Oral disease in adults treated with hemodialysis: prevalence, predictors, and association with mortality and adverse cardiovascular events: the rationale and design of the ORAL Diseases in hemodialysis (ORAL-D) study, a prospective, multinational, longitudinal, observational, cohort study

BMC Nephrology

Letitzia Gargano^1,16  Charlotta Wollheim^1,16  Jorgen Hegbrant^1,16  Domingo del Castillo¹  Juan Nin Ferrari³  Luc Frantzen⁴  Jan Dulawa⁵  Anna Bednarek-Skublewska⁹  Paul Stroumza⁴  Marietta Torok^1,15  Miguel R Leal^1,10  Ruben Gelfman^1,11  Eduardo Celia^1,11  David W Johnson^1,13  Pauline Ford⁸  Michele De Benedittis^1,17  Massimo Petruzzi^1,17  Fabio Pellegrini^1,12  Jonathan C Craig⁶  Valeria Saglimbene⁷  Patrizia Natale^1,16  Marinella Ruospo^1,16  Suetonia C Palmer^1,14  Giovanni FM Strippoli² 

[1] Diaverum Medical Office, Madrid, Spain;Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy;Diaverum Medical Office, Montevideo, Uruguay;Diaverum Medical Office, Lyon, France;Diaverum Medical Office, Poland and Department of Internal Medicine, Metabolic Diseases, Medical University of Silesia, Silesia, Poland;School of Public Health, University of Sydney, Sydney, Australia;Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Italy;The University of Queensland, School of Dentistry, Brisbane, Australia;Diaverum Medical Office, Poland; and Department of Nephrology, Medical University School of Lublin, Lublin, Poland;Diaverum Medical Office, Sintra, Portugal;Diaverum Medical Office, Capital Federal, Argentina;Consorzio Mario Negri Sud; “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo (FG), Italy;Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia;University of Otago Christchurch, Addington, New Zealand;Diaverum Medical Office, Budapest, Hungary;Diaverum Scientific Office, Lund, Sweden;Dental clinic, University of Bari, Bari, Italy

关键词: Prevalence;    Mortality;    Periodontitis;    Oral disease;    Chronic kidney disease;   

Others  :  1082949
DOI  :  10.1186/1471-2369-14-90

 received in 2012-11-17, accepted in 2013-04-16,  发布年份 2013

【 摘 要 】

Background

People with end-stage kidney disease treated with dialysis experience high rates of premature death that are at least 30-fold that of the general population, and have markedly impaired quality of life. Despite this, interventions that lower risk factors for mortality (including antiplatelet agents, epoetins, lipid lowering, vitamin D compounds, or dialysis dose) have not been shown to improve clinical outcomes for this population. Although mortality outcomes may be improving overall, additional modifiable determinants of health in people treated with dialysis need to be identified and evaluated.

Oral disease is highly prevalent in the general population and represents a potential and preventable cause of poor health in dialysis patients. Oral disease may be increased in patients treated with dialysis due to their lower uptake of public dental services, as well as increased malnutrition and inflammation, although available exploratory data are limited by small sample sizes and few studies evaluating links between oral health and clinical outcomes for this group, including mortality and cardiovascular disease. Recent data suggest periodontitis may be associated with mortality in dialysis patients and well-designed, larger studies are now required.

Methods/design

The ORAL Diseases in hemodialysis (ORAL-D) study is a multinational, prospective (minimum follow-up 12 months) study. Participants comprise consecutive adults treated with long-term in-center hemodialysis. Between July 2010 and February 2012, we recruited 4500 dialysis patients from randomly selected outpatient dialysis clinics in Europe within a collaborative network of dialysis clinics administered by a dialysis provider, Diaverum, in Europe (France, Hungary, Italy, Poland, Portugal, and Spain) and South America (Argentina). At baseline, dental surgeons with training in periodontology systematically assessed the prevalence and characteristics of oral disease (dental, periodontal, mucosal, and salivary) in all participants. Oral hygiene habits and thirst were evaluated using self-administered questionnaires. Data for hospitalizations and mortality (total and cause-specific) according to baseline oral health status will be collected once a year until 2022.

Discussion

This large study will estimate the prevalence, characteristics and correlations of oral disease and clinical outcomes (mortality and hospitalization) in adults treated with dialysis. We will further evaluate any association between periodontitis and risk of premature death in dialysis patients that has been suggested by existing research. The results from this study should provide powerful new data to guide strategies for future interventional studies for preventative and curative oral disease strategies in adults who have end-stage kidney disease.

【 授权许可】

   
2013 Strippoli et al.; licensee BioMed Central Ltd.

【 图 表 】

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