-2.00) and all-cause mortality (adjusted HR = 1.55, 95% CI: 1.04-2.32) but not hemodialysis (HD) transfer (adjusted HR = 1.89, 95% CI: 0.87-4.10) compared to participants with good oral health.

Conclusion: Poor oral health status was present in one-fourth of PD patients and was independently associated with a higher risk of peritonitis and death.

Keywords: PDOPPS; oral health hygiene; patient survival; peritonitis.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Patient flow diagram. OHIP, oral health impact profile; PDOPPS, peritoneal sialysis outcomes and practice patterns study.
Figure 2
Figure 2
Kaplan-Meier survival curves demonstrating peritonitis-free survival among PD patients with good, fair, and poor self-reported oral health hygiene at the study entry. OHIP, oral health impact profile. After adjustment for participant age, gender, PD vintage, comorbidities, shared frailty by study sites, and serum albumin using cause-specific hazards models in the presence of competing events, peritonitis-free survival was significantly lower for poor oral health (adjusted hazard ratio 1.45, 95% confidence interval 1.06–2.00, P = 0.03) but not fair oral health (adjusted hazard ratio 1.08, 95% confidence interval 0.82–1.44, P = 0.59) compared with good oral health (reference).
Figure 3
Figure 3
Kaplan-Meier survival curves demonstrating patient survival among PD patients with good, fair, and poor self-reported oral health hygiene at the study entry. OHIP, oral health impact profile. After adjustment for participant age, gender, PD vintage, comorbidities, shared frailty by study sites, and serum albumin using cause-specific hazards models in the presence of competing events, peritonitis-free survival was significantly lower for poor oral health (adjusted hazard ratio 1.55, 95% confidence interval 1.04–2.32, P = 0.03) but not fair oral health (adjusted hazard ratio 1.20, 95% confidence interval 0.73–1.98, P = 0.46) compared with good oral health (reference).
Figure 4
Figure 4
Kaplan-Meier survival curves demonstrating technique survival among PD patients with good, fair, and poor self-reported oral health hygiene at the study entry. OHIP, oral health impact profile. After adjustment for participant age, gender, PD vintage, comorbidities, shared frailty by study sites, and serum albumin using cause-specific hazards models in the presence of competing events, peritonitis-free survival was significantly lower for poor oral health (adjusted hazard ratio 1.61, 95% confidence interval 0.88–2.94, P = 0.14) but not fair oral health (adjusted hazard ratio 1.89, 95% confidence interval 0.87–4.10, P = 0.14) compared with good oral health (reference).
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References

    1. Akar H., Akar G.C., Carrero J.J., et al. Systemic consequences of poor oral health in chronic kidney disease patients. Clin J Am Soc Nephrol. 2011;6:218–226. doi: 10.2215/CJN.05470610. - DOI - PubMed
    1. Proctor R., Kumar N., Stein A., et al. Oral and dental aspects of chronic renal failure. J Dent Res. 2005;84:199–208. doi: 10.1177/154405910508400301. - DOI - PubMed
    1. De Rossi S.S., Glick M. Dental considerations for the patient with renal disease receiving hemodialysis. J Am Dent Assoc. 1996;127:211–219. doi: 10.14219/jada.archive.1996.0171. - DOI - PubMed
    1. Buhlin K., Barany P., Heimburger O., et al. Oral Health and pro-inflammatory status in end-stage renal disease patients. Oral Health Prev Dent. 2007;5:235–244. - PubMed
    1. Chen L.P., Chiang C.K., Chan C.P., et al. Does periodontitis reflect inflammation and malnutrition status in hemodialysis patients? Am J Kidney Dis. 2006;47:815–822. doi: 10.1053/j.ajkd.2006.01.018. - DOI - PubMed