The directional and non‐directional associations of periodontitis with chronic kidney disease: A systematic review and meta‐analysis of observational studies
Bibliographic record
Abstract
This systematic review aimed to assess the current evidence on the directional and non‐directional associations of periodontitis with chronic kidney disease ( CKD ). Electronic search for observational studies on the association of periodontitis with CKD was performed in MEDLINE , EMBASE , PubMed, Open GREY and Cochrane library up to June 5, 2017. Two reviewers conducted study selection, data collection and assessment of methodological quality using the original and modified Newcastle‐Ottawa Scale. Cohort, case‐control and cross‐sectional studies were included, which clearly defined periodontitis and CKD or reported acceptable clinical parameters of these 2 diseases in adults. Meta‐analysis was employed to estimate the pooled odds ratio on the non‐directional association and the incidence rate ratio ( IRR ) for the directional association. Among 2530 potential eligible articles, 47 were finally included. Most of them investigated a non‐directional association of periodontitis with CKD , including 7 case‐control studies and 38 cross‐sectional studies; 24 studies had statistical analysis on the non‐directional association and 75% of them reported significant results, which were supported further by the meta‐analysis (random: odds ratio = 2.12, P < .001; χ 2 = 25.74, I 2 = 88.3%). None of the studies focused on the directional association of CKD (as the exposure) with periodontitis (as the outcome), whereas 2 retrospective cohort studies explored a directional association of periodontitis (as the exposure) with CKD (as the outcome) (random: IRR =2.10, P > .05; fixed: IRR =1.76, P < .05; χ 2 = 4.65, I 2 = 78.3%). Overall, the high heterogeneity of studies limits the significance of these results. There is substantial evidence on the non‐directional association of periodontitis with CKD , while there are limited studies on the directional association. Well‐designed prospective studies with longer follow‐ups in representative communities are needed to clarify the directional association and enhance the quality of the evidence on this topic.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.026 | 0.071 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.030 |
| Bibliometrics | 0.012 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".