Oxidative stress links periodontal inflammation and renal function

Abstract

Aims Patients with chronic kidney disease (CKD) are also susceptible to periodontitis. The causal link between periodontitis and CKD may be mediated via systemic inflammation/oxidative stress. Using structural equation modelling (SEM), this cross‐sectional study aimed to explore the causal relationship between periodontal inflammation (PI) and renal function. Materials and methods Baseline data on 770 patients with stage 3–5 (pre‐dialysis) CKD from an ongoing cohort study were used. Detailed, bioclinical data on PI and renal function, as well as potential confounders and mediators of the relationship between the two, were collected. SEMs of increasing complexity were created to test the causal assumption that PI affects renal function and vice versa. Results Structural equation modelling confirmed the assumption that PI and renal function are causally linked, mediated by systemic oxidative stress. The magnitude of this effect was such that a 10% increase in PI resulted in a 3.0% decrease in renal function and a 10% decrease in renal function resulted in a 25% increase in PI. Conclusions Periodontal inflammation represents an occult source of oxidative stress in patients with CKD. Further clinical studies are needed to confirm whether periodontal therapy, as a non‐pharmacological approach to reducing systemic inflammatory/oxidative stress burden, can improve outcomes in CKD.

Natural Bioactive Compounds in the Management of Oral Diseases in Nephropathic Patients

“…An interesting study conducted on 359 CKD patients highlighted how non-surgical periodontal treatment induced a reduction in systemic inflammation, monitored by pro-inflammatory cytokines [58]. Therefore, it is hypothesized that the treatment of CPD in CKD patients may have a positive effect on oxidative stress (OS) and on systemic inflammatory state [16,59]. These last represent prognostic factors associated with more sudden worsening of residual renal function [60].…”

“…Therefore, it is plausible to hypothesize that CPD may represent an important risk factor for the onset and the progression of CKD [58]. Furthermore, the mortality rate of CKD patients seems to be profoundly increased in the presence of periodontitis [16].…”

“…The oral diseases and CKD seem to be connected to each other in a mutual cause-effect relationship, in which the presence of one induces the onset and progression of the other [14,15]. Recent epidemiological studies suggest that CKD patients appear to be more predisposed to oral diseases compared to the general population [16,17]. However, the mechanisms underlying this relationship are still poorly studied and the available data need to be confirmed by larger randomized clinical trials.…”

The Advent of COVID-19; Periodontal Research Has Identified Therapeutic Targets for Severe Respiratory Disease; an Example of Parallel Biomedical Research Agendas

“…This said, these two concepts are not mutually exclusive, and therefore we must emphasize that both putative mechanisms could be involved in those associations, as demonstrated by studies that show bidirectionality of association. For instance, early epidemiological studies have demonstrated the bidirectional adverse interrelationship between an altered host inflammatory response in PD and the metabolic imbalance in diabetes (37) while more recently, a causal association was demonstrated between periodontitis and chronic kidney diseases mediated via oxidative stress (38), which seems highly relevant to this argument. We also point out that oxidative stress is a key element of PMN hyperfunctionality related to overproduction of ROS and downregulation of endogenous antioxidants such as NrF2 mediated expression of superoxide dismutase (39).…”

TNF-α, IL-1β, MMP-8 Crevicular Profile in Patients with Chronic Kidney Disease and Periodontitis

“…Sci. 2022, 12, 736 2 of 14 the cytokine and chemokine family, that control leucocytes and monocytes chemotaxis towards the kidney damaged site [5,6]. On the other hand, CKD is associated with a poor immune status, determined either by the diseases that cause kidney failure (for example, diabetes mellitus and cardiovascular disorders), or uremia, or as a consequence of specific therapy (dialysis or transplant).…”