Periodontal Health of Pre-Dialysis Chronic Kidney Disease Patients in a Northeast Peninsular Malaysia Tertiary Hospital

Abstract

Introduction: Chronic kidney disease (CKD) is associated with periodontal disease due to its hyperinflammatory state. Limited studies have explored the prevalence of periodontal disease among CKD patients in Malaysia. Objective: To assess the periodontal status of pre-dialysis CKD patients in Hospital Universiti Sains Malaysia. Methods: A total of 46 pre-dialysis CKD patients who attended the nephrology clinic at Hospital Universiti Sains Malaysia were enrolled in this study. Periodontal examination was performed using the periodontal probing depth (PPD), clinical attachment loss (CAL) and plaque index. Results: The majority of the CKD patients were Malay (95.7%) and 80.4% were males. The mean age of the patients was 58.5 years. Using PPD measurement, 37 (74.0%) of the patients had mild periodontitis, 9 (20.0%) had moderate periodontitis and 3 (6.0%) had no periodontitis. Based on CAL measurement, 12 (26%) patients had mild periodontitis, 29 (63.0%) had moderate periodontitis and 5 (11%) had severe periodontitis. The mean (standard deviation [SD]) value of mild and moderate-to-severe periodontitis by PPD measurement were 4.26 (0.26) and 5.24 (0.36), respectively. The mean of mild and moderate-to-severe periodontitis by CAL measurement were 2.66 (0.62) and 4.98 (0.73), respectively. There was no correlation between the periodontal parameters and estimated glomerular filtration rate (PPD: r = −0.160, P = 0.914; CAL: r = −0.135, P = 0.372; plaque index: r = 0.005, P = 0.974). Conclusion: This study revealed a greater prevalence and severity of chronic periodontitis among CKD patients. Thus, the periodontal health of CKD patients' needs to be screened and monitored.

Severity of Periodontal Disease in Chronic Kidney Disease Patients: A Hospital-Based Study

“…In contrast to our findings, Ibrahim et al [ 23 ] reported no correlation between PI in healthy and pre-dialytic CKD groups as the sample size was small and the focus was only on one group (i.e., pre-dialysis). Further, no difference in PI between end-stage renal disease (ESRD) patients and control was seen.…”

“…Significantly higher plaque scores were noted among the CKD patients of the study compared with healthy controls, which has been reported by previous studies [ 3 , 9 , 22 ] The association of poor oral hygiene with CKD may be linked to the consumption of antidiuretic drugs, which may impair salivary flow, thus reducing lubrication in the oral cavity and further promoting plaque accumulation [ 23 ]. In addition, oral healthcare practice was insufficient, which may, in turn, worsen the oral hygiene of these patients [ 24 ].…”

“…On the contrary, Bots et al, in their study on ESRD patients receiving hemodialysis, observed that their periodontal status showed no increase in periodontal indices [ 26 ]. It was also found that the moderate and severe GI parameters were least observed in dialysis patients [ 23 ]. Kerr et al suggested that the uremic state in hemodialysis patients may suppress inflammatory reactions in the tissues, which would result in infrequent detection of gingival inflammation [ 27 ].…”

“…Regarding CAL, our study showed increased attachment loss in the CKD group. Several studies have indicated periodontal destruction measured by CAL to be higher among patients on maintenance dialysis therapy [ 3 , 10 , 23 , 25 , 28 ].…”

Relação Entre Doenças Sistêmicas E Manifestações Periodontais: Um Enfoque Em Grupos De Risco Da Covid-19 / Relationship Between Systemic Diseases and Periodontal Manifestations: A Focus on Covid-19 Risk Groups

“…Em concordânia com o que foi apresentado, Ibrahim (37) relaciona os achados de problemas periodontais em pacientes submetidos a tratamentos renais ao uso de drogas antidiuréticas que reduzem o fluxo salivar, de modo a impedir a correta lubrificação da cavidade oral, provocando o acúmulo de placa. Ademais, a falta de assistência e instrução em saúde bucal e a situação de vulnerabilidade dos pacientes também corroboram significativamente para o quadro.…”