Effects of non-surgical periodontal therapy on serum inflammatory factor high-sensitive C-reactive protein, periodontal parameters and renal biomarkers in patients with chronic periodontitis and chronic kidney disease

Abstract

Background: Chronic kidney disease (CKD) is associated with significant morbidity and mortality, and there are various risk factors for this disease. Although the association between CKD and periodontal disease (PD) has been reported in various cross-sectional studies, longitudinal intervention studies are scarce.

Objectives: This study aimed to evaluate the effects of non-surgical periodontal therapy (NSPT) on periodontal clinical parameters, serum inflammatory factor high-sensitivity C-reactive protein (hs-CRP) and renal biomarkers in patients with CKD and chronic periodontitis (CP).

Material and methods: A total of 80 patients with confirmed CKD aged 22-65 years, attending the Institute of Kidney Diseases Research Centre (IKDRC) in Ahmedabad, India, and referred to the Government Dental College and Hospital, Ahmedabad (GDCHA), were enrolled in this study. The patients were divided into 2 groups: group 1 received NSPT, including scaling and root planing (SRP), as well as oral hygiene instructions; and group 2 received oral hygiene instructions without NSPT. Periodontal clinical parameters, such as probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BoP), the periodontal inflamed surface area (PISA) score, and the Simplified Oral Hygiene Index (OHI-S), were recorded. Biomarkers, including hs-CRP, the estimated glomerular filtration rate (eGFR) and the urine albumin-to-creatinine ratio (UACR), were obtained from medical records. The comparisons of periodontal parameters, hs‑CRP and renal biomarkers within and between the groups were performed at baseline, and 3 and 6 months after treatment.

Results: The periodontal parameter scores as well as the serum levels of hs‑CRP and UACR significantly decreased while eGFR significantly increased in group 1 after treatment as compared to baseline (p < 0.001). Six months after treatment, group 1 showed significantly lower values than group 2 for periodontal parameters, the serum levels of hs‑CRP and renal biomarkers except for eGFR, which improved and increased (p < 0.001).

Conclusions: Periodontitis is an important source of chronic inflammation and the treatment of periodontitis can hinder systemic inflammation in CKD patients. Non-surgical periodontal therapy resulted in improved periodontal health, with significant decreases in hs‑CRP and UACR, and an increase in eGFR in CKD patients with CP in comparison with CKD patients not receiving NSPT.

Keywords: chronic renal insufficiency; glomerular filtration rate; periodontal disease; urine albumin-tocreatinine ratio.