Association between periodontitis and systemic inflammation in patients with end-stage renal disease

Patients with end-stage renal disease (ESRD) experience a significantly increased rate of atherosclerotic complications. Inflammation plays a central role in the pathogenesis of these complications and C-reactive protein (CRP) has been found to be predictive of all-cause and cardiovascular mortality. Many patients have elevated CRP levels without an apparent infection. Periodontal diseases in the general population have been associated with both an increased prevalence of atherosclerotic complications and an elevation in serum CRP values. This study examined the association between periodontal disease and elevated CRP in patients with ESRD on chronic dialysis.

Eighty patients on chronic dialysis were included in the study. Demographic information, medical history and CRP levels were recorded. Periodontal examination was carried out by a single calibrated examiner and included gingival index (GI), bleeding on probing (BoP), probing depths (PD) and clinical attachment loss (CAL). These measurements were recorded in relation to the Ramfjord teeth. The presence in any one sextant of PD > or =4 mm or clinical loss of attachment > or =3 mm was diagnosed as periodontitis.

Mean age of subjects was 50.3 +/- 9.06 years with a median time on dialysis of 24 months. 57.5% (n=46) of subjects were diagnosed as having periodontitis; of these 52.2% had CRP levels >10 mg/l. Of the 34 subjects with healthy periodontium, only 10 (29.4%) had elevated CRP levels. The serum CRP levels between these two groups were significantly different (p = 0.004).

The results of the study showed significantly elevated levels of CRP in ESRD patients with periodontitis. Periodontal diseases may be an overlooked source of inflammation in ESRD patients.