Serum markers of periodontal disease status and inflammation in hemodialysis patients

Rahmati, Margaret A.; Craig, Ronald G.; Homel, Peter; Kaysen, George A.; Levin, Nathan W.

doi:10.1053/ajkd.2002.36330

Cited by 97 publications

(85 citation statements)

References 39 publications

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“…In fact, as reported in the Hemodialysis (HEMO) study, many hospitalizations in HD patients are related to infections [13] . In another study, high levels of IgG antibodies to bacterial species (associated with destructive periodontal diseases), were associated with elevated C-reactive protein (CRP) levels [14] . Hepatitis may be yet another cause of chronic inflammation in HD patients.…”

Section: Causes Of Inflammationmentioning

confidence: 98%

End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes

Dai

Gołembiewska

Lindholm

et al. 2017

Contributions to Nephrology

151

111

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Despite marked improvements in renal replacement therapy during the last 30 years, the age-adjusted mortality rate in end-stage renal disease (ESRD) patients is still unacceptably high and comparable to that of many malignancies. Cardiovascular disease (CVD) remains the major cause of morbidity and mortality in ESRD patients. However, traditional risk factors can only partially explain the high premature cardiovascular burden in this population. Nontraditional risk factors, including persistent low-grade inflammation, are critical in the pathogenesis of atherosclerosis, vascular calcification, and other causes of CVD and may also contribute to protein-energy wasting and other complications in chronic kidney disease (CKD) patients. Inflammatory biomarkers, such as high sensitivity C-reactive protein and interleukin-6, independently predict mortality in these patients. The causes of inflammation in CKD are multifactorial and include imbalance between increased production (due to multiple sources of inflammatory stimuli such as oxidative stress, acidosis, volume overload, co-morbidities, especially infections, genetic and epigenetic influences, and the dialysis procedure) and inadequate removal (due to decreased glomerular filtration rate or in ESRD patients, inadequate dialytic clearance) of pro-inflammatory cytokines. Though there are currently no established guidelines for the treatment of low-grade inflammation in ESRD patients, several strategies have been proposed, such as lifestyle modifications, pharmacological treatment, and optimization of dialysis. Further studies on pathways involved in pathogenic processes of inflammation in ESRD, and long-term effects of anti-inflammatory interventions targeting production or removal of cytokines or both on premature CVD and clinical outcomes in this patient group are warranted.

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Section: Causes Of Inflammationmentioning

confidence: 98%

End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes

Dai

Gołembiewska

Lindholm

et al. 2017

Contributions to Nephrology

151

111

View full text Add to dashboard Cite

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“…IgG antibodies to some periodontal bacilli are related to higher CRP levels (32). Moreover, CRP levels and erythrocyte sedimentation rate significantly decrease after periodontal treatment (33).…”

Section: Infectionsmentioning

confidence: 99%

Inflammatory Syndrome in Patients on Hemodialysis

Jofre

Rodríguez-Benítez²,

López‐Gómez³

et al. 2006

Journal of the American Society of Nephrology

210

169

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Mortality is markedly elevated in hemodialysis (HD) patients. Between 30 and 50% of prevalent patients have elevated serum levels of inflammatory markers such as C-reactive protein and IL-6. The presence of inflammation, chronic or episodic, has been found to be associated with increased mortality risk. The causes of inflammation are multifactorial and include patient-related factors, such as underlying disease, comorbidity, oxidative stress, infections, obesity, and genetic or immunologic factors, or on the other side, HD-related factors, mainly depending on the membrane biocompatibility and dialysate quality. The adequate knowledge of these causes and their prevention or treatment if possible may contribute to improving the inflammatory state of patients who are on HD and possibly their mortality.

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“…Recent evidence suggests a high prevalence of periodontitis among individuals at early stages of CKD (9,10) and at end-stage kidney disease (11)(12)(13)(14)(15)(16) …”

mentioning

confidence: 99%

Severe Periodontitis Is Associated with Low Serum Albumin among Patients on Maintenance Hemodialysis Therapy

Kshirsagar

Craig

Beck

et al. 2007

Clinical Journal of the American Society of Nephrology

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The relationship between periodontitis and two measures of systemic inflammation, serum albumin and C-reactive protein (CRP), were examined among patients who were receiving chronic outpatient hemodialysis. Adult patients at two locations, North Carolina and New York City, were evaluated by dentist examiners. Six sites per tooth (up to 32 teeth per patient) were examined. A periodontitis case was defined as >60% of sites with attachment level >4 mm. Multivariable logistic regression was used to determine the association of periodontitis with low serum albumin, defined as <3.5 mg/dl, and with high CRP, defined as >3.0 mg/dl. A total of 154 patients completed the study. The mean age was 54.6 yr (SD 13.3), and average duration of dialysis was 4.0 yr (3 mo to 16 yr). Eighty-six (54.6%) were men, and 89 (58.2%) were black. Common causes of end-stage kidney disease were hypertension (12.3%), diabetes (22.1%), glomerulonephritis (7.1%), and other (58.4%). The average number of teeth was 20.3 (SD 8.4). Thirty-five (23%) patients were periodontitis cases. Severe periodontitis was associated with low serum albumin (odds ratio 8.20; 95% confidence interval 1.61 to 41.82; P ‫؍‬ 0.01) compared with individuals without severe periodontitis disease after adjustment for age, gender, race, diabetes, hypertension, body mass index, smoking, study site, total cholesterol, serum calcium, serum phosphorus, and normalized protein catabolic rate. There was no observed association of severe periodontitis with CRP. Investigation of the potential contribution of periodontitis to serum albumin and possibly to morbidity and mortality among patients with end-stage kidney disease seems warranted.

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Serum markers of periodontal disease status and inflammation in hemodialysis patients

Cited by 97 publications

References 39 publications

End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes

End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes

Inflammatory Syndrome in Patients on Hemodialysis

Severe Periodontitis Is Associated with Low Serum Albumin among Patients on Maintenance Hemodialysis Therapy

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