The association between edentulism and chronic kidney disease with mortality: results from the NHANES study (2009–2020)

Few studies have examined the association of edentulism and chronic kidney disease (CKD). This study aimed to investigate the association of edentulism and CKD, as well as the association of edentulism and all-cause mortality. This study analysed 19,427 patients with varying degrees of edentulism from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2020. The endpoints were all-cause mortality and CKD, which were determined through the National Death Index (NDI). CKD was calculated based on the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio. A logistic regression classification model and interaction test were used to determine the association of edentulism and CKD. Kaplan–Meier survival analysis, multivariate Cox regression survival models, and stratified analyses were used to explore the correlation between edentulism and mortality risk. During the follow-up period that included the data of 19,427 individuals, a total of 1,579 cases of all-cause mortality were recorded, representing an incidence 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, 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 mortality due to CKD or all causes. Compared with 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 the CKD-related mortality rate was significantly elevated by 45% (HR 1.45, 95% CI 1.11 ~ 1.90, p = 0.007). Participants with both maxillary and mandibular tooth loss presented a significant increase in the all-cause mortality rate of 102% (HR 2.02, 95% CI 1.73 ~ 2.35, p < 0.001). The CKD mortality rate was significantly increased by 69% (HR 1.69, 95% CI 1.33 ~ 2.14, p < 0.001). Complete loss of both maxillary and mandibular dentition not only increases the prevalence of CKD but also increases the all-cause mortality and the mortality rates associated with CKD.