Patient-related factors that link chronic kidney disease and periodontitis: a meta-analysis and scoping review

Abstract

Abstract Background Several studies proposed an association between periodontal and chronic kidney disease (CKD) based on biological assumptions. Growing evidence indicates that chronic inflammation caused by periodontitis may contribute to the advancement of chronic kidney disease. This study aims to investigate the studies that link CKD and periodontitis, including periodontitis proxies such as oral hygiene and tooth loss, and patient-related factors like inflammatory response and genetic polymorphisms. It also provides a meta-analysis of the case-control and cohort studies and a narrative from a public health perspective about strategies to improve the management of both conditions. Materials and Methods An electronic search was conducted on the MEDLINE (PubMed) database using advanced search option. After reviewing the articles, a total of 32 studies were included in the synthesis in three groups as interventional, case-control, and cohort studies. A meta-analysis was conducted on studies that reported the diagnosis of periodontal disease and chronic kidney disease according to the diagnostic criteria and provided measurable outcomes. Results A total of thirty-two studies were included in the synthesis. Of which, four studies were interventional and sixteen were cohort studies. Twelve studies had a case-control design. A total of 9 case-control or cohort studies matched the inclusion criteria for the meta-analysis. There was a high heterogeneity among results (I2 statistic, 91%) and effect size was borderline significant (random effects model, OR 1.99 95% CI [1.01; 3.91]). Overall, periodontitis prevalence was significantly higher in study participants with CKD, periodontal disease diagnosis was associated with an increase in the risk of incident CKD, periodontal disease parameters were negatively correlated with kidney function, Conclusions Current evidence indicate a possible association between chronic kidney disease and periodontitis and supports future longitudinal studies to investigate the bidirectional effect, causality, and pathophysiology.