Dental health and mortality in people with end-stage kidney disease treated with hemodialysis: A multinational cohort study

Suetonia Palmer, Marinella Ruospo, Germaine Wong, Jonathan Craig, Massimo Petruzzi, Michele De Benedittis, Pauline Ford, David Johnson, Marcello Tonelli, Patrizia Natale, Valeria Saglimbene, Fabio Pellegrini, Eduardo Celia, Ruben Gelfman, Miguel Leal, Marietta Torok, Paul Stroumza, Anna Bednarek-Skublewska, Jan Dulawa, Luc FrantzenJuan Ferrari, Domingo Del Castillo, Amparo Bernat, Jorgen Hegbrant, Charlotta Wollheim, Letizia Gargano, Caspar Bots, Giovanni Strippoli

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Background Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.

Original languageEnglish
Pages (from-to)666-676
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number4
Publication statusPublished - 1 Oct 2015


  • all-cause mortality
  • cardiovascular mortality
  • dental disease
  • end-stage kidney disease
  • hemodialysis
  • modifiable risk factor
  • oral health
  • oral hygeine
  • ORAL-D (Oral Diseases in Hemodialysis) Study
  • Renal failure


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