ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title A Positive Association Between Periodontal Disease and Chronic Kidney Disease is Evident, But Periodontal Treatment Effects Unknown
Clinical Question In patients with chronic kidney disease, does periodontal treatment improve kidney function (estimated glomerular filtration rate (eGFR))?
Clinical Bottom Line Periodontal disease and chronic kidney disease share similar risk factors (smoking, impaired wound healing, diabetes mellitus, malnutrition, and poor oral hygiene) and a positive association between the two diseases has been shown. Intervention studies offer limited and inconsistent evidence for improvement following periodontal treatment in patients with CKD and periodontitis. No adverse outcomes were seen in patients that received periodontal treatment.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23432795Chambrone/2013Chronic kidney disease (CKD) and periodontitis.Systematic review of non-randomized trials
Key results80% of studies showed an association between chronic kidney disease and periodontal disease. A meta-analysis of four of five studies showed a degree of association between CKD and periodontitis to be OR=1.65. Two interventional studies reported eGFRs following periodontal treatment, with one showing a slight increase and the other a slight decrease.
Evidence Search systematic[sb] AND (("periodontal diseases"[MeSH Terms] OR ("periodontal"[All Fields] AND "diseases"[All Fields]) OR "periodontal diseases"[All Fields] OR ("periodontal"[All Fields] AND "disease"[All Fields]) OR "periodontal disease"[All Fields]) AND ("kidney diseases"[MeSH Terms] OR ("kidney"[All Fields] AND "diseases"[All Fields]) OR "kidney diseases"[All Fields] OR ("kidney"[All Fields] AND "disease"[All Fields]) OR "kidney disease"[All Fields]))
Comments on
The Evidence
Validity: Due to heterogeneity and a limited number of studies evaluating the effect of periodontal treatment on eGFR, no meta-analyses were performed evaluating a treatment effect. No randomized clinical trials were included in this systematic review. The three interventional studies included in this review had limited sample sizes (19, 40, and 62) and a resultant eGFR was reported in two of these studies, with one showing a slight increase and the other a slight decrease. The third study failed to report eGFR following treatment. No adverse effects or complications following periodontal treatment were reported in any interventional trial. This is the only systematic review that has evaluated the association of periodontal disease and chronic kidney disease and the effects of periodontal treatment on eGFR. Perspective: While there appears to be an association between these two clinical conditions, the evidence for periodontal disease to affect kidney function is lacking at this time. Existing clinical trials are limited in design, and while this systematic review did assess study quality, it was not incorporated into their outcomes.
Applicability This systematic review shows that patients with CKD may have an increased level of periodontal disease, but any benefits from non-surgical periodontal treatment remain to be determined.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Periodontal disease, chronic kidney disease, periodontal therapy
ID# 2938
Date of submission: 10/14/2015spacer
E-mail ringdahl@livemail.uthscsa.edu
Author Sarah Ringdahl, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD
Faculty mentor/Co-author e-mail OATES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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