Prevalência e fatores associados às doenças periodontais em pacientes com glomerulonefrites

Abstract

Chronic kidney disease (CKD) affects 9.5% of people worldwide and is a publichealth problem, with glomerulonephritis (GN) as the third cause of dialysis CKD. Periodontitis (PO) in its severe forms affects around 10.0% of the world's population. There is an association between CKD and PO, making PO more prevalent and severe in this subgroup of patients. There is an association between CKD and PO, making PO more prevalent and severe in this subgroup of patients. The fact that PO is associated with inflammation in patients with CKD, it was hypothesized that GN, inflammatory/immunological diseases, may be associated with OP even with a normal glomerular filtration rate. The objective of this observational cross-sectional study was to evaluate the prevalence and factors associated with periodontal diseases (PD) in patients with GN, treated at the Glomerulopathies Outpatient Clinic of the University Hospital of the Federal University of Juiz de Fora from August/2021 to November/2022. A total of 217 medical records were evaluated and, after applying the exclusion criteria, the final sample consisted of 176 patients. To analyze and establish correlations between PD and associated factors, sociodemographic, clinical and laboratory variables were defined. The patients underwent examinations of periodontal parameters: plaque index (PI); probing depth (PD); clinical attachment loss (CAL), and; bleeding on probing (BOP). Sociodemographic, clinical and laboratory variables were compared with periodontal condition and logistic regression analysis was performed, adjusted for confounders, with PO and its defining components as the outcome variable. The average age was 46  14.4 years. The female gender (61.9%) and the white race (68.7%) prevailed in the sample. When evaluating the association between periodontal condition and the variables, moderate and severe PO were older (p < 0.0001); diabetes mellitus was prevalent in the moderate and severe PO group (p = 0.051), and; in the health group with reduced periodontium, amyloidosis (p < 0.0001) and multiple myeloma (p = 0.022) were more prevalent. In general, there was a high prevalence of PD, with 20.5% of severe/very severe PO. When correlating sociodemographic, clinical and laboratory variables with the CAL  5 mm versus CAL  5 mm, an association was observed with the use of calcium channel blockers (p = 0.002), just as the use of cyclosporine was associated with BOP (p = 0.037). When performing logistic regression, cardiovascular disease (CVD) was found to be an associated factor (p = 0.030) with severe/very severe PO; in PD 6  mm as the outcome variable, age became a risk factor (p = 0.021) and CVD remained an associated factor (p = 0.030); in the CAL  5 mm, age remained a risk factor (p < 0.0001) and non-smoking emerged as a protective factor (p = 0.030); in BOP  30% of sites as the outcome variable, proteinuria was an associated factor (p = 0.032). Thus, this study showed that there was a high prevalence of PD in patients with GN and when analyzing the situation overall, CVD was associated with severe PO and PD and proteinuria with BOP. There was an association involving cardiovascular and inflammatory changes in both pathologies, PO and GN.