UCSF

ABSTRACT

Introduction: It has been suggested in the literature that a bidirectional relationship exists between periodontal disease and Chronic Kidney Disease (CKD), which in turn, modifies the host’s ability to manage and respond to punitive periodontal pathogens. The objective of this study was to determine if there is a difference in periodontal outcomes between non-surgically treated CKD patients with periodontal disease and those with the disease who did not obtain treatment.

Materials and Methods: This is an un-blinded, randomized, controlled pilot trial with two intent-to-treat treatment arms: intensive intervention (INT) group, which obtained non-surgical periodontal treatment with local delivery of Arestin at baseline and at four months, and the community treatment (CT) group, which did not receive periodontal intervention until the end of the study. All subjects had a history of periodontal disease and identified as having compromised renal function if they presented with at least two estimated glomerular filtration (eGFR) rate measurements of 15-59 mL/min/1.73 m within the preceding 12 months.

Results: 12 subjects from the San Francisco General Hospital Renal Clinic have completed the study. All sites within the treatment intervention group showed that there were significant changes in average pocket depth (PD) (0.82mm reduction, p=0.0078), percent bleeding on probing (BOP) (28% reduction, p=0.0078), and gingival index (GI) (0.78 reduction, p=0.0078) at four months compared to baseline. Intergroup comparison from baseline to four months demonstrated that the treatment group had significantly different average GI change at all sites than the control group (treatment: 0.78 average reduction, control: 0.06 average reduction, p=0.0283) and marginally significantly different percent BOP change for all sites than the control group (treatment: 28% average reduction, control: 2% average increase, p=0.0727).

Conclusion: Our results showed that the intensive intervention groups experienced a significant improvement in the periodontal parameters measured (PD, BOP, clinical attachment level (CAL), and GI). Additionally, BOP and GI improved statistically when compared between groups. Given the demonstrated potential benefits of non-surgical periodontal therapy, longitudinal studies should be completed to determine the bidirectional relationship as well as to assess the role of inflammation and its link to CKD and periodontal disease.