Impact of Red Complex Bacteria and TNF-α Levels on the Diabetic and Renal Status of Chronic Kidney Disease Patients in the Presence and Absence of Periodontitis

Abstract

Scientific evidence shows a positive association in the etiopathogenesis of periodontitis and chronic kidney disease (CKD). Various confounding factors, such as obesity, diabetes, and inflammation, also play a significant role in the progression of CKD, which remains unexplored. We hypothesise the role of red complex bacteria with various confounding factors associated with chronic kidney disease. The study comprised a total of 120 participants categorised into 4 groups: the control group (C), periodontitis subjects without CKD (P), periodontally healthy chronic kidney disease subjects (CKD), and subjects having both periodontitis and CKD (P + CKD), with 30 subjects in each group. Demographic variables, and periodontal, renal, and diabetic parameters were recorded. Tumour necrosis factor (TNF)-α levels and those of red complex bacteria such as Prophyromonas gingivalis (P.g), Treponema denticola (T.d), and Tonerella forsythia (T.f) were assessed, and the obtained results were statistically analysed. Among the various demographic variables, age showed a level of significance. Mean PI, GI, CAL, and PPD (the proportion of sites with PPD ≥ 5 mm and CAL ≥ 3 mm) were elevated in the P + CKD group. Diabetic parameters such as fasting blood sugar (FBS) and HbA1c levels were also greater in the P + CKD group. Renal parameters such as eGFR and serum creatinine levels were greater in CKD patients. The estimation of red complex periodontal pathogens such as Pg, Td and Tf levels were significantly greater in the P and P + CKD groups. Pearson correlation analysis revealed significant correlation of red complex bacteria with all variables. Greater levels of P.g, T.d and T.f were found in the P groups, thus indicating their important role in the initiation and progression of inflammation of periodontitis and CKD, with diabetes as one of the confounding factors. The study also confirmed a log-linear relationship between TNF-α levels and red complex bacteria, thereby demonstrating the role of inflammatory biomarkers in periodontal disease progression that could contribute to the development of systemic inflammation such as CKD.

Potential Impact of Prosthetic Biomaterials on the Periodontium: A Comprehensive Review

“…However, the microbiota can undergo substantial changes as a result of various factors (unbalanced diet, smoking and poor oral hygiene) [ 69 , 70 ] that disrupt bacterial homeostasis and lead to a state of dysbiosis, where one or more types of periodontopathogenic bacteria proliferate, at least temporarily taking over the immune system, as happens in gingivitis and periodontitis [ 71 , 72 ]. A representation showing the associations between bacterial species colonizing the gingival sulcus is that of bacterial complexes in ecological equilibrium [ 67 ], where Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola , which are the most periodontopathogenic bacteria constituting the red complex, have been detected in higher proportions in periodontitis conditions compared to healthy subjects [ 73 , 74 , 75 , 76 ] and even in patients with periodontitis and other systemic diseases [ 77 ].…”

Chronic Kidney Disease and Periodontitis Interplay—A Narrative Review

“…As such, the interrelation of CKD and gut microbiome is well-documented, but changes of oral microflora in CKD are less studied [69]. Oral keystone bacteria associated with PO such as Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola [70], Aggregatibacter actinomycetemcomitans, and Actinomyces dentalis [71][72][73] have been found to be more prevalent in CKD patients than in the general population.…”

“…PO is also a cause of subclinical inflammation and associated with an increase of markers of systemic inflammation [88]. In their recent work, Mahendra [73] et al found that the presence of periodontogenic bacteria strongly correlates to serum levels of TNF α and predicts a degree of kidney damage, as reflected by GFR kidney damage and of PO, such as plaque index, gingival index, probing pocket depth, or CAL. The cytokines reported as increased in PO patients with CKD notably TNFα, and proinflammatory…”

“…PO is also a cause of subclinical inflammation and associated with an increase of markers of systemic inflammation [88]. In their recent work, Mahendra [73] et al found that the presence of periodontogenic bacteria strongly correlates to serum levels of TNF α and predicts a degree of kidney damage, as reflected by GFR kidney damage and of PO, such as plaque index, gingival index, probing pocket depth, or CAL. The cytokines reported as increased in PO patients with CKD notably TNFα, and proinflammatory cytokines are known to be involved in kidney damage in different models: IL 8 is involved in pathogenesis of glomerulonephritis [89], IL 17 is associated with kidney damage from hypertension [90], and TNFα participates in disease progression and contributes to renal inflammatory response in glomerular diseases such as diabetic nephropathy [91].…”

Salivary microbiome in kidney diseases: A narrative review

“…Nevertheless, there is a scarcity of studies regarding the modifications in oral microbiota among persons diagnosed with CKD 32 . The presence of certain oral keystone bacteria, such as P. gingivalis , T. forsythia , T. denticola , A. actinomycetemcomitans , and Actinomyces dentalis , has been found to be more common in individuals with CKD when compared to the general population 33–36 …”