Effect of Non-Surgical Periodontal Therapy on Chronic Kidney Disease Patients: A Systematic Review

Oza, Ranu; Sharma, Varsha; Khatib, Mahalaqua Nazli; Dhadse, Prasad; Bajaj, Pavan; Ganji, Kiran Kumar; Issrani, Rakhi; Salloum, Mahmoud Gamal; Alonazi, Meshal Abeer

doi:10.1590/pboci.2024.033

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Pesquisa Brasileira em Odontopediatria e Clínica Integrada

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SYSTEMATIC REVIEW • Pesqui. Bras. Odontopediatria Clín. Integr. 24 • 2024 • https://doi.org/10.1590/pboci.2024.033 copy

Effect of Non-Surgical Periodontal Therapy on Chronic Kidney Disease Patients: A Systematic Review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the effectiveness of “non-surgical periodontal therapy (NSPT)” on periodontal and renal parameters in periodontitis patients diagnosed with chronic kidney disease.

Material and Methods:

The review protocol has been registered in Prospero (CRD42020150938). Up to November 2019, we searched the PUBMED database without language constraints. We included randomized controlled (parallel-group or cross-over) trials with CKD and chronic periodontitis in adults aged 18 years and above. Three review authors independently assessed the studies. Three review writers gathered data and simultaneously assessed the risk of bias for individual trials using traditional Cochrane procedures.

Results:

Studies showed high variability. Three randomized clinical trials (RCT) were excluded because of high heterogeneity; meta-analysis could not be performed.

Conclusion:

Non-surgical periodontal therapy effectively improves periodontal and renal parameters. However, a meta-analysis could not be performed because of the high heterogeneity among the studies.

Keywords:
Kidney Diseases; Periodontitis; Therapeutics

Variables	Categories	Artese et al. [¹⁷17 Artese HPC, de Sousa CO, Luiz RR, Sansone C, Torres MCM de B. Effect of non-surgical periodontal treatment on chronic kidney disease patients. Braz Oral Res 2010; 24(4):449-454. https://doi.org/10.1590/S1806-83242010000400013 https://doi.org/10.1590/S1806-8324201000... ]	Fang et al. [¹⁶16 Fang S, Wang Y, Sui D, Liu H, Ross MI, Gershenwald JE, et al. C-reactive protein as a marker of melanoma progression. J Clin Oncol 2015; 33(12):1389-1396. https://doi.org/10.1200/JCO.2014.58.0209 https://doi.org/10.1200/JCO.2014.58.0209... ]	Graziani et al. [²⁰20 Graziani F, Cei S, La Ferla F, Vano M, Gabriele M, Tonetti M. Effects of non-surgical periodontal therapy on the glomerular filtration rate of the kidney: An exploratory trial. J Clin Periodontol 2010; 37(7):638-643. https://doi.org/10.1111/j.1600-051X.2010.01578.x https://doi.org/10.1111/j.1600-051X.2010... ]	Artese et al. [²2 Artese HPC, de Sousa CO, Torres MCM de B, Silva-Boghossian CM, Colombo PV. Effect of non-surgical periodontal treatment on the subgingival microbiota of patients with chronic kidney disease. Braz Oral Res 2012; 26(4):366-372. https://doi.org/10.1590/S1806-83242012005000008 https://doi.org/10.1590/S1806-8324201200... ]	Jamieson et al. [¹⁹19 Jamieson L, Skilton M, Maple-Brown L, Kapellas K, Askie L, Hughes J, et al. Periodontal disease and chronic kidney disease among Aboriginal adults; An RCT. BMC Nephrol 2015; 16(1):1-8. https://doi.org/10.1186/s12882-015-0169-3 https://doi.org/10.1186/s12882-015-0169-... ]	Grubbs et al. [¹⁸18 Grubbs V, Garcia F, Jue BL, Vittinghoff E, Ryder M, Lovett D, et al. The Kidney and Periodontal Disease (KAPD) study: A pilot randomized controlled trial testing the effect of non-surgical periodontal therapy on chronic kidney disease. Contemp Clin Trials 2017; 53:143-150. https://doi.org/10.1016/j.cct.2016.12.017 https://doi.org/10.1016/j.cct.2016.12.01... ]
Demographics	Country	Brazil	China	Switzerland	Colombo	Adelide, Australia	USA
	Type of Study	RCT	RCT	Exploratory trial	RCT	RCT protocol	RCT
	Number of Groups	G1: 21 predialysis patients G2: 19 with chronic periodontitis with no history of CKD	Intervention=48 Control=49	Intervention =20 NA	Intervention=16 CKD Patients Control=14 systemically healthy	Intervention=300 Control=300	Intervention=34 Control=17
Participation Details	Age	36-76 years	55-60 years	35-75 years	35-76 years	18+	34-73 years
	Gender (M/F)	NR	NR	Exploratory trial	9 females in IG and 10 in CG	NR
	Type of periodontal disease	Chronic periodontitis	Chronic periodontitis	Generalized Chronic periodontitis	Chronic periodontitis	Periodontal disease	Chronic periodontitis
	Grade of chronic kidney disease	Grade 1 GFR-89-15ml/min	ESRD	Systemically healthy	Grade 1 GFR between 89-15 ml/l	Grade 3-5	Grade 1
Intervention	Type	SCRP + oral hygiene instructions	SCRP + oral hygiene instructions	SCRP	SCRP + oral hygiene instructions	SCRP + oral hygiene instructions	SCRP
	Duration	3 months	36 months	6 months	11 months	24 months	12 months
	Frequency	Baseline, 3 months	Baseline, 6 weeks,3 months,6 months	BL, 1 day, 7 days, 30 days, 90 days, 180 days	Baseline, 3 months	Baseline, 3 months, 6 months	BL, 4 months, 8 months, 12 months
Outcomes	Parameters	Primary - PI, CI, CAL, BOP, SUP	Primary: PI, PPD, BOP, GR, CAL. Secondary: tnfalfa.IL-6, CRP, ferritin, Alb, BUN, Cr, ALC	Positive with respect to periodontal parameters.	Primary: microbiological assessment, secondary: PPD, CAL, VP, BOP, SUP	Primary: change in carotid intima-media thickness secondary: progression of CKD	Accepted manuscript
	Technique/Definition	CAL>4mm and BOP, secondary - GFR, serum creatinine.	>1mm CAL as per AAP, 16 teeth, third molars excluded	Statistically significant improvement in periodontal parameters only	15 teeth,>4sites,3 different teeth CAL>4mm	Dialysis; egfr levels of <60 ml/min/1.73 m2 (CKD
	Time of reporting	3 months Both groups responded well, contrary to the original hypothesis.	6 months - (IG- 6 weeks- 48, 3 months - 48 , 6 months - 46) (CG- 6weeks - 48, 3months - 48, 6 months - 46)	6 months - (1 day, 7 day, 30 days, 90 days, 120 days - 19)	3 months -(IG- 9, CG-10)	Stages 3 to 5); iii. ACR ≥30 mg/mmol irrespective of Egfr (CKD Stages 1 and 2); iv. Diabetes plus albuminuria

Outcomes Parameters	Artese et al. [¹⁷17 Artese HPC, de Sousa CO, Luiz RR, Sansone C, Torres MCM de B. Effect of non-surgical periodontal treatment on chronic kidney disease patients. Braz Oral Res 2010; 24(4):449-454. https://doi.org/10.1590/S1806-83242010000400013 https://doi.org/10.1590/S1806-8324201000... ]		Fang et al. [¹⁶16 Fang S, Wang Y, Sui D, Liu H, Ross MI, Gershenwald JE, et al. C-reactive protein as a marker of melanoma progression. J Clin Oncol 2015; 33(12):1389-1396. https://doi.org/10.1200/JCO.2014.58.0209 https://doi.org/10.1200/JCO.2014.58.0209... ]		Artese et al. [²2 Artese HPC, de Sousa CO, Torres MCM de B, Silva-Boghossian CM, Colombo PV. Effect of non-surgical periodontal treatment on the subgingival microbiota of patients with chronic kidney disease. Braz Oral Res 2012; 26(4):366-372. https://doi.org/10.1590/S1806-83242012005000008 https://doi.org/10.1590/S1806-8324201200... ]
Outcomes Parameters	Mean of Intervention + SD	Mean of Control + SD	Change from Baseline in IG	Change from Baseline in CG	Mean of Intervention + SD	Mean of Control + SD
PPD	Pre SCRP: 29.9+12.6	Pre SCRP: 23.3+15.8	1.53+0.13	0.08+0.11	BI: 4.5+0.2	BI: 4.5+0.4
	Post SCRP: 1.3+2.8	Post SCRP: -0.6+1.3			3 months: 1.8+0.2	3 months: 1.7+0.2
BOP	Pre SCRP: 60.4+16.4	Pre SCRP: 58.3+14.9	27.31+5.94	10.80+3.89	BI l: 77.8+5.2	BI: 67.4+6.3
	Post SCRP: 46.2+15.4	Post SCRP: 38.5+11.6			3 months: 58.3+6.6	3 months: 53.5+4.9
CAL	Pre SCRP: 33.2+14.4	Pre SCRP: 25.4+17.0	0.35	0.01	BI: 5.3+0.4	BI: 5.3+0.4
	Post SCRP: 4.2+9.1	Post SCRP: 1.6+2.9			3 months:4.3+0.4	3 months: 4.1+0.3”

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[1] Corresponding author: Kiran Kumar Ganji E-mail: kiranperio@gmail.com