The association between periodontal disease and serum biomarkers levels in haemodialysis patients: a narrative review

Abstract

The vast majority of studies has demonstrated that periodontal infection promotes significant systemic inflammatory status. The specific effects of these systemic alterations in response to periodontal inflammation have been comprehensively described and appear to be higly stereotyped, and it is well known the pathophisiological mechanism related to immune functioning linking periodontitis and pathologies such as diabetes or cardiovascular diseases, adverse pregnancy outcomes, and rheumatoid arthritis. More recently, it has been proposed that this association could be extended to consider periodontal infection as trigger to complications in maintenance haemodialysis (HD) patients through the establishment of inflammatory status in association to impaired nutritional status, emphasizing the role of periodontal infection in increase of C-reactive protein serum marker, a  notably  predictor of the cardiovascular risk. The aim of this narrative review was to summarize the currently literature evidence that has developed around the correlation between periodontal inflammatory status  and serum biomarker levels monitoring the severity of systemic conditions in HD patients, in which cardiovascular events and malnutrition are the most common causes of mortality and morbidity.

Methods: an electronic PubMed, Google Scholar and Cochrane database search complemented by a manual search of the bibliographies cited in all identified articles was performed until 2019.

Results: thirteen articles were identified. Studies currently available on the impact of periodontitis on the serum markers level in HD patients are analogous. Results confirmed the impact of subclinical inflammation related to periodontitis on C-reactive protein and albumin serum levels,  supporting the emerging hypothesis of relationship between periodontal infection and HD status.

Conclusions: Although many studies have suggested that the inflammatory cytokines release may play a key role in several clinical alterations related to HD maintenance, further studies are needed to investigate the long-term consequences of chronic inflammation caused by periodontitis. There is a paucity of data concerning to the impact of periodontal disease on maintenance hemodialysis patients and about mechanisms involved.  Clinical trial and observational studies summarized here suggest but do not prove that persistent low level  inflammation periodontitis-related are causing harm to hemodialysis manteinance.