Effect of non-surgical periodontal therapy on renal function in chronic kidney disease patients with periodontitis: a systematic review and meta-analysis of interventional studies.

OBJECTIVE: This systematic review evaluated the impacts of non-surgical periodontal therapy (NSPT) in patients with chronic kidney disease (CKD) and periodontitis in order to explore causality and assess the potential benefits of co-management.

METHODS: This systematic review and meta-analyses were conducted by searching MEDLINE, EMBASE, PubMed, Cochrane Library, and Open GREY. Interventional studies of adult patients suffering from CKD and periodontitis were investigated. Effect of NSPT on renal function was analyzed.

RESULTS: A total of 109 participants from four case-series studies and 97 participants from one randomized controlled trial were included in this review. Sixty percent of the eligible studies (3/5) aimed at the effect of NSPT on nutritional status and systemic inflammation in dialysis patients. The other two studies concluded a beneficial impact of NSPT on estimated glomerular filtration rate (eGFR) in patients with CKD stages 2-4. Moreover, two meta-analyses were accomplished on eGFR and serum creatinine to evaluate the changes between baseline and 3-month follow-up. The pooled mean of eGFR was not significantly different pre- and post-NSPT using random and fixed-effect models. The change for creatinine was not significant using the random effect model but was significant when the fixed effect model was used (p < 0.001).

CONCLUSIONS: There is insufficient evidence to conclude the potential benefit of NSPT on renal function in CKD patients with periodontitis.

CLINICAL RELEVANCE: Periodontitis contributes to the inflammatory burden and has been associated with impaired kidney function in many observational studies. However, well-designed clinical trials in pre-dialysis patients investigating the impact of NSPT on renal function-related parameters are missing.