Long-term Association of Periodontitis With Decreased Kidney Function.

RATIONALE & OBJECTIVE: Previous studies have yielded inconclusive findings regarding the relationship between periodontitis and kidney function. We sought to investigate whether periodontitis is associated with subsequent decreases in kidney function (reductions in estimated glomerular filtration rate [eGFR] and increased urinary albumin-creatinine ratio [UACR]) in the general population. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: We used baseline and 11-year follow-up data from 2,297 and 1,512 adult participants, respectively, in the Study of Health in Pomerania (SHIP). Age range was limited to 20 to 59 years to avoid the potential influence of tooth loss. EXPOSURES: Periodontal status defined by periodontal pocket probing depth (PPD) and clinical attachment level. Mean levels and the percentage of sites ≥ 3mm was determined for either all sites (PPD) or interproximal sites (clinical attachment level). All PPDs≥4mm were summed to calculate the total PPD. OUTCOMES: GFR estimated from serum creatinine and serum cystatin C (eGFRcr-cys). Moderately increased albuminuria defined as UACR>30mg/g. ANALYTICAL APPROACH: Adjusted linear and logistic mixed regression models. RESULTS: At baseline and follow-up, average eGFRcr-cys was 118.3 and 105.0mL/min/1.73m2, respectively. Using mixed models, no consistently significant associations between periodontitis variables and eGFRcr-cys were detected. Long-term changes in UACR were inconsistently associated with periodontitis measures. After imputation of missing data, associations were either attenuated or no longer detectable. LIMITATIONS: Because periodontal assessments were performed using a partial recording protocol, periodontal disease severity estimates might have been underestimated, resulting in attenuated effect estimates. CONCLUSIONS: We found no consistent evidence for an association between periodontitis and decreased kidney function. In contrast to previous studies, these results do not support the hypothesis that periodontitis is an important risk factor for chronic kidney disease.

Inverse association between number of teeth and left ventricular mass in women.

OBJECTIVES: Recently, we have demonstrated a sex-specific inverse association between the number of teeth and hypertension. Left ventricular hypertrophy is a major cardiac sequel of hypertension. With the present study we sought to investigate whether there is also an inverse association between the number of teeth and left ventricular mass (LVM). METHODS: We used data from 1913 subjects (1036 women and 877 men) who were recruited for the population-based Study of Health in Pomerania (SHIP). The number of teeth, with the exception of the third molars, was counted in the full mouth. LVM was determined echocardiographically. Multivariable analyses were adjusted for major confounders. RESULTS: Women with fewer teeth had higher values for LVM than women with more teeth. This association was stable when controlled for major confounders. In the full model, edentulous women had an adjusted LVM of 178.4 g [95% confidence interval (CI) 170.4, 186.3 g] while women with 24-28 teeth had an adjusted LVM of 164.8 g (95% CI 156.8, 172.9 g; P < 0.01). In men, no such differences were observed. CONCLUSIONS: We conclude that there is an association between the number of teeth and LVM in women aged 45 years or older. In women, these findings further explain why poor oral health predicts all-cause and circulatory mortality. Further research in young, low-risk populations is needed to explore this association in men.

Gender differences in the relation between number of teeth and systolic blood pressure.

BACKGROUND: Tooth loss predicts total and circulatory mortality. The reasons for the increased mortality in subjects with a low number of teeth may be related to enhanced atherosclerosis, elevated arterial pressure and more frequent hypertension. The present study was designed to investigate whether there is an association between the number of teeth and arterial pressure or hypertension. METHODS: We used data of 4185 adult subjects (2150 women) collected for the population-based Study of Health in Pomerania. The number of teeth was counted by trained and certified dentists. Hypertension was defined as systolic blood pressure >or= 140 mmHg or diastolic blood pressure >or= 90 mmHg or use of antihypertensive medication. Multivariable analyses were adjusted for relevant confounders. RESULTS: The adjusted mean (standard error) systolic blood pressure in men having 0-6 teeth was 149.6 mmHg (1.3 mmHg) compared to 142.6 mmHg (1.2 mmHg) in men having 27-28 teeth (P < 0.05). The adjusted odds for hypertension in men with 0-6 teeth compared to men with 27-28 teeth were 1.91 (95% confidence interval 1.21; 3.02, P < 0.05). In women no such relations were found. CONCLUSION: There is an inverse association between the number of teeth and systolic blood pressure and hypertension in men but not in women. The present findings partly explain the relation between tooth loss and mortality.

Intrarenal artery superoxide is mainly NADPH oxidase-derived and modulates endothelium-dependent dilation in elderly patients.

AIMS: The present study was performed to investigate the contribution of NADPH oxidases (Nox) to superoxide formation in human renal proximal resistance arteries and to test whether superoxide formation contributes to acute vasoconstrictor responses and endothelium-dependent vasodilation in these vessels. METHODS AND RESULTS: Arcuate and proximal interlobular artery segments were from patients who underwent nephrectomy because of a renal tumour. Vessels were dissected from tumour-free parts of the kidneys. Additional intrarenal arteries were obtained from rats. Superoxide formation was measured by lucigenin-enhanced chemiluminescence, expression of Nox isoforms was analysed by RT-PCR, and functional studies were performed by small vessel wire myography. Sixty per cent of superoxide formation in human arcuate and proximal interlobular arteries was due to Nox activity. mRNA expression analyses revealed the presence of Nox2 and Nox4 but not Nox1. Phenylephrine and endothelin-1 induced powerful concentration-dependent vasoconstrictions that were unaffected by superoxide scavengers. Vasopressin elicited small and variable vasoconstrictions with signs of tachyphylaxis. Endothelium-dependent vasodilation was blunted by tiron and Nomega-nitro-L-arginine methyl ester but not by superoxide dismutase or catalase. Exogenous hydrogen peroxide elicited vasoconstriction. CONCLUSION: Nox activity is the major source of superoxide formation in renal proximal resistance arteries from elderly patients. Acute vasoconstrictor responses to alpha1-adrenoreceptor activation and to endothelin-1 do not depend on superoxide formation, while endothelium-dependent vasodilation in intrarenal arteries is reactive oxygen species-dependent.