Good oral health linked to better prognosis of patients of CKD

The purpose of this investigation was to analyze the prevalence of apical periodontitis (AP) and periodontal disease (periodontitis) (PD) in Chronic kidney disease (CKD) patients in relation to their treatment phase.

Chronic kidney disease (CKD) is a progressive, slow, silence, and irreversible disease characterized by a gradual destruction of the nephrons and a consequent reduction of kidney function in a few months or years and cause a systemic inflammatory reaction. CKD is clinically defined as estimated decrease glomerular filtration rate (GFR) <60 mL/min/1.73 m2, for 3 months or more (Levey et al., 2005). The number of patients with CKD is increasing worldwide, estimating its global prevalence, including the end-stage kidney disease, between 11% and 13%, being stage 3 (GFR 30–59) the most prevalent (7.6%). Thus, CKD can be considered a main public health problem. The well-established risk factors for people with CKD include uncontrolled diabetes, cardiovascular disease, uncontrolled high blood pressure, and age more than 60 years. The life-saving treatment of CKD includes dialysis (hemodialysis or peritoneal dialysis), which is the most common treatment, and/or kidney transplant. On the other hand, inflammation is the result of the body's immune response to different stimuli. In acute inflammation, the primary immune response draws immune cells to the site of injury, thus resolving the problem and allowing a return to the status quo. However, chronic inflammation, the result of acquired immune response, can lead to tissue damage and fibrosis, having been associated with numerous diseases, such as arthritis, asthma, atherosclerosis, autoimmune diseases, diabetes, cancer, aging, and CKD.

In this cross-sectional study, 188 patients with CKD were divided into two groups: patients without dialysis (WD group, n = 53) and patients on dialysis (DP group, n = 135). Panoramic radiographs were used to diagnose AP. The presence of periodontal disease was evaluated radiographically assessing alveolar bone loss. Student's t-test, chi-squared test, and logistic regression analysis were used to determine the significance of differences between groups.

Results

In the WD group, 55% of patients had at least one tooth with AP, whereas in the DP group 67% had at least one tooth with AP (OR = 2.11; 95% CI = 1.09–4.08; p < 0.05). PD was more prevalent in the DP group (78%) than in the WD group (36%) (OR = 6.26; CI 95% = 3.13–12.52; p < 0.01).

Oral infections are more prevalent in the advanced stages of CKD. The treatment of PD and AP should be incorporated in the treatment planning of patients with CKD.

Reference:

Palmeira, E., de Liz Pérez-Losada, F., Díaz-Flores-García, V., Segura-Sampedro, J. J., Segura-Egea, J. J., & López-López, J. (2023). Prevalence of oral infections in chronic kidney disease patients: A cross-sectional study. Oral Diseases, 00, 1–8. https://doi.org/10.1111/odi.14663

Keywords:

Palmeira, E., de Liz Pérez-Losada, F., Díaz-Flores-García, V., Segura-Sampedro, J. J., Segura-Egea, J. J., & López-López, J, Oral Diseases