The relationship among edentulism, chronic kidney disease and mortality: Results from the NHANES study(2009-2020)

Background: Limited research has examined the connection between edentulous jaws and chronic kidney disease (CKD), as well as their implications for mortality rates. This study aims to elucidate the correlation between edentulous jaws and CKD, in addition to exploring the connections between all-cause mortality and CKD mortality in this patient population. Methods: The study analyzed 19,427 patients with varying degrees of tooth loss from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2020. The endpoints were the mortality by all causes and CKD, determined through the National Death Index (NDI). CKD was calculated based on the eGFR and urinary albumin-to-creatinine ratio. A Logistic regression classification model and interaction test were used to determine the connection between edentulousness and CKD. Kaplan-Meier survival analysis, multivariable Cox regression survival models, and stratified analyses were used to explore the correlation between edentulousness and mortality risk. Results: During a follow-up period encompassing 19,427 persons, a total of 1,579 cases of all-cause mortality were recorded, representing an incidence rate of 8.13%. Among these, 865 cases, accounting for 54.78% of the total mortality, were attributed to chronic kidney disease (CKD). After multivariable-adjusted logistic regression analysis, it was found that the risk of CKD increased by 39% among participants with complete edentulism (OR 1.39, 95% CI 1.17 ~ 1.66, P<0.001). Following multivariable-adjusted Cox regression models, a significant connection was identified between edentulism and the mortality by CKD or all causes. Compared to participants without tooth loss, those with maxillary tooth loss had a significantly increased all-cause mortality rate of 61% (HR 1.61, 95% CI 1.30 ~ 1.98, p < 0.001), and CKD mortality rate was also significantly elevated by 45% (HR 1.45, 95% CI 1.11~1.90, p=0.007); participants with both maxillary and mandibular tooth loss exhibited a significant increase in all-cause mortality rate of 102% (HR 2.02, 95% CI 1.73 ~ 2.35, p<0.001), and CKD mortality rate was significantly increased by 69% (HR 1.69, 95% CI 1.33 ~ 2.14, p<0.001). Conclusion: The complete loss of both maxillary and mandibular dentition not only increases the prevalence of CKD but also elevates the all-cause mortality rate and the mortality rate associated with CKD. Clinical Trial Number: Not applicable.