Periodontal Disease in Patients Receiving Dialysis

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.

Salivary microbiome in patients undergoing hemodialysis and its associations with the duration of the dialysis

“…Periodontitis has been identified as a novel risk factor for morbidity and mortality in patients undergoing long-term hemodialysis treatment [ 32 – 35 ]. Moreover, nonsurgical periodontal treatment, as a relatively simple intervention, has beneficial impact on periodontal status, circulating inflammatory markers and nutritional status in ESRD patients [ 36 – 38 ] that underlines the importance of oral health and efficient periodontal treatment to maintain prolong survival and quality of life in these patients. However, very few patients have regular dental care [ 39 , 40 ] suggesting that more effort should be paid to provide reasonable clinical guideline for dental treatment [ 41 ] and to improve the oral health status of this population.…”

Periodontal disease and systemic health

“…gingivitis is a reversible inflammatory condition due to dental plaque accumulation, affecting approximately 50% of the adult population. It is characterized by an initial increase in blood flow, increased vascular permeability and an influx of cells (polymorphonucleated leukocytes (PMns) and macrophages) from the peripheral blood to the periodontal connective tissue (1)(2)(3).…”

“…there are a number of systemic factors that can contribute to the progression of periodontal diseases such as heredity, nervous system disorders (psychicstress), endocrine imbalances (diabetes), immune deficiencies, cardiovascular, hematological, hepatic, renal diseases and nutrition deficient (2,11).…”

Quality of life and periodontal health of patients submitted to hemodialysis

“…When approximately 10% decrease in normal renal function occurs, kidney replacement therapy is necessary to maintain patient survival. Therefore, hemodialysis therapy is one of the techniques capable of performing this replacement by removing excess fluid, electrolytes and uremic toxins through a dialysis membrane [5].…”

“…In addition to altered physiological conditions, the impairment of daily activities in these patients is notorious, which causes psychological discomfort and becomes an aggravating factor in their quality of life, which has a direct link to health [10]. Widespread poor hygiene and high rates of periodontitis are directly linked to this fact and become a major factor in contributing to such conditions [5].…”