Periodontal Disease in Chronic Kidney Disease Patients: Implications for Systemic Health and Dental Management
DOI:
https://doi.org/10.36283/ziun-pjmd14-2/010Keywords:
Chronic Kidney Disease, Periodontal Disease, Dental Management, Preventive DentistryAbstract
Background: Research suggested that the chronic kidney disease (CKD) exists as an inflammatory condition while studies established that periodontal disease interacts with CKD in two directions. This work measured that the periodontal disease affects kidney disease progression as well as identify proper treatment methods for dental conditions.
Methods: This retrospective cohort study was conducted and analyzed collaboratively mainly at RAK College of Medical Sciences, IMDC Islamabad and LUMHS Jamshoro from December 2022 to December 2023. An assessment of 80 CKD patients aged 55.3 ± 10.7 years was done via Purposive sampling technique was used and patients were selected based on pre-defined criteria (CKD diagnosis at stages 3–5 and documented periodontal health status). Clinical parameters of periodontal health included probing depth measurements and attachment loss quantification along with inflammatory mediators’ assessment. The research evaluated patient-reported oral health data with renal function results along with systematic inflammatory marker levels. Data analysis included descriptive statistics, Pearson correlation and multivariate regression with SPSS (p < 0.05) to evaluate the relationship of periodontal disease with CKD progression and systemic inflammation.
Results: Patients with severe periodontal disease experienced accelerated CKD progression together with increased systemic inflammation at p-values of 0.015 and 0.021 respectively. CKD patients who had poor oral health presented higher rates of cardiovascular complications according to statistical analysis (p = 0.008).
Conclusion: Structured periodontal care featuring non-surgical therapy alongside antimicrobial therapies enhanced patient well-being by improving inflammatory profiles in patients. Periodontal disease among CKD patients creates systemic inflammation which leads to negative outcomes for their medical condition.
References
Kim JY, Park JT, Kim HW, Chang TI, Kang EW, Ahn C et al. Inflammation Alters Relationship Between High-Density Lipoprotein Cholesterol and Cardiovascular Risk in Patients With Chronic Kidney Disease: Results From KNOW-CKD. J Am Heart Assoc. 2021;10(16):e021731. doi: 10.1161/JAHA.120.021731.
Baciu SF, Mesaroș AȘ, Kacso IM. Chronic Kidney Disease and Periodontitis Interplay-A Narrative Review. Int J Environ Res Public Health. 2023 ;20(2):1298. doi: 10.3390/ijerph20021298.
Parsegian K, Randall D, Curtis M, Ioannidou E. Association between periodontitis and chronic kidney disease. Periodontol 2000. 2022 ;89(1):114-124. doi: 10.1111/prd.12431.
Costacurta M, Basilicata M, Marrone G, Di Lauro M, Campolattano V, Bollero P et al. The Impact of Chronic Kidney Disease on Nutritional Status and Its Possible Relation with Oral Diseases. Nutrients. 2022 ;14(10):2002. doi: 10.3390/nu14102002.
Li L, Zhang YL, Liu XY, Meng X, Zhao RQ, Ou LL et al. Periodontitis Exacerbates and Promotes the Progression of Chronic Kidney Disease Through Oral Flora, Cytokines, and Oxidative Stress. Front Microbiol. 2021 ;12:656372. doi: 10.3389/fmicb.2021.656372.
Mahendra J, Palathingal P, Mahendra L, Alzahrani KJ, Banjer HJ, Alsharif KF et al. Impact of Red Complex Bacteria and TNF-α Levels on the Diabetic and Renal Status of Chronic Kidney Disease Patients in the Presence and Absence of Periodontitis. Biology (Basel). 2022 ;11(3):451. doi: 10.3390/biology11030451.
Delbove T, Gueyffier F, Juillard L, Kalbacher E, Maucort-Boulch D, Nony P et al. Effect of periodontal treatment on the glomerular filtration rate, reduction of inflammatory markers and mortality in patients with chronic kidney disease: A systematic review. PLoS One. 2021 ;16(1):e0245619. doi: 10.1371/journal.pone.0245619.
Kalhan AC, Wong ML, Allen F, Gao X. Periodontal disease and systemic health: An update for medical practitioners. Ann Acad Med Singap. 2022 ;51(9):567-574. doi: 10.47102/annals-acadmedsg.2021503.
Tai YH, Chen JT, Kuo HC, Chang WJ, Wu MY, Dai YX et al. Periodontal disease and risk of mortality and kidney function decline in advanced chronic kidney disease: a nationwide population-based cohort study. Clin Oral Investig. 2021 ;25(11):6259-6268. doi: 10.1007/s00784-021-03924-6.
Chapple ILC, Hirschfeld J, Cockwell P, Dietrich T, Sharma P. Interplay between periodontitis and chronic kidney disease. Nat Rev Nephrol. 2024:1-5 . doi: 10.1038/s41581-024-00910-5.
Shlipak MG, Tummalapalli SL, Boulware LE, Grams ME, Ix JH, Jha V et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021 ;99(1):34-47. doi: 10.1016/j.kint.2020.10.012.
Tinti F, Lai S, Noce A, Rotondi S, Marrone G, Mazzaferro S et al. Chronic Kidney Disease as a Systemic Inflammatory Syndrome: Update on Mechanisms Involved and Potential Treatment. Life (Basel). 2021 ;11(5):419. doi: 10.3390/life11050419.
Vachhani KS, Bhavsar NV. Effects of non-surgical periodontal therapy on serum inflammatory factor high-sensitive C-reactive protein, periodontal parameters and renal biomarkers in patients with chronic periodontitis and chronic kidney disease. Dent Med Probl. 2021 ;58(4):489-498. doi: 10.17219/dmp/136034.
Martínez-García M, Hernández-Lemus E. Periodontal Inflammation and Systemic Diseases: An Overview. Front Physiol. 2021 ;12:709438. doi: 10.3389/fphys.2021.709438.
Valenzuela-Narváez RV, Valenzuela-Narváez DR, Valenzuela-Narváez DAO, Córdova-Noel ME, Mejía-Ruiz CL, Salcedo-Rodríguez MN, Gonzales-Aedo O. Periodontal disease as a predictor of chronic kidney disease (CKD) stage in older adults. J Int Med Res. 2021 ;49(7):3000605211033266. doi: 10.1177/03000605211033266.
Tavares LTR, Saavedra-Silva M, López-Marcos JF, Veiga NJ, Castilho RM, Fernandes GVO. Blood and Salivary Inflammatory Biomarkers Profile in Patients with Chronic Kidney Disease and Periodontal Disease: A Systematic Review. Diseases. 2022 ;10(1):12. doi: 10.3390/diseases10010012.
Chaudhry A, Kassim NK, Zainuddin SLA, Taib H, Ibrahim HA, Ahmad B et al. Potential Effects of Non-Surgical Periodontal Therapy on Periodontal Parameters, Inflammatory Markers, and Kidney Function Indicators in Chronic Kidney Disease Patients with Chronic Periodontitis. Biomedicines. 2022;10(11):2752. doi: 10.3390/biomedicines10112752.
Ghanem AS. The Role of Systemic Health Indicators, Including C-Reactive Protein and eGFR, in Predicting Periodontal Disease: A Longitudinal Study. Int J Mol Sci. 2025 ;26(2):741. doi: 10.3390/ijms26020741.
Chambrone L, Foz AM, Guglielmetti MR, Pannuti CM, Artese HP, Feres M et al. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J Clin Periodontol. 2013;40(5):443-56. doi: 10.1111/jcpe.12067.
Roy N, Rosas SE. IL-6 Is Associated with Progression of Coronary Artery Calcification and Mortality in Incident Dialysis Patients. Am J Nephrol. 2021;52(9):745-752. doi: 10.1159/000518652.
Zhu F, Gan W, Liu H, Chen W, Zeng X. Risk factors for renal progression in patients with CKD and coexisting COPD. Int Urol Nephrol. 2024 . doi: 10.1007/s11255-024-04227-x.
Ebert T, Neytchev O, Witasp A, Kublickiene K, Stenvinkel P, Shiels PG. Inflammation and Oxidative Stress in Chronic Kidney Disease and Dialysis Patients. Antioxid Redox Signal. 2021 ;35(17):1426-1448. doi: 10.1089/ars.2020.8184.
Bezerra PL, de Carvalho Júnior AD, da Silva AF, Pereira NEG, da Costa SRR, de Sousa JNL, Bernardino ÍM. Effects of periodontal treatment on the C-reactive protein levels in hemodialysis patients: A systematic review and meta-analysis. Spec Care Dentist. 2024 ;44(1):28-39. doi: 10.1111/scd.12834.
Lu H, Wu H, Yang Y, Feng X, Ma X, Xie Y et al. Relationship between chronic periodontitis and inflammatory cytokines in patients undergoing maintenance hemodialysis. Clin Oral Investig. 2022 ;26(11):6699-6709. doi: 10.1007/s00784-022-04629-0.
Joseph P, Prabhakar P, Holtfreter B, Pink C, Suvan J, Kocher T et al. Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of non-surgical periodontal treatment in patients with concurrent systemic conditions. Clin Oral Investig. 2023 ;28(1):21. doi: 10.1007/s00784-023-05392-6.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
