Effects of Periodontal Treatment in Patients with Periodontitis and Kidney Failure: A Pilot Study

Abstract

Periodontitis and chronic kidney disease are both chronic inflammatory diseases and share some common risk factors. This 3-month pilot study aimed to clarify whether non-surgical periodontal therapy is beneficial in clinical, biochemical, and microbiological conditions in patients with periodontitis and kidney failure. Kidney failure patients with moderate to severe periodontitis were recruited from two hospitals. Treatment group received non-surgical periodontal therapy, and control group received oral hygiene instruction only. Outcome assessments were conducted 1 and 3 months after treatment. Non-parametric tests were used to analyze the patient-level data. Periodontal site-level assessments were analyzed by Student t-test and paired t-test. Statistical significance was set at p-value < 0.05. A total of 11 subjects completed the study. There was no significant difference between groups in all-cause mortality, cardiovascular events, infection events, systemic parameters, and serum biomarkers. Comparing to control group, clinical periodontal parameters, gingival crevicular fluid interleukin-1β (IL-1β) level and periodontal pathogens showed significant improvement in the treatment group. Non-surgical periodontal treatment did not change systemic outcomes in kidney failure patients, but changed the local micro-environment.

Keywords: kidney failure; non-surgical periodontal treatment; renal dialysis.

Figure 1

Flow-chart.

Figure 2

Change of biomarkers level in gingival crevicular fluid (GCF) and serum. *: p-value < 0.05.

Figure 3

Change of periodontal parameters by site-level analysis. **: p-value < 0.003; ***: p-value < 0.001.

Figure 4

Subgingival microbial diversity. (a) Comparison of the α-diversity between the microbiota of the treatment and control group patients. We used the four indices to represent the α-diversity (the observed, Chao, Shannon, Simpson index). (b) Principal coordinate analysis. It showed the grouping patterns of the microbiota between the post-treatment and post self-care patients based on the GUniFrac distances, which showed a significant difference between groups (ADONIS analysis, p = 0.006). (Each closed circle represents a sample. Distances between any pair of samples represent their dissimilarities.) (c) Significantly discriminative taxa between groups were determined using the Linear Discriminant Analysis (LDA) Effect Size. (d) LDA shows the taxa meeting the thresholds (>3). (Different colored regions represent different groups. From the interior to the exterior, each layer represents the phylum, class, order, family, and genus level).

Figure 4

Subgingival microbial diversity. (a) Comparison of the α-diversity between the microbiota of the treatment and control group patients. We used the four indices to represent the α-diversity (the observed, Chao, Shannon, Simpson index). (b) Principal coordinate analysis. It showed the grouping patterns of the microbiota between the post-treatment and post self-care patients based on the GUniFrac distances, which showed a significant difference between groups (ADONIS analysis, p = 0.006). (Each closed circle represents a sample. Distances between any pair of samples represent their dissimilarities.) (c) Significantly discriminative taxa between groups were determined using the Linear Discriminant Analysis (LDA) Effect Size. (d) LDA shows the taxa meeting the thresholds (>3). (Different colored regions represent different groups. From the interior to the exterior, each layer represents the phylum, class, order, family, and genus level).

Figure 4

Subgingival microbial diversity. (a) Comparison of the α-diversity between the microbiota of the treatment and control group patients. We used the four indices to represent the α-diversity (the observed, Chao, Shannon, Simpson index). (b) Principal coordinate analysis. It showed the grouping patterns of the microbiota between the post-treatment and post self-care patients based on the GUniFrac distances, which showed a significant difference between groups (ADONIS analysis, p = 0.006). (Each closed circle represents a sample. Distances between any pair of samples represent their dissimilarities.) (c) Significantly discriminative taxa between groups were determined using the Linear Discriminant Analysis (LDA) Effect Size. (d) LDA shows the taxa meeting the thresholds (>3). (Different colored regions represent different groups. From the interior to the exterior, each layer represents the phylum, class, order, family, and genus level).