Relationship Between Periodontal Disease and Serum Factors in Patients Undergoing Hemodialysis

Abstract

Background:Chronic renal disease is a common condition with several recognized risk factors. Periodontal disease is a recently suggested risk factor for renal disease. We aimed to assess the relationship between periodontal disease and several serum factors in patients undergoing hemodialysis.Methods:This descriptive cross-sectional study was conducted on 57 patients undergoing hemodialysis. Periodontal examination was done by measuring the mean Pocket Depth (PD), Silness-Löe Plaque Index (PI), Ainamo and Bay Bleeding On Probing (BOP), Löe and Silness Gingival Index (GI) and Clinical Attachment Loss (CAL). Serum levels of albumin, calcium, phosphorus, hemoglobin, ferritin and creatinine were measured via a routine blood test. Cystatin C was separately measured. Data were analyzed using independent t-test, Pearson’s correlation coefficient, chi square test and Mann Whitney test (alpha=0.05).Results:37 men and 20 women were evaluated. Of these, 26.3% had periodontitis and 73.7% had gingivitis. Serum level of albumin (P=0.02) and ferritin (P=0.043) in patients with periodontitis was significantly higher than that in patients with gingivitis. The serum level of creatinine (P=0.02), cystatin C (P=0.013), calcium (P=0.046) and phosphorus (P=0.037) had a significant correlation with severity of periodontitis and increase in CAL.Conclusion:Increase in the serum levels of albumin and ferritin was related to the progression of gingivitis to periodontitis. Also, the serum levels of creatinine, cystatin C, calcium and phosphorus increased with an increase in CAL.

Periodontal Disease in Patients Receiving Dialysis

“…As shown in Table 3, to our knowledge, all reports that have investigated changes in serum calcium levels by periodontitis in HD patients showed no significant difference [10,13,36,48]. In contrast, a cross-sectional study reported that higher calcium intake (584.5–1478.5 mg/day) was inversely associated with probing pocket depth (PPD) > 4 mm (adjusted odds ratio; 0.53, 95% CI; 0.30–0.94, p = 0.03) compared to a lower intake group (230.7–393.4 mg/day) [50].…”

“…Regarding phosphorus in HD patients, the mean/SD serum levels in healthy/gingivitis patients (5.87/1.59 mg/dL) showed a trend towards being higher than in moderate/severe periodontitis (5.29/1.68 mg/dL) patients; however, this difference did not reach statistical significance ( p = 0.084) [10]. In addition, several investigators have shown that serum phosphorus levels in periodontal disease are not significantly different compared to non-gingivitis groups [36,48]. However, in contrast to these results, other investigators showed that serum phosphorus levels in HD patients with periodontitis (mean/SD; 5.02/1.19 mg/dL) were significantly lower ( p = 0.024) than in patients without periodontitis (6.25/1.72 mg/dL) [13].…”

“…However, in contrast to these results, other investigators showed that serum phosphorus levels in HD patients with periodontitis (mean/SD; 5.02/1.19 mg/dL) were significantly lower ( p = 0.024) than in patients without periodontitis (6.25/1.72 mg/dL) [13]. In addition, serum phosphorus levels have been reported to be positively correlated with clinical attachment loss (CAL; r = 0.47, p = 0.037) [48]. However, the above study also showed that serum phosphorus levels were not associated with other periodontal parameters, such as PD, PI, GI, or bleeding on probing [48].…”

“…In addition, serum phosphorus levels have been reported to be positively correlated with clinical attachment loss (CAL; r = 0.47, p = 0.037) [48]. However, the above study also showed that serum phosphorus levels were not associated with other periodontal parameters, such as PD, PI, GI, or bleeding on probing [48]. Conversely, serum phosphorus levels in patients with untreated chronic periodontitis (6.1/1.2 mg/dL) have been reported to be similar ( p = 0.221) to those of treated patients (6.5/1.2 mg/dL) [37].…”

Impact of Periodontal Inflammation on Nutrition and Inflammation Markers in Hemodialysis Patients

“…In hemodialysis patients, several negative alterations lead to the progression of MICS [13], which represents the most common cause of death in this population. The patients undergoing hemodialysis are more prone to developing an inflammatory status as well as a state of malnutrition due to multiple factors, which range from the bioincompatibility between blood and dialyzer to the presence of endotoxins in dialysis fluid and access-related infections [14], and emerging non-traditional risk factors [15][16][17][18][19], including exposure to general inflammation [20]. Periodontitis potentially activates inflammatory cells and triggers inflammatory signaling pathways, promoting a low-grade systemic inflammatory status that could compromise clinical outcomes in patients undergoing hemodialysis [21][22][23].…”