Treatment of chronic periodontitis decreases serum prohepcidin levels in patients with chronic kidney disease

Abstract

OBJECTIVE:To determine the impact of periodontal treatment on serum levels of prohepcidin (the prohormone of hepcidin) and systemic inflammation markers, as well as correlations among these markers, in patients with chronic periodontitis and chronic kidney disease who were not undergoing dialysis.METHODS:We included 56 chronic periodontitis patients, 36 with chronic kidney disease and 20 without systemic diseases and with normal renal function (control group). Chronic kidney disease was defined as suggested by the clinical practice guidelines in the National Kidney Foundation. Chronic periodontitis was defined through clinical attachment level and by probing pocket depth, according to the American Association of Periodontology. The inflammatory markers ultrasensitive C-reactive protein, interleukin-6, and prohepcidin were evaluated before and 3 months after periodontal treatment.RESULTS:The efficacy of periodontal treatment was confirmed by the improvement in clinical parameters of chronic periodontitis in the control and chronic kidney disease groups. Periodontal treatment resulted in significant reductions in ultrasensitive C-reactive protein, interleukin-6 and serum prohepcidin levels in both groups. Moreover, in multivariate linear regression, the reduction in prohepcidin after periodontal treatment was significantly and independently associated with interleukin-6 levels in the control group.CONCLUSIONS:By inducing a decline in the systemic inflammatory response and a decrease in serum prohepcidin, successful periodontal treatment may represent an important means of ameliorating the inflammatory burden seen in patients with chronic kidney disease. Trial registration: ISRCTN59866656.

Avaliação do conhecimento sobre doença periodontal em uma amostra de nefrologistas e enfermeiros que atuam com doença renal crônica pré-dialítica

“…Chronic PD, a bacterial infection of the toothsupporting tissues, and which is found in the subgingival plaque, may lead to increased CRP and IL-6 serum levels, which decrease, along with clinical markers of the disease, after treatment. 14,19,22 Therefore, chronic PD also contributes to this low-grade inflammation, with exposure to oxidative stress, through increased levels of oxygen-reactive species and decreased Our results are worrying. The high prevalence of PD in the general population, 2 its association with CKD, 4 and the greater severity of PD in CKD patients 13 all point to the importance of immediate referral of CKD patients with a diagnosis of PD to dental treatment, a practice that does not seem to be frequent among the professionals directly caring for these patients.…”

“…12 CKD patients have more severe PD compared with the PD of patients without a systemic disease. 13 Compared to individuals without systemic diseases and PD, CKD patients have higher levels of traditional systemic inflammatory markers (IL-6 and C-reactive protein) and of pro-hepcidin (the pro-hormone form of hepcidin, the main regulator of iron homeostasis), 14 which, along with parameters of clinical severity, level of clinical insertion and probing depth, decrease after PD treatment.…”

Treatment of Periodontal Diseases Reduces Chronic Systemic Inflammation in Maintenance Hemodialysis Patients

“…We found the significant positive correlation between hs-CRP and periodontal status and significantly decreased inflammatory marker in the next 8 weeks after completion of periodontal therapy. Vilela et al 49 also reported the reduction of prohepcidin, IL-6, and hs-CRP in both chronic kidney disease and control patients following periodontal treatment. This study differed from previous reports that demonstrated significant reduction of inflammation in the next 12 weeks after completion of therapy.…”

Effect of Nonsurgical Periodontal Therapy on Serum Levels of Predialysis Chronic Kidney Disease Patients

“…The results concluded that patients undergoing periodontal treatment experience perturbations of systemic inflamma tion of a greater magnitude after nonsurgical than surgical periodontal therapy. Viela M et al 30 reported the effect of periodontal treatment in patients with CKD and found that the treatment resulted in significant reductions in Creactive protein, interleukin6, and prohepcidin levels before and 3 months after treatment. The study concluded that successful periodontal treatment may represent an important means of ameliorating the inflammatory burden seen in CKD.…”