The directional and non‐directional associations of periodontitis with chronic kidney disease: A systematic review and meta‐analysis of observational studies

Abstract

This systematic review aimed to assess the current evidence on the directional and non-directional associations of periodontitis with chronic kidney disease (CKD). Electronic search for observational studies on the association of periodontitis with CKD was performed in MEDLINE, EMBASE, PubMed, Open GREY and Cochrane library up to June 5, 2017. Two reviewers conducted study selection, data collection and assessment of methodological quality using the original and modified Newcastle-Ottawa Scale. Cohort, case-control and cross-sectional studies were included, which clearly defined periodontitis and CKD or reported acceptable clinical parameters of these 2 diseases in adults. Meta-analysis was employed to estimate the pooled odds ratio on the non-directional association and the incidence rate ratio (IRR) for the directional association. Among 2530 potential eligible articles, 47 were finally included. Most of them investigated a non-directional association of periodontitis with CKD, including 7 case-control studies and 38 cross-sectional studies; 24 studies had statistical analysis on the non-directional association and 75% of them reported significant results, which were supported further by the meta-analysis (random: odds ratio = 2.12, P < .001; χ = 25.74, I = 88.3%). None of the studies focused on the directional association of CKD (as the exposure) with periodontitis (as the outcome), whereas 2 retrospective cohort studies explored a directional association of periodontitis (as the exposure) with CKD (as the outcome) (random: IRR=2.10, P > .05; fixed: IRR=1.76, P < .05; χ = 4.65, I = 78.3%). Overall, the high heterogeneity of studies limits the significance of these results. There is substantial evidence on the non-directional association of periodontitis with CKD, while there are limited studies on the directional association. Well-designed prospective studies with longer follow-ups in representative communities are needed to clarify the directional association and enhance the quality of the evidence on this topic.

Could drug burden be associated with severe periodontitis in patients receiving haemodialysis?

“…; Zhao et al . ). These two conditions which have significant interactions with each other may facilitate the development of CVD in this patient population.…”

“…Periodontitis is also a common problem in patients with CKD (Akar et al 2011;Tiwari et al 2013) and it is thought that CKD and periodontitis could affect the course of each other. While periodontitis could facilitate the development of chronic inflammation in this patient population (Wasserman et al 2003), CKD could mechanistically influence the onset and/or progression of periodontal disease, possibly mediated by systemic risk factors including diabetes and hypertension and local risk factors such as xerostomia (Le Gall et al 2016;Zhao et al 2018). These two conditions which have significant interactions with each other may facilitate the development of CVD in this patient population.…”

“…; Zhao et al . ). Although several factors have been defined in the development of inflammation, the exact mechanism is not entirely understood.…”

“…Chronic inflammation, which increases morbidity and mortality by triggering cardiovascular diseases (CVDs), is a prominent problem in patients with chronic kidney disease (CKD) (Kerr et al 2013;Zhao et al 2018). Although several factors have been defined in the development of inflammation, the exact mechanism is not entirely understood.…”

Association between severe periodontitis and chronic kidney disease severity in predialytic patients: A cross‐sectional study

“…More recently, a large population‐based study did not corroborate the initial observations (Shin, ). Although a recent systematic review observed a robust body of evidence on the non‐directional association of periodontitis and CKD, studies reporting directional associations are still scarce (Zhao et al, ). It is important to highlight that the current literature presents some limitations including secondary analysis of subgroups, partial‐mouth protocols of periodontal examinations, case definition of periodontal disease and lack of a better description of medical status study participants.…”