Tooth loss elevates all-cause and cause-specific mortality in adults with chronic kidney disease: The mediating role of frailty

作者：Jiaxin Shao, Yiren Bao, Kexin Zhang, Xinyi Zheng, Jiazhen Yin, Caifeng Zhu · 发表于：Medicine · 年份：2026 · DOI：10.1097/md.0000000000049843 · 研究领域：Dental Health and Care Utilization、Oral microbiology and periodontitis research、Bone and Dental Protein Studies

Chronic kidney disease (CKD) patients experience a high oral disease burden and mortality. We evaluated whether loss of natural teeth predicts all-cause and cause-specific mortality in adults with CKD and whether a Frailty Index (FI) mediates this association. We analyzed 12,639 adults with CKD from the National Health and Nutrition Examination Survey 1999-2018. Tooth counts (third molars excluded) were grouped clinically. A 53-item FI was constructed. Survey-weighted Cox models with sensitivity checks, restricted cubic splines, piecewise Cox regression, and counterfactual mediation analysis were applied. Sequential models added FI and then ln(hs-CRP) to examine attenuation. Prespecified subgroup and sensitivity analyses were conducted, including cycles with prosthetic information. Greater tooth loss was independently associated with higher all-cause, cardiovascular, and cancer mortality. In fully adjusted models, compared with complete dentition, adjusted hazard ratios (HRs; 95% confidence intervals) for all-cause mortality were as follows: tooth loss, 1.53 (1.24-1.88); lacking functional, 1.93 (1.54-2.42); severe tooth loss, 1.99 (1.54-2.57); and edentulism, 2.16 (1.75-2.67). Spline analyses supported nonlinearity for all-cause, cardiovascular, and cancer mortality; segmented models were consistent with a steeper slope at lower tooth counts and a plateau thereafter. Piecewise analysis identified a threshold at 3 missing teeth: below the threshold, each additional missing to...