A Randomized Controlled Trial of Intensive Periodontal Therapy on Metabolic and Inflammatory Markers in Patients With ESRD: Results of an Exploratory Study

Abstract

Background Periodontitis is a novel risk factor for inflammation and cardiovascular disease in the dialysis population. Limited information about the impact of periodontal therapy in patients receiving dialysis exists. Study Design Randomized, controlled trial to assess feasibility and gather preliminary data. Setting & Participants Dialysis patients with moderate/severe chronic periodontitis. Intervention Intensive treatment, consisting of scaling and root planing, extraction of hopeless teeth, and placement of local delivery antibiotics was performed at the baseline visit for treatment group patients and following study completion for control group patients. Outcomes Outcomes were feasibility (screening, recruitment, enrollment, adverse events and study withdrawal/completion), clinical periodontal parameters [probing depth (PD), clinical attachment level, bleeding on probing, gingival index (GI), and plaque index] and serum albumin and interleukin 6 levels at 3 and 6 months postintervention. Results A total of 342 dialysis patients were approached for participation: 53 were randomized, with 26 participants assigned to immediate treatment and 27 to a control arm for treatment after 6 months. 51 patients completed baseline appointments; 46 were available for 3 month follow up and 45 were available for 6 month follow up examinations. 43 participants completed all visits. At 3 months, there was a statistically significant improvement for the treatment group compared to the control group for 3 periodontal parameters: mean PD (p=0.008), extent PD ≥ 4 mm (p=0.02), and extent GI ≥1 (p=0.01). By 6 months, however, the difference between groups was no longer present for any variable except PD ≥ 4 mm (p=0.04). There was no significant difference between the groups for serum albumin or high-sensitivity interleukin 6 at any time point, when adjusted for body mass index, diabetic status, and plaque index. Limitations Small sample size and relatively healthy population. Imbalance in diabetes. Conclusions This small trial demonstrates successful cooperation between dentists and nephrologists and successful recruitment, treatment and retention of dialysis patients with periodontitis. Larger studies with longer follow up are needed to determine whether treatment can improve markers of inflammation and morbidity.

Periodontal Disease: A Covert Source of Inflammation in Chronic Kidney Disease Patients

“…The most recent study of Wehmeyer and coworkers, in 2013 [57], conducted an investigation on 53 ESRD patients (26 in the treatment group and 27 in the control group) with associated moderate and severe chronic periodontitis; intensive periodontal therapy was delivered and the following parameters were measured: clinical periodontal indices, serum albumin, and IL-6; at 3-month postintervention, there was a statistically significant improvement of the periodontal parameters for the treatment group, but at 6 months, the difference was no longer present; however, serum albumin and IL-6 showed no significant difference between groups, at any time, during the follow-up period.…”

The clinical response and systemic effects of non‐surgical periodontal therapy in end‐stage renal disease patients: a 6‐month randomized controlled clinical trial

“…, Siribamrungwong & Puangpanngam , Wehmeyer et al. , Yazdi et al. ) provide more direct evidence than other research methods, such as cross‐sectional surveys (Rahmati et al.…”

“…Some interventional studies have applied different therapies to reduce periodontal inflammation, such as extensive periodontal therapy, pocket‐reduction surgery or local administration of antibiotics (Siribamrungwong & Puangpanngam , Wehmeyer et al. ). Kadiroglu studied haematologic indices, C‐reactive protein (CRP) levels, and periodontal indices before and after periodontal therapy including oral hygiene instructions and scaling and root planing in 41 haemodialysis (HD) patients on recombinant human erythropoietin therapy.…”

Comparison of short-term efficacy of iron sucrose with those of ferric chloride in hemodialysis patients: An open-label study

“…Underlying disease, oxidative stress, chronic inflammatory state, obesity, immunological factors, membrane biocompatibility, and dialysate quality could have influenced our data in these patients. [31]…”