Periodontal Disease in Patients Receiving Dialysis

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Abstract

Chronic kidney disease (CKD) is characterized by kidney damage with proteinuria, hematuria, and progressive loss of kidney function. The final stage of CKD is known as end-stage renal disease, which usually indicates that approximately 90% of normal renal function is lost, and necessitates renal replacement therapy for survival. The most widespread renal replacement therapy is dialysis, which includes peritoneal dialysis (PD) and hemodialysis (HD). However, despite the development of novel medical instruments and agents, both dialysis procedures have complications and disadvantages, such as cardiovascular disease due to excessive blood fluid and infections caused by impaired immunity. Periodontal disease is chronic inflammation induced by various pathogens and its frequency and severity in patients undergoing dialysis are higher compared to those in healthy individuals. Therefore, several investigators have paid special attention to the impact of periodontal disease on inflammation-, nutrient-, and bone metabolism-related markers; the immune system; and complications in patients undergoing dialysis. Furthermore, the influence of diabetes on the prevalence and severity of manifestations of periodontal disease, and the properties of saliva in HD patients with periodontitis have been reported. Conversely, there are few reviews discussing periodontal disease in patients with dialysis. In this review, we discuss the available studies and review the pathological roles and clinical significance of periodontal disease in patients receiving PD or HD. In addition, this review underlines the importance of oral health and adequate periodontal treatment to maintain quality of life and prolong survival in these patients.

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Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol.

J Suvan, M Tonetti, F D'Aiuto … (2005)

Severe periodontitis has been associated with increased systemic inflammation. In a three-arm preliminary randomized trial, we investigated the impact of standard (SPT) and intensive periodontal therapy (IPT) on serum inflammatory markers and cholesterol levels. Medical and periodontal parameters, C-reactive protein (CRP), interleukin-6 (IL-6), total cholesterol, and LDL cholesterol were evaluated in 65 systemically healthy subjects suffering from severe generalized periodontitis. Two months after treatment, both SPT and IPT resulted in significant reductions in serum CRP compared with the untreated control (0.5 +/- 0.2 mg/L for SPT, P = 0.030 and 0.8 +/- 0.2 mg/L for IPT, P = 0.001). Similar results were observed for IL-6. Changes in inflammation were independent of age, gender, body mass index, and ethnicity, but a significant interaction between cigarette smoking and treatment regimen was found. The IPT group also showed a decrease in total and LDL cholesterol after 2 months. Analysis of these data indicates that periodontitis causes moderate systemic inflammation in systemically healthy subjects.

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Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates.

P Copleston, S Fenton, Y. Mao … (1997)

Although kidney transplantation is the preferred treatment method for patients with ESRD, most patients are placed on dialysis either while awaiting transplantation or as their only therapy. The question of which dialytic method provides the best patient survival remains unresolved. Survival analyses comparing hemodialysis and continuous ambulatory peritoneal dialysis/continuous cyclic peritoneal dialysis (CAPD/CCPD), a newer and less costly dialytic modality, have yielded conflicting results. Using data obtained from the Canadian Organ Replacement Register, we compared mortality rates between hemodialysis and CAPD/CCPD among 11,970 ESRD patients who initiated treatment between 1990 and 1994 and were followed-up for a maximum of 5 years. Factors controlled for include age, primary renal diagnosis, center size, and predialysis comorbid conditions. The mortality rate ratio (RR) for CAPD/CCPD relative to hemodialysis, as estimated by Poisson regression, was 0.73 (95% confidence interval: 0.68 to 0.78). No such relationship was found when an intent-to-treat Cox regression model was fit. Decreased covariable-adjusted mortality for CAPD/CCPD held within all subgroups defined by age and diabetes status, although the RRs increased with age and diabetes prevalence. The increased mortality on hemodialysis compared with CAPD/CCPD was concentrated in the first 2 years of follow-up. Although continuous peritoneal dialysis was associated with significantly lower mortality rates relative to hemodialysis after adjusting for known prognostic factors, the potential impact of unmeasured patient characteristics must be considered. Notwithstanding, we present evidence that CAPD/CCPD, a newer and less costly method of renal replacement therapy, is not associated with increased mortality rates relative to hemodialysis.

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Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies.

Daniela Chambrone, L. Chambrone, Débora Lima … (2010)

To systematically assess the factors influencing tooth loss during long-term periodontal maintenance (PM). CENTRAL, MEDLINE and EMBASE were searched up to and including September 2009. Studies limited to patients with periodontitis who underwent periodontal therapy and followed a maintenance care programme for the at least 5 years were eligible for inclusion in this review. Studies were considered for inclusion if they reported data on tooth loss during PM. The search strategy identified 527 potentially eligible articles, of which 13 retrospective case series were included in this review. The risk of bias assessment evaluated by the Newcastle-Ottawa scale showed that eight studies were considered of medium methodological quality and five of low methodological quality. Of 41,404 teeth present after active periodontal treatment, 3919 were lost during PM. The percentages of tooth loss due to periodontal reasons and of patients who did not experience tooth loss varied from 1.5% to 9.8% and 36.0% to 88.5%. Studies' individual outcomes showed that different patient-related factors (i.e. age and smoking) and tooth-related factors (tooth type and location, and the initial tooth prognosis) were associated with tooth loss during PM. The considerable heterogeneity found among studies did not allow definitive conclusions. Age, smoking and initial tooth prognosis were found to be associated with tooth loss during PM. Overall, patients must be instructed to follow periodic PM and quit smoking (smokers). Prospective cohort studies are required to confirm the possible predictors of tooth loss due to periodontal reasons. The allocation of patients into subgroups according to the type of periodontitis and smoking frequency will allow more accurate evaluations.

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Journal

Journal ID (nlm-ta): Int J Mol Sci

Journal ID (iso-abbrev): Int J Mol Sci

Journal ID (publisher-id): ijms

Title: International Journal of Molecular Sciences

Publisher: MDPI

ISSN (Electronic): 1422-0067

Publication date (Electronic): 03 August 2019

Publication date Collection: August 2019

Volume: 20

Issue: 15

Electronic Location Identifier: 3805

Affiliations

[1 ]Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan

[2 ]Department of Nephrology, Nagasaki University Hospital, Nagasaki 852-8501, Japan

[3 ]Division of Blood Purification, Nagasaki University Hospital, Nagasaki 852-8501, Japan

[4 ]Department of Respiratory Medicine, Unit of Basic Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8591, Japan

[5 ]Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan

Author notes

[* ]Correspondence: yasu-myt@ 123456nagasaki-u.ac.jp ; Tel.: +81-95-819-7340; Fax: +81-95-819-7343

Author information

Yasuyoshi Miyata https://orcid.org/0000-0001-6272-6657

Kojiro Ohba https://orcid.org/0000-0003-2841-1998

Atsutoshi Yoshimura https://orcid.org/0000-0002-5766-1286

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Publisher ID: ijms-20-03805

DOI: 10.3390/ijms20153805

PMC ID: 6695931

PubMed ID: 31382656

SO-VID: c45fafb5-b1f7-4ace-a9d6-7ee8e231e026

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Periodontal Disease in Patients Receiving Dialysis

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Biomarkers for Inflammatory Lung Disease

Most cited references 87

Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol.

Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates.

Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies.

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